To all currently practicing therapists out there,
I am in a place of concern right now, and would like to get some feedback from current therapists out there. I currently work at a SNF and would like to see if this is a problem that is rampant throughout skilled nursing facilities. Currently, the SNF I work at takes all forms of insurance, from commercial insurance plans to Medicare A, B, etc. As many who work in a SNF know, many of the commercial plans like blue cross blue shield, United, Aetna, Coventry, provided limited funds for PT services. Due to this, if a patient's insurance provider believe the PT services are unnecessary or no longer justifiable, they refuse further PT services and we discharge them.
My problem comes from Medicare Part A. The facility I work for CONSTANTLY wants us to provide services for the 100 days that are paid by Medicare because, well, frankly, it pays the facility big bucks. Recently I have had patients who are making absolutely NO PROGRESS and are no longer justifiable to keep on therapy services. When I go to discharge a patient from my services, the administrator and rehab director give me the runaround and say, "you can't d/c a patient from PT services! It has to be approved by the physician, then a cut-letter written by the social worker, and THEN you can discharge the services!" Well, here is the problem. The physician rarely comes to facility, and the social worker is always weeks late on his work. If the physician DOES come to the facility, he is usually too busy, and tells the therapist, "I will get to the discharge when I can." Where does this leave me and the other therapists? We are forced to provide services for weeks beyond what we believe is appropriate. I am to the point where I am going to tell the facility, "I refuse to treat this patient. If you tell me I have to, then I quit."
When I ask my fellow PTs about problems like this, they all say, "Oh yeah, I work in a SNF too, same problem. I treated a patient for 100 days who was practically in a coma because the doctor never signed the discharge paperwork." Well, when the refusal letters start showing up and Medicare starts calling out "FRAUD! FRAUD!", who is it that is going to have to explain themselves? The physician, or the therapists who keep treating patients when they believe it to be medically unnecessary and unjustifiable?
This is the one thing that makes me want to work in a hospital or outpatient facility. At those facilities, If you believe the patient will not make any more gains, its up to YOU, the autonomous and independent practitioner to make that judgement. At a SNF, the MD has all the power, even to decide whether or not he believes you should keep performing PT treatments when YOU, as the PT, believe its not right.
I am in a place of concern right now, and would like to get some feedback from current therapists out there. I currently work at a SNF and would like to see if this is a problem that is rampant throughout skilled nursing facilities. Currently, the SNF I work at takes all forms of insurance, from commercial insurance plans to Medicare A, B, etc. As many who work in a SNF know, many of the commercial plans like blue cross blue shield, United, Aetna, Coventry, provided limited funds for PT services. Due to this, if a patient's insurance provider believe the PT services are unnecessary or no longer justifiable, they refuse further PT services and we discharge them.
My problem comes from Medicare Part A. The facility I work for CONSTANTLY wants us to provide services for the 100 days that are paid by Medicare because, well, frankly, it pays the facility big bucks. Recently I have had patients who are making absolutely NO PROGRESS and are no longer justifiable to keep on therapy services. When I go to discharge a patient from my services, the administrator and rehab director give me the runaround and say, "you can't d/c a patient from PT services! It has to be approved by the physician, then a cut-letter written by the social worker, and THEN you can discharge the services!" Well, here is the problem. The physician rarely comes to facility, and the social worker is always weeks late on his work. If the physician DOES come to the facility, he is usually too busy, and tells the therapist, "I will get to the discharge when I can." Where does this leave me and the other therapists? We are forced to provide services for weeks beyond what we believe is appropriate. I am to the point where I am going to tell the facility, "I refuse to treat this patient. If you tell me I have to, then I quit."
When I ask my fellow PTs about problems like this, they all say, "Oh yeah, I work in a SNF too, same problem. I treated a patient for 100 days who was practically in a coma because the doctor never signed the discharge paperwork." Well, when the refusal letters start showing up and Medicare starts calling out "FRAUD! FRAUD!", who is it that is going to have to explain themselves? The physician, or the therapists who keep treating patients when they believe it to be medically unnecessary and unjustifiable?
This is the one thing that makes me want to work in a hospital or outpatient facility. At those facilities, If you believe the patient will not make any more gains, its up to YOU, the autonomous and independent practitioner to make that judgement. At a SNF, the MD has all the power, even to decide whether or not he believes you should keep performing PT treatments when YOU, as the PT, believe its not right.
