Skilled Care

[IrisSong]

Hi All,

I just wanted to see if anyone else was struggling with this as much as I am. I feel like the idea of "skilled care" is not even a question in other health professions but is something PT's have to constantly defend. Does anyone else feel this way?

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[truthseeker]

yes. I feel that I have to defend opposite of what many have to defend. What i mean is that often, our inpatients are no longer skilled and the doctors want them to remain in the hospital for as a skilled swing bed. If my mom could do it, its not a skilled PT intervention (just walking with someone is not "gait training") I have not had issues convincing someone that what I do is skilled when it is. When it is not, I seem to have to convince the doctors and the discharge planners that it is no longer skilled. The whole problem stems from many in our profession billing insurance companies for wtching their patients doing their home exercise programs that they are already doing at home or doing modalities that have no scientific support for weeks on end. Its a bed that our predecessors have made for us.

 

[markelmarcel]

I think it's really important to be able to defend what is skilled and what isn't. Kind of like the previous poster said, just because you are walking with someone doesn't make it gait training... When you have a solid reasoning as to why you are doing what you are doing, then you are showing skilled need. So, it no longer becomes patient completes 2 sets of 15 rows, but patient performing exercises to assist with postural control, thus improving efficiency of breathing. Does it suck that we have so much pressure to prove our worth? Of course, but it helps keep me in line as far as making it worth my time, and more importantly, the patient's time.

 

[DesertPT]

The whole problem stems from many in our profession billing insurance companies for wtching their patients doing their home exercise programs that they are already doing at home or doing modalities that have no scientific support for weeks on end. Its a bed that our predecessors have made for us.

Excellent, thank you.

 

[DesertPT]

I think one reason that the PT profession is more likely to lend itself to having its practitioners spending time preforming "unskilled" tasks is that PT is something that occurs in relatively long sessions over an extended period of time. A pharmacist, a dentist and a surgeon all have a very specific task they are going to perform as a service to you all at once. Because of the nature of their work they very rarely would spend enough time with each client in the first place to even have the opportunity to "waste time" with their clients like a PT might have the opportunity to. A pharmacist is only going to spend a couple of minutes with someone a best. A dentist might spend a couple hours working on you, to get done what needs to be done. Same thing with a surgeon, just however long the surgery takes. But if somebody has a massive stroke or a TBI PTs will probably spend over 100 hours with that person without even breaking a sweat, over the course of months. So there is more time to be filled and more opportunity to fill it with "unskilled" work. Should PTs watch the way their patients are doing their HEP exercises periodically to correct bad form as needed, make adjustments, etc. Yes of course that is an absolute must. But because a PT has to do that, there is an opportunity right there for the PT to end up standing watching someone do shoulder pulleys for 15 mins. I have been to some clinics where their sales pitch is that they only employ PTs, not techs or trainers. While in an ideal world I would rather have a PT watch me do all my exercises for the session, just in case I am doing something wrong, that is wasteful. I think this is more likely to be a concern in the inpatient settings as outpatient settings generally have more patients and are populated by a lot of techs.

 

[truthseeker]

I think one reason that the PT profession is more likely to lend itself to having its practitioners spending time preforming "unskilled" tasks is that PT is something that occurs in relatively long sessions over an extended period of time. A pharmacist, a dentist and a surgeon all have a very specific task they are going to perform as a service to you all at once. Because of the nature of their work they very rarely would spend enough time with each client in the first place to even have the opportunity to "waste time" with their clients like a PT might have the opportunity to. A pharmacist is only going to spend a couple of minutes with someone a best. A dentist might spend a couple hours working on you, to get done what needs to be done. Same thing with a surgeon, just however long the surgery takes. But if somebody has a massive stroke or a TBI PTs will probably spend over 100 hours with that person without even breaking a sweat, over the course of months. So there is more time to be filled and more opportunity to fill it with "unskilled" work. Should PTs watch the way their patients are doing their HEP exercises periodically to correct bad form as needed, make adjustments, etc. Yes of course that is an absolute must. But because a PT has to do that, there is an opportunity right there for the PT to end up standing watching someone do shoulder pulleys for 15 mins. I have been to some clinics where their sales pitch is that they only employ PTs, not techs or trainers. While in an ideal world I would rather have a PT watch me do all my exercises for the session, just in case I am doing something wrong, that is wasteful. I think this is more likely to be a concern in the inpatient settings as outpatient settings generally have more patients and are populated by a lot of techs.

The things you said in the middle of your post, the reviewing and correcting of technique is skilled. As far as your last line, where there are lots of techs, well, IMO, that doesn't happen in the good ones because things evolve fast enough where you need a skilled eye to know when and how to modify and progress the patient.