Skilled physical therapy treatments

[physical therapist 1992]

I'm opening a topic that is near and dear to me.

Are physical therapist and physical therapist assistants providing skilled treatments? Do most clinicians understand what skilled physical therapy is?

thank you. I would appreciate your thoughts.

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[jadedphysiotherapist]

What setting? Interdisciplinary or just therapists? Hospital, irf, snf, outpatient?

Every single setting will get a different response

 

[physical therapist 1992]

very good point, thank you.

Do you think there is that much of a difference with what kind of skilled physical therapy one provides with each setting? I was under the assumption that skilled therapy is skilled therapy.

thanks for you input.

What setting? Interdisciplinary or just therapists? Hospital, irf, snf, outpatient?

Every single setting will get a different response

 

[truthseeker]

skilled is skilled. If the intervention requires the training, education, eyes, experience of a physical therapist or PTA it is skilled. IMO there are LOTS of places where the therapy is redundant. i.e. watching the patient do their home exercise program for the 5th time is NOT skilled once they have demonstrated correct performance of said exercises.

I am kind of a stickler on this one.
If my mother in law could do it, it isn't skilled. If the nurse could do it as well as I can, in the inpatient world, it is not skilled.

 

[Bones26]

I smell a fake.

 

[physical therapist 1992]

Thank you. We all should be diligent about proving the correct skilled service.

skilled is skilled. If the intervention requires the training, education, eyes, experience of a physical therapist or PTA it is skilled. IMO there are LOTS of places where the therapy is redundant. i.e. watching the patient do their home exercise program for the 5th time is NOT skilled once they have demonstrated correct performance of said exercises.

I am kind of a stickler on this one.
If my mother in law could do it, it isn't skilled. If the nurse could do it as well as I can, in the inpatient world, it is not skilled.

 

[physical therapist 1992]

What smells fake to you?

I smell a fake.

 

[jesspt]

What smells fake to you?

Well, you.

What's your opinion on what should be considered skilled PT intervention and it's prevalence in the various settings that PTs commonly practice in?

 

[Bones26]

What smells fake to you?

Generic user name asking vague questions. I don't get the feeling that this a fellow PT initiating a discussion to better our profession or educate students.

 

[physical therapist 1992]

thanks. i am not a fake.

skilled treatments are treatments that only a clinician can provide. no the same repetitive exercise that one has been doing for 4 visits. therapy should not be about exercise that a patient can do on their own after an exercise program is printed. walking with the walker is not skilled if you are not correcting a problem.

please do not be quick to call people names.

Well, you.

What's your opinion on what should be considered skilled PT intervention and it's prevalence in the various settings that PTs commonly practice in?

 

[physical therapist 1992]

don't be quick to judge. physical therapist 1992 was created as i graduated in 1992. I am trying to start a dialogue with my fellow clinicians and students so we can put our profession where it needs to be.

what are your thoughts on skilled services my colleague?

Generic user name asking vague questions. I don't get the feeling that this a fellow PT initiating a discussion to better our profession or educate students.

 

[PTMattI]

I think in a busy OP clinic, it is almost impossible to provide skilled treatment most of the time because a therapist will be juggling several patients at the same time therefore delegating the care of at least 1 patient to an aide / tech.

 

[jesspt]

I think in a busy OP clinic, it is almost impossible to provide skilled treatment most of the time because a therapist will be juggling several patients at the same time therefore delegating the care of at least 1 patient to an aide / tech.

In your mind does skilled treatment=1:1 care?

 

[truthseeker]

I think in a busy OP clinic, it is almost impossible to provide skilled treatment most of the time because a therapist will be juggling several patients at the same time therefore delegating the care of at least 1 patient to an aide / tech.

I disagree. you can delegate skilled services to a PTA or ATC but if you are simply having someone put ice on the patient why can't they do that at home? There may be some warm up activities that are relatively less skilled but they are part of the prep for the stuff that you need to watch/teach/assess. If what you say is true, then you are not providing skilled care but billing for it. that's fraud.

 

[jadedphysiotherapist]

In your mind does skilled treatment=1:1 care?

For evaluations, reassessments, and the start of large progressions....YES.

Maintenance and monitoring through repetitions and sets....not really, but I still don't plan to practice with assistants running around.

 

[PTMattI]

In your mind does skilled treatment=1:1 care?

Most of the time, yes. However I think there could be exceptions. For example if I am coaching / instructing two clients at the same time in the squat. What do you think?

 

[PTMattI]

I disagree. you can delegate skilled services to a PTA or ATC but if you are simply having someone put ice on the patient why can't they do that at home? There may be some warm up activities that are relatively less skilled but they are part of the prep for the stuff that you need to watch/teach/assess. If what you say is true, then you are not providing skilled care but billing for it. that's fraud.

I dont have PTA or ATC where I work. I typically have 30 minutes, sometimes more 1 on 1 time with all patients, I only bill the 1 on 1 time and that is when I either do manual therapy or teach / supervise the more complex exercises.

 

[truthseeker]

For evaluations, reassessments, and the start of large progressions....YES.

Maintenance and monitoring through repetitions and sets....not really, but I still don't plan to practice with assistants running around.

There you go, maintenance is rarely skilled. keeping track of reps, if it is an exercise or activity that your patient does at home, then it is not skilled. To treat ethically is not always a good immediate business model but in the long run you sleep better and those patients will come back when something else bothers them because they will know you will treat them the right way.