therapy abuse

[deleted185747]

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Who really controls PT and OT? As a physiatrist I write for the needed therapy and a range for the number of visits as well as what needs to be primarily focused on. I am aware that any doctor can write for physical therapy or occupational therapy.

I was talking with someone who opened a home health company and coordinates patients who need therapy with the therapists who can provide the service. The people running the company push the therapists to extend and provide more than is needed and will brainstorm together about ways to extend the number of therapy sessions. This has the feel of an illegal operation and possibly even medicare fraud, but I don't really know for sure. They even brag about how good they are and that they use "unconventional" methods for treating their patients. Like I'm supposed to get excited about how well unconventional treatments work or something???

My question is how are these people policed? Therapists have a financial incentive to extend therapy visits. They even describe home health nurses telling patients which pills to take when multiple doctors prescribe pain medications and the patient does not know which pills ought to be taken. Are therapists allowed to do unconventional treatments? Do they have community standards as doctors do? If you send your patient to a physical therapist do you want that physical therapist telling your patient to take certain herbs and neutraceuticals? We doctors know the most (at least about conventional treatments, medications and disease) and some therapist who proclaims how good their treatment is should be stopped because even doctors cannot make guarantees or promises that anything will work. That is the reality. Yet I continue to ramble...

 

[PMR 4 MSK]

PTs and OTs do a lot of things that we physicians are not taught. Much of their techniques are more based in theory than hard science, as it is difficult to do the traditional double-blind, sham-controlled study on therapy. Like in medicine, a lot of what they do comes from "gurus" who proclaim what they are doing is the best thing since sliced bread, and others follow suit.

They tend to have wider latitude in "community standards" simply because they rarely get sued. Most harm they are capable of causing is usually temporary - bruising, aches and pains.

Private PT/OT clinics are incentivized by our fee-for-service system to do as much as possible - i.e. "pad the bill." But so are doctors. So are auto mechanics, plumbers and electricians. Ethics should always win out, but your definition of what is ethical, and someone else's may be different.

Therapists are "policed" by their licensing boards and by Medicare, but little else. The boards handle complaints, just like ours. CMS is very well aware of the ripeness of home-based PT and OT for overbilling and watches it. Ask most patients who had in-home PT, and they'll tell you the PT was there for 10-15 minutes, stood them up, walked them across the room, did a little stretching, checked a wound then ran out as fast as they could to get to the next client. I've seen very few pts get much better with in-home PT and consider it simply a bridge to outpt PT.

I've talked with plenty of therapists who do in-home PT. Some do it b/w inpt or outpt cases. Treat a few in the clinic, run out for an hour or two and knock out 6 cases, come back for more appts. Many take pride in how many they can do per hour.

Kinda like pain docs who brag about seeing 40 clinic pts in half a day, or knocking out 25 epidurals in a half day. Yeah, you probably can do it, but speed kills.

 

[RUOkie]

Who really controls PT and OT? As a physiatrist I write for the needed therapy and a range for the number of visits as well as what needs to be primarily focused on. I am aware that any doctor can write for physical therapy or occupational therapy.

I was talking with someone who opened a home health company and coordinates patients who need therapy with the therapists who can provide the service. The people running the company push the therapists to extend and provide more than is needed and will brainstorm together about ways to extend the number of therapy sessions. This has the feel of an illegal operation and possibly even medicare fraud, but I don't really know for sure. They even brag about how good they are and that they use "unconventional" methods for treating their patients. Like I'm supposed to get excited about how well unconventional treatments work or something???

My question is how are these people policed? Therapists have a financial incentive to extend therapy visits. They even describe home health nurses telling patients which pills to take when multiple doctors prescribe pain medications and the patient does not know which pills ought to be taken. Are therapists allowed to do unconventional treatments? Do they have community standards as doctors do? If you send your patient to a physical therapist do you want that physical therapist telling your patient to take certain herbs and neutraceuticals? We doctors know the most (at least about conventional treatments, medications and disease) and some therapist who proclaims how good their treatment is should be stopped because even doctors cannot make guarantees or promises that anything will work. That is the reality. Yet I continue to ramble...

Doctors have community standards? If so, why is there so much Rx drug abuse? Why is xanax still prescribed as often as it is? Why is there so much spine surgery being done when even radiculopathy improves without surgery?

 

[jesspt]

Who really controls PT and OT? As a physiatrist I write for the needed therapy and a range for the number of visits as well as what needs to be primarily focused on. I am aware that any doctor can write for physical therapy or occupational therapy.

Well, here in Illinois, I am licensed through the Department of Financial & Professional Regulation.
So, I supposed that my practice is controlled by the physical therapy practice act, The Physical Therapy Licensing and Disciplinary Board, which is approved by the Director of the Deaprtment of Professional Regulation. And, in Illinois, PT can be prescribed by any "...
physician, dentist, advanced practice nurse, physician assistant, or podiatrist who maintains medical supervision of the patient and makes a diagnosis or verifies that the patient's condition is such that it may be treated by a physical therapist (taken from the Illinois Phjysical Therapy Practice Act.)"

I was talking with someone who opened a home health company and coordinates patients who need therapy with the therapists who can provide the service. The people running the company push the therapists to extend and provide more than is needed and will brainstorm together about ways to extend the number of therapy sessions. This has the feel of an illegal operation and possibly even medicare fraud, but I don't really know for sure. They even brag about how good they are and that they use "unconventional" methods for treating their patients. Like I'm supposed to get excited about how well unconventional treatments work or something???

It certainly sounds unethical, and illegal to me, based on the fact that they are committing Medicare Fraud. Their marketing of unconventional methods sounds like a different matter, and just means they are clinically foolish, rather than more corrupt than they already are.

My question is how are these people policed? Therapists have a financial incentive to extend therapy visits.

My first response probably gives you some insight into your first question. And yes, PTs have some financial incentive to extend visits, just as physicians have financial incentives to provide more procedures. This isn't a problem that PTs have cornered the market on. Anyone paying attention to what's going on in spinal surgery lately?

Are therapists allowed to do unconventional treatments?

You need to define unconventional. The definition may vary from one professional to the next. I provide spinal and peripheral joint thrust manipulation to some of my patients, which some would consider unconventional for a physical therapist to provide. Some therapists provide myofascial release and craniosacral therapy which I consider to be unconventional and essentially hogwash. Do you know what interventions they are providing that they are callign unconventional?

Regardless, the interventions they provide are limited by their state practice act and their skill set. As for myself, if I recieve a referral from a physican that I do not know, and I am going to provide an intervention that was not requested, I will usually give a call to the MD/DO/DPM and talk to them about it.

Do they have community standards as doctors do?

Not sure what you mean by community standards. What community standards do physicians have?

If you send your patient to a physical therapist do you want that physical therapist telling your patient to take certain herbs and neutraceuticals?

Nope. And it is well beyond the scope of a physical therapist, and is probably outside of their practice act.

...and some therapist who proclaims how good their treatment is should be stopped because even doctors cannot make guarantees or promises that anything will work...

If the therapist is quoting good research to back up their claims, then I can't see this as harmful. If you are concerned about their claims, your best bet is to make a phone call to the particular therapist, or if the entire company uses these "unconventional treatments", call a representative of the company and see what evidence they have to back up their claims.

 

[Jitter Bug]

There are idiots in every field. Including medicine as much as we hate to admit it. Spinebound, rather than trusting the degree PT or OT trust the person. Get to know the group and inidivudual therapists, it's time well spent, and you can be more comfortable referring patients to a PT or OT when you know their overall philosophy (manual, Mckenzie, mechanical link, etc).

 

[deleted185747]

There are idiots in every field. Including medicine as much as we hate to admit it. Spinebound, rather than trusting the degree PT or OT trust the person. Get to know the group and inidivudual therapists, it's time well spent, and you can be more comfortable referring patients to a PT or OT when you know their overall philosophy (manual, Mckenzie, mechanical link, etc).

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[Fiveoboy11]

Who really controls PT and OT? As a physiatrist I write for the needed therapy and a range for the number of visits as well as what needs to be primarily focused on. I am aware that any doctor can write for physical therapy or occupational therapy.

I was talking with someone who opened a home health company and coordinates patients who need therapy with the therapists who can provide the service. The people running the company push the therapists to extend and provide more than is needed and will brainstorm together about ways to extend the number of therapy sessions. This has the feel of an illegal operation and possibly even medicare fraud, but I don't really know for sure. They even brag about how good they are and that they use "unconventional" methods for treating their patients. Like I'm supposed to get excited about how well unconventional treatments work or something???

My question is how are these people policed? Therapists have a financial incentive to extend therapy visits. They even describe home health nurses telling patients which pills to take when multiple doctors prescribe pain medications and the patient does not know which pills ought to be taken. Are therapists allowed to do unconventional treatments? Do they have community standards as doctors do? If you send your patient to a physical therapist do you want that physical therapist telling your patient to take certain herbs and neutraceuticals? We doctors know the most (at least about conventional treatments, medications and disease) and some therapist who proclaims how good their treatment is should be stopped because even doctors cannot make guarantees or promises that anything will work. That is the reality. Yet I continue to ramble...

The issues are mostly among businesses that employ physical therapists, not the physical therapists themselves. PT's have to deal with management that doesn't have a clue about the practice of physical therapy, not to mention undertrained PTA's and techs (who masquerade as PT's). It is pathetic but true. I've always found it funny how businesses I've worked for advertise what PT is and what patient's get in PT. Most of it is ignorant uselessness, but apparently they think it looks good in a brochure with some white toothed geriatric.