RE: PTA's and joint mobs

July 19, 2005

No need to apologize Joe, I usually try not to be abrupt online

since you couldn't hear the pensiveness of the sigh. Like I said,

you just happened to throw out a well intended missive that

caught me like " trolling " - throwing out some bait to see

who would bite. Perhaps members are trying to be

thought provoking and I am all for free speech... I have noticed

a bit of tendency instead of taking a risk/stand

on an issue and posting a thoughtful missive, we seem to

have a larger percentage of " is it ethical to beat our front office

person daily " type posts. In many ways I guess I feel

like PTAs in general are reestablishing a good working

relationship with PTs/APTA and I don't want to stir

things up in a nonproductive manner.

I actually love discussion, and agree with a lot that you

have posted. I just would have rather seen more

background/rationale. I would love to find an answer

to this conundrum

Dee

not offended and apologetic for appearing to stifle

discussion

>

> Dee,

> Sorry you seem offended that I should ask a question. What is the harm is

> discussing this among fellow professionals?

>

July 19, 2005

No need to apologize Joe, I usually try not to be abrupt online

since you couldn't hear the pensiveness of the sigh. Like I said,

you just happened to throw out a well intended missive that

caught me like " trolling " - throwing out some bait to see

who would bite. Perhaps members are trying to be

thought provoking and I am all for free speech... I have noticed

a bit of tendency instead of taking a risk/stand

on an issue and posting a thoughtful missive, we seem to

have a larger percentage of " is it ethical to beat our front office

person daily " type posts. In many ways I guess I feel

like PTAs in general are reestablishing a good working

relationship with PTs/APTA and I don't want to stir

things up in a nonproductive manner.

I actually love discussion, and agree with a lot that you

have posted. I just would have rather seen more

background/rationale. I would love to find an answer

to this conundrum

Dee

not offended and apologetic for appearing to stifle

discussion

>

> Dee,

> Sorry you seem offended that I should ask a question. What is the harm is

> discussing this among fellow professionals?

>

July 19, 2005

No need to apologize Joe, I usually try not to be abrupt online

since you couldn't hear the pensiveness of the sigh. Like I said,

you just happened to throw out a well intended missive that

caught me like " trolling " - throwing out some bait to see

who would bite. Perhaps members are trying to be

thought provoking and I am all for free speech... I have noticed

a bit of tendency instead of taking a risk/stand

on an issue and posting a thoughtful missive, we seem to

have a larger percentage of " is it ethical to beat our front office

person daily " type posts. In many ways I guess I feel

like PTAs in general are reestablishing a good working

relationship with PTs/APTA and I don't want to stir

things up in a nonproductive manner.

I actually love discussion, and agree with a lot that you

have posted. I just would have rather seen more

background/rationale. I would love to find an answer

to this conundrum

Dee

not offended and apologetic for appearing to stifle

discussion

>

> Dee,

> Sorry you seem offended that I should ask a question. What is the harm is

> discussing this among fellow professionals?

>

July 19, 2005

Hi everyone,

I guess I missed a lot while I was on vacation.

Joe,

You can count me on the side of being absolutely against PTA's doing any

mobilization. I too was there for the discussion in the House of Delegates.

First of all there was an email reminding us of the fact that the APTA

position on this issue is a position, not a policy. While an APTA position

carries less weight than its policies, it does still have purpose and the

APTA expects that its members will be ethical and adhere to it.

I want to bring up some of the arguments and questions that I can remember

from the House of Delegates discussions:

1) Is manipulation something that requires ongoing assessment and

evaluation, skills traditionally reserved for the physical therapist, or do

you consider that parts of manipulation do not require the skills of a

physical therapist?

This question was always answered in the HOD discussion by manual therapists

and orthopaedic instructors with far more experience than I have and it was

always answered that all manipulation needs ongoing assessment skills,

skills that only PT's traditionally have. I realize educational standards

of the PTA have changed and maybe it is time to reexamine the question.

Until then, no one has brought a valid argument to me to answer this

question other than that all manipulation needs the skills of ongoing

evaluation and assessment traditionally learned only by the PT.

2) If we allow PTA's to do spinal manipulation will it hurt our efforts to

fight the chiropractic attacks against our ability to practice manipulation

as we are trained?

The answer to this is a firm yes. Most of the chiropractic arguments have

centered on the number of hours PT's spend in training in manipulation and

that we aren't qualified to manipulate spines (and yes I know that some of

the arguments get into thrust, Grade V and adjustment subtleties). The

bottom line, the APTA needed a position to secure its commitment to the

training of PT's in manipulation that was firm and clear and not ambiguous

(i.e. by allowing PTA's to do some manipulations but not others). This

position was established at a time when the challenges by chiropractors was

at a crucial point.

3) Does allowing PTA's and techs to do procedures that are recommended as

only in the realm of the PT hurt the profession? There are many, including

myself, who feel that it does. I agree with Mr. s that when someone

comes to my clinic, they come with the expectation to see a PT. What does

it say about our profession if we say that PTA's and techs can do everything

we can but evaluate someone? What value does that give our profession? How

does that help the public's perception of what we do? (Remember, these are

also the arguments from the HOD discussions)

The APTA position was another clear and unambiguous statement of position to

help clear up public misconceptions. I happen to agree with this.

4) Does the education of the PTA and the completion of continuing education

prepare the PTA to do manipulation? My recollection was that the discussion

on this was mixed. Again this may be something that needs to be revisited.

I can say that those educators that spoke out that the education of the PTA

does not prepare a PTA for manipulation were convincing to me. It is still

a concern to me.

5) What are the ramifications to reimbursement? This was another issue.

The APTA already has to fight with CMS and private insurers over

reimbursement. They needed a clear position on what interventions are to be

exclusively done by PT's to help their fight on reimbursement. The main

questions that always come up is that the more we turn over to the PTA the

less likely insurances will consider what we do worth reimbursement. Again

this devalues the role of the PT, this time from a different perspective.

It is a valid risk.

6) What are the ramifications to state practice acts? Part of the need for

this position was to help states update their practice acts. As president

of the Idaho PT Association, we updated our act and it helped tremendously

to have a clear position on this. We had to compromise in our practice act

to secure the support of Idaho PT's, let alone MD's DC's and other

stakeholders. Having clear positions like this allow states to be more

clear and concise with their acts. Quite a few practice acts follow the

APTA position. (need to check with APTA government affairs on how many)

That speaks to yet another group that supports the position.

So if you got to the end of this long discussion, I hope you understand a

little bit more why the APTA has this position in the first place and why a

majority of the HOD supported it. It is a clear and concise position that

was needed to serve many purposes. I continue to support it because the

arguments and concerns are still valid.

And yes, I agree that the best way to move on from here is to speak up and

be heard and encourage it to go before the House of Delegates again.

Thanks for allowing me to respond.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

ptclinic@...

Re: PTA's and joint mobs

Am I the only one against?

Simonetti, PT

Chestertown, MD

>

> Group,

> How bout an informal survey?

>

> For or against PTA's performing joint mobs?

>

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July 20, 2005

As I stand firmly in opposition to the APTA in this, and Tom (who is

strongly in agreement) has done the right thing and listed points of

argument, I thought I would get some finger exercise and respond to the

points.

1) Is manipulation something that requires ongoing assessment and

evaluation, skills traditionally reserved for the physical therapist, or do

you consider that parts of manipulation do not require the skills of a

physical therapist?

This point is taken from a false premise: that PTAs do not make evaluative

decisions. PTAs can and do make such decisions, all the time, within the

context of the treatment procedures they employ. Every time a muscle is

stretched, for example, there is an evaluative process going on, based,

among other things, on the immediate patient response (How far to go? How

hard to push? Is a certain level of pain appropriate?). No one disputes that

a PTA can safely stretch a hamstring (an exercise, needless to say, that we

routinely teach to patients). What we (should) mean when we say that PTAs

can't evaluate is that PTAs cannot synthesize and interpret the entire

constellation of clinical and other information available to us that we use

to make treatment decisions. To extend that into the ongoing details of how

a particular modality is affecting a patient is spreading the peanut butter

too thin.

2) If we allow PTA's to do spinal manipulation will it hurt our efforts to

fight the chiropractic attacks against our ability to practice manipulation

as we are trained?

I would like to hope that our definitions of quality could remain happily

outside the ugly perimeter of reimbursement wars, but I see that's a foolish

notion. I will merely say here that those chiros who maintain that our

training in manipulation is inadequate to protect patient safety should be

required to explain how so many PTAs have mobilized joints for so long

without significant problems.

3) Does allowing PTA's and techs to do procedures that are recommended as

only in the realm of the PT hurt the profession?

Recommended by whom? Not by me! The APTA has made a bad recommendation, then

explains that not following it will hurt the profession because, well,

because the profession would be out of step with the recommendation. That

sort of circularity can be easily fixed by withdrawing the recommendation.

4) Does the education of the PTA and the completion of continuing education

prepare the PTA to do manipulation?

A good question, for which I have no direct answer. Nevertheless I can say

that both PTAs who work with me here at Laurel Health System were taught

mobilization in school, and afterward attended related CE courses (side by

side with PTs!). Seems to me that the supervising PT would have to answer

that.

5) What are the ramifications to reimbursement?

First, see #2 above. Then think about what is ethical here. If a procedure

can be safely and effectively performed by cheaper personnel, then why on

earth would we stand in the way? I can recall a similar storm years ago when

some PTs were lamenting losing the right to apply hot packs. If that sounds

quaint, it is, but the point is that often the reimbursement tail wags the

clinical dog.

6) What are the ramifications to state practice acts?

I'm not sure what the point is here, but will say that at least one previous

post on this subject reminded us that the APTA was merely taking a position,

not making a ruling. But whatever you call it, the effect is the same. Among

other things, this " position " facilitates the like changing of state

practice acts. It also has the effect of a " ruling " for the reason that Ken

Mailly earlier explained: Any lawyer worth his salt will exploit it in a

malpractice claim. A rose by any other name...

Dave Milano, PT

Director of Rehab Services

Laurel Health System

Re: PTA's and joint mobs

Am I the only one against?

Simonetti, PT

Chestertown, MD

>

> Group,

> How bout an informal survey?

>

> For or against PTA's performing joint mobs?

>

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association.

Join

and participate now!

July 20, 2005

,

So you're saying that PTA's shouldn't be hands-on at all? Are we only able to

turn on stim machines, do US, and teach/supervise patients in the gym? PTA's are

far more educated than that. I know our PTA's didn't just go to school to do

modalities only. You must not know how to utilize your PTA's. Anyone else

agree with me? The PT may not always be the " best person to do the job. " I know

of PTA's who have their own case load and report to the PT any changes the pt

has made, or check with the PT to change anything with the pt's Rx. The pt.

only sees the PT somestimes once a week so he/she can stay up to date with the

pt's progress. Some pts may prefer to see a particular PTA rather than the PT.

I know everyone is entitled to their opinion, but you need to get off your

pedestal and realize that PTA's can do a lot more than what you lead on. PTA's

are aware of their practice act and know not to do anything to jeopardize their

license (or at least they shouldn't)!!

, CPC-PTA

Billing Administrator

lin Physical Therapy, LLC

s wrote:

,

You can count me in as against as well, simply too much room for

overutilization. We all come on here and say yes, but only if the

PTA is trained, ect.. The problem is that there are too many places

that utilize far too many PTA's per PT and far too many places that

don't care how well the PTA is trained, only whether or not they can

bill for the PTA's time. My philosophy and that of my clinic is

that we need to make every effort possible to meet or exceed the

expectations of the patient when they walk through our door. The

patient's expectation when they enter a Physical Therapist's office

to recieve Physical Therapy is that the person performing their care

will be a Physical Therapist. We need to meet that expectation. I

know some great PTA's and hope I don't offend but this is simply the

way I feel I would want to be treated, the best person to do the

job, the one most qualified and skilled, should be the PT, not the

PTA; each patient deserves that.

E. s, PT, DPT, OCS

s Orthopedic & Spine Rehabilitation, Inc.

Bonita Springs, Fla

-- In PTManager , " "

wrote:

> Am I the only one against?

>

> Simonetti, PT

> Chestertown, MD

>

> >

> > Group,

> > How bout an informal survey?

> >

> > For or against PTA's performing joint mobs?

> >

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a professional

workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association. Join and

participate now!

July 20, 2005