Re: Professional in the Hospital

[Guest guest]

Hospitals provide a variety of services including medical, surgical, nursing,

rehabilitative, nutritional, counseling, etc... Only a fraction of these

services are revenue generators, although one of the biggest revenue generators

is rehabilitative services (that is why some hospitals focus soley on

rehabilitation services). Most physicians working in urban environments have

privileges in hospitals. Thus, they can admit their private patients into

certain hospitals and follow them while they are there. While their patients

are in the hospital they are still allowed to provide medical care to their

patients and bill their patients (i.e. insurance) for their professional medical

services. Likewise, if they request a consult by another specialist (e.g.

cardiology), that physician or physician group will bill the patient (i.e. their

insurance) for the professional services they provided (even though they didn't

admit the patient). Even physiatrists do

this, even though they don't provide any rehabilitative services. They only

provide medical care to the patient while the patient is in the rehab unit of a

hospital or is in a rehab specialty hospital. Physical therapists are

specialists also. Does anyone know if any hospitals/organizations in the

country allow physical therapists or physical therapy groups to provide services

in a hospital, rehab center, or skilled nursing facility in a manner similar to

that of medical professionals and bill for their services? I would imagine

that the hospital can still bill the patient for facility/equipment use (e.g.

like radiological services).

Dr. Sumesh , PT

Board Certified Clinical Specialist in Orthopedic Physical Therapy

APTA - Certified Clinical Instructor

________________________________________________________________________________\

____

Sick sense of humor? Visit Yahoo! TV's

Comedy with an Edge to see what's on, when.

http://tv.yahoo.com/collections/222

[Guest guest]

The CMS rules state that Rehab Services (PT/OT and ST) are not separately

billable services (even if pro-fee billed) and are inclusive in the case

payments for acute care DRG's, and IRF's, and in the per diem payments on SNF's.

Physician services are separately billable. The facility is responsible to

provide the service and pay of rit, so what contract rehab staff often do is

contract with the hospital or the SNF to provide the services, but the facility

has to bill for the services inclusive in their case billing.

Pamela Yzerman

Vice President of Outpatient Services

High Point Regional Health System

fax

>>> Sumesh 8/3/2007 7:37 AM >>>

Hospitals provide a variety of services including medical, surgical, nursing,

rehabilitative, nutritional, counseling, etc... Only a fraction of these

services are revenue generators, although one of the biggest revenue generators

is rehabilitative services (that is why some hospitals focus soley on

rehabilitation services). Most physicians working in urban environments have

privileges in hospitals. Thus, they can admit their private patients into

certain hospitals and follow them while they are there. While their patients

are in the hospital they are still allowed to provide medical care to their

patients and bill their patients (i.e. insurance) for their professional medical

services. Likewise, if they request a consult by another specialist (e.g.

cardiology), that physician or physician group will bill the patient (i.e. their

insurance) for the professional services they provided (even though they didn't

admit the patient). Even physiatrists do

this, even though they don't provide any rehabilitative services. They only

provide medical care to the patient while the patient is in the rehab unit of a

hospital or is in a rehab specialty hospital. Physical therapists are

specialists also. Does anyone know if any hospitals/organizations in the

country allow physical therapists or physical therapy groups to provide services

in a hospital, rehab center, or skilled nursing facility in a manner similar to

that of medical professionals and bill for their services? I would imagine

that the hospital can still bill the patient for facility/equipment use (e.g.

like radiological services).

Dr. Sumesh , PT

Board Certified Clinical Specialist in Orthopedic Physical Therapy

APTA - Certified Clinical Instructor

________________________________________________________________________________\

____

Sick sense of humor? Visit Yahoo! TV's

Comedy with an Edge to see what's on, when.

http://tv.yahoo.com/collections/222

[Guest guest]

Sumesh,

This has nothing to do with what hospitals allow or disallow. CMS (and as

you know, as Medicare goes, so goes the world) views physician services

differently than other services. Physicians bill separately. All other acute

inpatient services are paid inclusively, generally according to DRG rates.

Needless to say, this system grew naturally from the manner in which

hospital care is provided---physicians take special responsibility for

directing and administering that care, and are therefore treated (properly,

in my view) as unique entities. (Physicians employed by hospitals are

similarly handled. Their fees though, belong to the hospital, which then

pays the physician.)

A strong conviction that something must be done is the parent of many bad

measures. Webster

Dave Milano, PT, Director of Rehab Services

Laurel Health System

Re: Professional in the Hospital

Hospitals provide a variety of services including medical, surgical,

nursing, rehabilitative, nutritional, counseling, etc... Only a fraction of

these services are revenue generators, although one of the biggest revenue

generators is rehabilitative services (that is why some hospitals focus

soley on rehabilitation services). Most physicians working in urban

environments have privileges in hospitals. Thus, they can admit their

private patients into certain hospitals and follow them while they are

there. While their patients are in the hospital they are still allowed to

provide medical care to their patients and bill their patients (i.e.

insurance) for their professional medical services. Likewise, if they

request a consult by another specialist (e.g. cardiology), that physician or

physician group will bill the patient (i.e. their insurance) for the

professional services they provided (even though they didn't admit the

patient). Even physiatrists do

this, even though they don't provide any rehabilitative services. They only

provide medical care to the patient while the patient is in the rehab unit

of a hospital or is in a rehab specialty hospital. Physical therapists are

specialists also. Does anyone know if any hospitals/organizations in the

country allow physical therapists or physical therapy groups to provide

services in a hospital, rehab center, or skilled nursing facility in a

manner similar to that of medical professionals and bill for their services?

I would imagine that the hospital can still bill the patient for

facility/equipment use (e.g. like radiological services).

Dr. Sumesh , PT

Board Certified Clinical Specialist in Orthopedic Physical Therapy

APTA - Certified Clinical Instructor

__________________________________________________________

Sick sense of humor? Visit Yahoo! TV's

Comedy with an Edge to see what's on, when.

http://tv.yahoo. <http://tv.yahoo.com/collections/222> com/collections/222

[Guest guest]

As times change and healthcare evolves our profession will adapt. Laws will be

changed to ensure safe, efficient, and cost effective healthcare for society.

Physical therapists are responsible for the care of their patients (as are

physicians) regardless of whether they are administering that care themselves or

are directing the care through their assistants. J. McMenamin, PT said

it best, " the economic infrastructure and culture of physical therapy allow most

of the surplus value (profit) of our service to be drained [by others] who use

it for their purposes not ours. " Those who really have the most to lose by

allowing physical therapists to become autonomous are those who enslave us and

profit from our labor. We must break away from the shackles of the practices of

the past, and take control of our future.

Dr. Sumesh , PT

Board Certified Clinical Specialist in Orthopedic Physical Therapy

APTA - Certified Clinical Instructor

Re: Professional in the Hospital

Hospitals provide a variety of services including medical, surgical,

nursing, rehabilitative, nutritional, counseling, etc... Only a fraction of

these services are revenue generators, although one of the biggest revenue

generators is rehabilitative services (that is why some hospitals focus

soley on rehabilitation services). Most physicians working in urban

environments have privileges in hospitals. Thus, they can admit their

private patients into certain hospitals and follow them while they are

there. While their patients are in the hospital they are still allowed to

provide medical care to their patients and bill their patients (i.e.

insurance) for their professional medical services. Likewise, if they

request a consult by another specialist (e.g. cardiology), that physician or

physician group will bill the patient (i.e. their insurance) for the

professional services they provided (even though they didn't admit the

patient). Even physiatrists do

this, even though they don't provide any rehabilitative services. They only

provide medical care to the patient while the patient is in the rehab unit

of a hospital or is in a rehab specialty hospital. Physical therapists are

specialists also. Does anyone know if any hospitals/organizat ions in the

country allow physical therapists or physical therapy groups to provide

services in a hospital, rehab center, or skilled nursing facility in a

manner similar to that of medical professionals and bill for their services?

I would imagine that the hospital can still bill the patient for

facility/equipment use (e.g. like radiological services).

Dr. Sumesh , PT

Board Certified Clinical Specialist in Orthopedic Physical Therapy

APTA - Certified Clinical Instructor

____________ _________ _________ _________ _________ _________ _

Sick sense of humor? Visit Yahoo! TV's

Comedy with an Edge to see what's on, when.

http://tv.yahoo. <http://tv.yahoo. com/collections/ 222> com/collections/ 222

[Guest guest]

I know that this will put me at odds with many of our profession's most

visible practitioners and administrators, but here goes:

The willy-nilly rush to raise the status and income of our profession has,

to me, a smarmy feel. We all know the potential value to us as PTs---it's

heralded in every related article and commentary---but where is the evidence

that autonomy (and its sister, higher levels of academic education) has real

value for PATIENTS? That would have been a very good question to answer

before we advocated for changing our practice model. Unfortunately, physical

therapists put the prestige " cart " before the outcome data " horse " and in

the process, I think, exposed a nasty streak of selfishness. I would dearly

like to see these conversations take at least a passing shot at that issue.

It is very important to note here that America is truly suffering from

rising medical car costs. A recent large-scale study out of Harvard found

that in 2006 medical care costs rose 7.7 percent---the lowest increase since

1999, yet still twice the overall inflation rate and way ahead of wage

increases. If that weren't enough, the cost trend's financial burden has

been augmented by alarmingly large per capita utilization increases. We

should all be aware that, concomitant with the profession's push for more

status, physical therapy utilization has increased even more than other

services. From 1999 to 2000 it increased 68 percent, and in subsequent

consecutive years, 35, 28, 16, and 32 percent. (That's without a significant

increase in submitted claims, i.e. the increased dollars were not related to

increased numbers of patients seeking/using services.) We need look no

further to discover why Medicare acted to decrease fee-schedule

reimbursements, and why it placed PT on the 2006 and 2007 OIG work-lists.

Most importantly, all that is happening without any real evidence that the

extra care is making America any healthier.

Physical therapists have made real efforts to advance and advocate

evidence-based practice. We should apply the same evidence-based approach to

our business and academic models.

Dave Milano, PT, Director of Rehab Services

Laurel Health System

Re: Professional in the Hospital

As times change and healthcare evolves our profession will adapt. Laws will

be changed to ensure safe, efficient, and cost effective healthcare for

society. Physical therapists are responsible for the care of their patients

(as are physicians) regardless of whether they are administering that care

themselves or are directing the care through their assistants. J.

McMenamin, PT said it best, " the economic infrastructure and culture of

physical therapy allow most of the surplus value (profit) of our service to

be drained [by others] who use it for their purposes not ours. " Those who

really have the most to lose by allowing physical therapists to become

autonomous are those who enslave us and profit from our labor. We must break

away from the shackles of the practices of the past, and take control of our

future.

Dr. Sumesh , PT

Board Certified Clinical Specialist in Orthopedic Physical Therapy

APTA - Certified Clinical Instructor

Re: Professional in the Hospital

Hospitals provide a variety of services including medical, surgical,

nursing, rehabilitative, nutritional, counseling, etc... Only a fraction of

these services are revenue generators, although one of the biggest revenue

generators is rehabilitative services (that is why some hospitals focus

soley on rehabilitation services). Most physicians working in urban

environments have privileges in hospitals. Thus, they can admit their

private patients into certain hospitals and follow them while they are

there. While their patients are in the hospital they are still allowed to

provide medical care to their patients and bill their patients (i.e.

insurance) for their professional medical services. Likewise, if they

request a consult by another specialist (e.g. cardiology), that physician or

physician group will bill the patient (i.e. their insurance) for the

professional services they provided (even though they didn't admit the

patient). Even physiatrists do

this, even though they don't provide any rehabilitative services. They only

provide medical care to the patient while the patient is in the rehab unit

of a hospital or is in a rehab specialty hospital. Physical therapists are

specialists also. Does anyone know if any hospitals/organizat ions in the

country allow physical therapists or physical therapy groups to provide

services in a hospital, rehab center, or skilled nursing facility in a

manner similar to that of medical professionals and bill for their services?

I would imagine that the hospital can still bill the patient for

facility/equipment use (e.g. like radiological services).

Dr. Sumesh , PT

Board Certified Clinical Specialist in Orthopedic Physical Therapy

APTA - Certified Clinical Instructor

____________ _________ _________ _________ _________ _________ _

Sick sense of humor? Visit Yahoo! TV's

Comedy with an Edge to see what's on, when.

http://tv.yahoo. <http://tv.yahoo.> < http://tv.yahoo. <http://tv.yahoo.>

com/collections/ 222> com/collections/ 222

[Guest guest]

Dave,

I have to agree with you on the necessity of the DPT. There is a

need for stronger evidence in almost all activities that we do and

putting a label of 'doctor' on our names does not changes whether a

certain treatment is more or less effective.

One of my biggest qualms of PT education is the disparity between

didactic programs and clinical interneships. I think that to ensure

future generations are more prepared and equally trained that the

accredidation board needs to create an established curriculum. Most

schools have stronger emphasis on certain areas depending on the

experience of the faculty and that experience can be prejudiced by

an individual faculties affiliations and certifications.

A con against the universal DPT designation, for me, is the need for

it in a LTC or home health setting. Will the DPT make a differnce in

how care is delivered in these areas? I have looked at tDPT programs

in the past and have chosen not to pursue it because the curriculum

had many similarities to the course I took for my Master's degree

and there was typically only a pharmacology and radiology course

that was different.

There is also the need to consider the impact of the boomer

population will have on the already lack of PT's in this country?

Will the transition to the DPT push away those that may want to

enter the profession but may be fearful of the education

requirements? I think the DPT is fine for those who want or who may

need the education, but ultimately the desingation after their

signature will remain 'PT'.

Gwilliam,PT

Bowie Memorial Hospital

>

> I know that this will put me at odds with many of our profession's

most

> visible practitioners and administrators, but here goes:

>

> The willy-nilly rush to raise the status and income of our

profession has,

> to me, a smarmy feel. We all know the potential value to us as PTs-

--it's

> heralded in every related article and commentary---but where is

the evidence

> that autonomy (and its sister, higher levels of academic

education) has real

> value for PATIENTS? That would have been a very good question to

answer

> before we advocated for changing our practice model.

Unfortunately, physical

> therapists put the prestige " cart " before the outcome data " horse "

and in

> the process, I think, exposed a nasty streak of selfishness. I

would dearly

> like to see these conversations take at least a passing shot at

that issue.

>

>

>

> It is very important to note here that America is truly suffering

from

> rising medical car costs. A recent large-scale study out of

Harvard found

> that in 2006 medical care costs rose 7.7 percent---the lowest

increase since

> 1999, yet still twice the overall inflation rate and way ahead of

wage

> increases. If that weren't enough, the cost trend's financial

burden has

> been augmented by alarmingly large per capita utilization

increases. We

> should all be aware that, concomitant with the profession's push

for more

> status, physical therapy utilization has increased even more than

other

> services. From 1999 to 2000 it increased 68 percent, and in

subsequent

> consecutive years, 35, 28, 16, and 32 percent. (That's without a

significant

> increase in submitted claims, i.e. the increased dollars were not

related to

> increased numbers of patients seeking/using services.) We need

look no

> further to discover why Medicare acted to decrease fee-schedule

> reimbursements, and why it placed PT on the 2006 and 2007 OIG work-

lists.

> Most importantly, all that is happening without any real evidence

that the

> extra care is making America any healthier.

>

>

>

> Physical therapists have made real efforts to advance and advocate

> evidence-based practice. We should apply the same evidence-based

approach to

> our business and academic models.

>

>

> Dave Milano, PT, Director of Rehab Services

> Laurel Health System

>

>

> Re: Professional in the Hospital

>

>

>

> As times change and healthcare evolves our profession will adapt.

Laws will

> be changed to ensure safe, efficient, and cost effective

healthcare for

> society. Physical therapists are responsible for the care of their

patients

> (as are physicians) regardless of whether they are administering

that care

> themselves or are directing the care through their assistants.

J.

> McMenamin, PT said it best, " the economic infrastructure and

culture of

> physical therapy allow most of the surplus value (profit) of our

service to

> be drained [by others] who use it for their purposes not ours. "

Those who

> really have the most to lose by allowing physical therapists to

become

> autonomous are those who enslave us and profit from our labor. We

must break

> away from the shackles of the practices of the past, and take

control of our

> future.

>

> Dr. Sumesh , PT

>

> Board Certified Clinical Specialist in Orthopedic Physical Therapy

>

> APTA - Certified Clinical Instructor

>

> Re: Professional in the Hospital

>

> Hospitals provide a variety of services including medical,

surgical,

>

> nursing, rehabilitative, nutritional, counseling, etc... Only a

fraction of

>

> these services are revenue generators, although one of the biggest

revenue

>

> generators is rehabilitative services (that is why some hospitals

focus

>

> soley on rehabilitation services). Most physicians working in urban

>

> environments have privileges in hospitals. Thus, they can admit

their

>

> private patients into certain hospitals and follow them while they

are

>

> there. While their patients are in the hospital they are still

allowed to

>

> provide medical care to their patients and bill their patients

(i.e.

>

> insurance) for their professional medical services. Likewise, if

they

>

> request a consult by another specialist (e.g. cardiology), that

physician or

>

> physician group will bill the patient (i.e. their insurance) for

the

>

> professional services they provided (even though they didn't admit

the

>

> patient). Even physiatrists do

>

> this, even though they don't provide any rehabilitative services.

They only

>

> provide medical care to the patient while the patient is in the

rehab unit

>

> of a hospital or is in a rehab specialty hospital. Physical

therapists are

>

> specialists also. Does anyone know if any hospitals/organizat ions

in the

>

> country allow physical therapists or physical therapy groups to

provide

>

> services in a hospital, rehab center, or skilled nursing facility

in a

>

> manner similar to that of medical professionals and bill for their

services?

>

> I would imagine that the hospital can still bill the patient for

>

> facility/equipment use (e.g. like radiological services).

>

> Dr. Sumesh , PT

>

> Board Certified Clinical Specialist in Orthopedic Physical Therapy

>

> APTA - Certified Clinical Instructor

>

> ____________ _________ _________ _________ _________ _________ _

>

> Sick sense of humor? Visit Yahoo! TV's

>

> Comedy with an Edge to see what's on, when.

>

> http://tv.yahoo. <http://tv.yahoo.> < http://tv.yahoo.

<http://tv.yahoo.>

> com/collections/ 222> com/collections/ 222

>

>

[Guest guest]

Below is a study published a couple of years ago which did highlight that

those in DPT programs scored significantly higher that their peers in Masters

programs in regards to managing musculoskeletal conditions. I would believe

that LTC and Home Health would see many patients with related musculoskeletal

conditions thus a DPT should benefit the patient

Newton, PT, DPT, OCS, CWS

A description of physical therapists' knowledge in managing musculoskeletal

conditions.

_Childs JD_

(

" [Author] & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPane

l.Pubmed_RVAbstractPlus) , _Whitman JM_

(

M " [Author] & itool=EntrezSystem2.PEnt

rez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus) , _Sizer PS_

(http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term= " Sizer%20PS " \

[Author]

& itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus)

, _Pugia ML_

(http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term= " Pugia%20ML " \

[Author] & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPan

el.Pubmed_RVAbstractPlus) , _Flynn TW_

(http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term= " Flynn%20TW " \

[Author] & itool=EntrezSystem2.PEntrez

..Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus) , _Delitto A_

(

" [Author] &

itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus)

..

US Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam

Houston, San , TX, USA. childsjd@...

BACKGROUND: Physical therapists increasingly provide direct access services

to patients with musculoskeletal conditions, and growing evidence supports

the cost-effectiveness of this mode of healthcare delivery. However, further

evidence is needed to determine if physical therapists have the requisite

knowledge necessary to manage musculoskeletal conditions. Therefore, the

purpose

of this study was to describe physical therapists' knowledge in managing

musculoskeletal conditions. METHODS: This study utilized a cross-sectional

design

in which 174 physical therapist students from randomly selected educational

programs and 182 experienced physical therapists completed a standardized

examination assessing knowledge in managing musculoskeletal conditions. This

same

examination has been previously been used to assess knowledge in

musculoskeletal medicine among medical students, physician interns and

residents, and

across a variety of physician specialties. RESULTS: Experienced physical

therapists had higher levels of knowledge in managing musculoskeletal

conditions

than medical students, physician interns and residents, and all physician

specialists except for orthopaedists. Physical therapist students enrolled in

doctoral degree educational programs achieved significantly higher scores than

their peers enrolled in master's degree programs. Furthermore, experienced

physical therapists who were board-certified in orthopaedic or sports physical

therapy achieved significantly higher scores and passing rates than their non

board-certified colleagues. CONCLUSION: The results of this study may have

implications for health and public policy decisions regarding the suitability

of

utilizing physical therapists to provide direct access care for patients

with musculoskeletal conditions.

PMID: 15963232 [PubMed - indexed for MEDLINE]

In a message dated 8/9/2007 3:06:46 P.M. Central Daylight Time,

dosrinc@... writes:

,

Re: your con for the DPT and it's appropriateness and/or necessity

in the LTC or home care setting.

My question would be: Do you feel that we as a profession have

maximized our abilities in these settings? Do you feel that most

home care and or long term care meets what you would consider the

expectation of the client and the clients families. I for one feel

that these are areas in which the profession has failed. There are

many reasons for this including lack of available PT's and lack of

available reimbursement but the fact remains that these are both

areas where the quality of Physical Therapy care can be improved

aponn. Is the DPT the answer? I dont know but I think if we look

at the amount of research the PT field has generated since the

advent of the DPT as compared to the decades before it, i think the

stimulus is there to help provide us with the answers. We as a

profession need to continue to move forward and not just accept

things as they are because that is the way they have always been.

Maybe an ambitious DPT student will conduct research that changes

the way home health and long term care PT is delivered, for the

benefit of all.

E. s, PT,DPT,OCS,FAAOMPT

www.douglasspt.www

> >

> > I know that this will put me at odds with many of our

profession's

> most

> > visible practitioners and administrators, but here goes:

> >

> > The willy-nilly rush to raise the status and income of our

> profession has,

> > to me, a smarmy feel. We all know the potential value to us as

PTs-

> --it's

> > heralded in every related article and commentary-- heralded

> the evidence

> > that autonomy (and its sister, higher levels of academic

> education) has real

> > value for PATIENTS? That would have been a very good question to

> answer

> > before we advocated for changing our practice model.

> Unfortunately, physical

> > therapists put the prestige " cart " before the outcome

data " horse "

> and in

> > the process, I think, exposed a nasty streak of selfishness. I

> would dearly

> > like to see these conversations take at least a passing shot at

> that issue.

> >

> >

> >

> > It is very important to note here that America is truly

suffering

> from

> > rising medical car costs. A recent large-scale study out of

> Harvard found

> > that in 2006 medical care costs rose 7.7 percent---the lowest

> increase since

> > 1999, yet still twice the overall inflation rate and way ahead

of

> wage

> > increases. If that weren't enough, the cost trend's financial

> burden has

> > been augmented by alarmingly large per capita utilization

> increases. We

> > should all be aware that, concomitant with the profession's push

> for more

> > status, physical therapy utilization has increased even more

than

> other

> > services. From 1999 to 2000 it increased 68 percent, and in

> subsequent

> > consecutive years, 35, 28, 16, and 32 percent. (That's without a

> significant

> > increase in submitted claims, i.e. the increased dollars were

not

> related to

> > increased numbers of patients seeking/using services.) We need

> look no

> > further to discover why Medicare acted to decrease fee-schedule

> > reimbursements, and why it placed PT on the 2006 and 2007 OIG

work-

> lists.

> > Most importantly, all that is happening without any real

evidence

> that the

> > extra care is making America any healthier.

> >

> >

> >

> > Physical therapists have made real efforts to advance and

advocate

> > evidence-based practice. We should apply the same evidence-based

> approach to

> > our business and academic models.

> >

> >

> > Dave Milano, PT, Director of Rehab Services

> > Laurel Health System

> >

> >

> > Re: Professional in the Hospital

> >

> >

> >

> > As times change and healthcare evolves our profession will

adapt.

> Laws will

> > be changed to ensure safe, efficient, and cost effective

> healthcare for

> > society. Physical therapists are responsible for the care of

their

> patients

> > (as are physicians) regardless of whether they are administering

> that care

> > themselves or are directing the care through their assistants.

> J.

> > McMenamin, PT said it best, " the economic infrastructure and

> culture of

> > physical therapy allow most of the surplus value (profit) of our

> service to

> > be drained [by others] who use it for their purposes not ours. "

> Those who

> > really have the most to lose by allowing physical therapists to

> become

> > autonomous are those who enslave us and profit from our labor.

We

> must break

> > away from the shackles of the practices of the past, and take

> control of our

> > future.

> >

> > Dr. Sumesh , PT

> >

> > Board Certified Clinical Specialist in Orthopedic Physical

Therapy

> >

> > APTA - Certified Clinical Instructor

> >

> > Re: Professional in the Hospital

> >

> > Hospitals provide a variety of services including medical,

> surgical,

> >

> > nursing, rehabilitative, nutritional, counseling, etc... Only a

> fraction of

> >

> > these services are revenue generators, although one of the

biggest

> revenue

> >

> > generators is rehabilitative services (that is why some

hospitals

> focus

> >

> > soley on rehabilitation services). Most physicians working in

urban

> >

> > environments have privileges in hospitals. Thus, they can admit

> their

> >

> > private patients into certain hospitals and follow them while

they

> are

> >

> > there. While their patients are in the hospital they are still

> allowed to

> >

> > provide medical care to their patients and bill their patients

> (i.e.

> >

> > insurance) for their professional medical services. Likewise, if

> they

> >

> > request a consult by another specialist (e.g. cardiology), that

> physician or

> >

> > physician group will bill the patient (i.e. their insurance) for

> the

> >

> > professional services they provided (even though they didn't

admit

> the

> >

> > patient). Even physiatrists do

> >

> > this, even though they don't provide any rehabilitative

services.

> They only

> >

> > provide medical care to the patient while the patient is in the

> rehab unit

> >

> > of a hospital or is in a rehab specialty hospital. Physical

> therapists are

> >

> > specialists also. Does anyone know if any hospitals/organizat

ions

> in the

> >

> > country allow physical therapists or physical therapy groups to

> provide

> >

> > services in a hospital, rehab center, or skilled nursing

facility

> in a

> >

> > manner similar to that of medical professionals and bill for

their

> services?

> >

> > I would imagine that the hospital can still bill the patient for

> >

> > facility/equipment use (e.g. like radiological services).

> >

> > Dr. Sumesh , PT

> >

> > Board Certified Clinical Specialist in Orthopedic Physical

Therapy

> >

> > APTA - Certified Clinical Instructor

> >

> > ____________ _________ _________ _________ _________ _________ _

> >

> > Sick sense of humor? Visit Yahoo! TV's

> >

> > Comedy with an Edge to see what's on, when.

> >

> > _http://tv.yahoo._ (http://tv.yahoo./) <_http://tv.yahoo._

(http://tv.yahoo./) > < _http://tv.yahoo._ (http://tv.yahoo./)

> <_http://tv.yahoo._ (http://tv.yahoo./) >

> > com/collections/ 222> com/collections/ 222

> >

> >

[Guest guest]

/-

" I dont know but I think if we look at the amount of research the

PT field has generated since the advent of the DPT as compared to

the decades before it, i think the stimulus is there to help provide

us with the answers. "

Is is the advent of the DPT or is it the drive for our profession

to be more effective that has created the increased research

activity? I agree that LTC and HH areas are greatly understaffed by

PTs, but where is your preference to practice?? How many of us right

out of school wanted to go straight into a LTC facility to practice?

My guess is not that many. Maybe their will be an ambitous student

in a DPT program that will want to do research in that area, but who

is doing most of the research in our profession?(seasoned PT's)

" I would believe that LTC and Home Health would see many patients

with related musculoskeletal conditions thus a DPT should benefit

the patient "

The summray of your article by Child's et al, places the

knowledge of experienced therapists, especially those with board

certifaction above the knowledge level of DPT students. The article

does not state how many of those experiences clinicians have a DPT

behind their name. Again, I value experience in the field over

didatic knowledge.

I am interested to know where you both practive currently and if you

would be willing to practice primarily in a LTC or HH setting? For

me I work in a hospital setting treating inpatient(including

swingbed), outpatient and home health.

Enjoying the discussion.

> > >

> > > I know that this will put me at odds with many of our

> profession's

> > most

> > > visible practitioners and administrators, but here goes:

> > >

> > > The willy-nilly rush to raise the status and income of our

> > profession has,

> > > to me, a smarmy feel. We all know the potential value to us as

> PTs-

> > --it's

> > > heralded in every related article and commentary---but where

is

> > the evidence

> > > that autonomy (and its sister, higher levels of academic

> > education) has real

> > > value for PATIENTS? That would have been a very good question

to

> > answer

> > > before we advocated for changing our practice model.

> > Unfortunately, physical

> > > therapists put the prestige " cart " before the outcome

> data " horse "

> > and in

> > > the process, I think, exposed a nasty streak of selfishness. I

> > would dearly

> > > like to see these conversations take at least a passing shot

at

> > that issue.

> > >

> > >

> > >

> > > It is very important to note here that America is truly

> suffering

> > from

> > > rising medical car costs. A recent large-scale study out of

> > Harvard found

> > > that in 2006 medical care costs rose 7.7 percent---the lowest

> > increase since

> > > 1999, yet still twice the overall inflation rate and way ahead

> of

> > wage

> > > increases. If that weren't enough, the cost trend's financial

> > burden has

> > > been augmented by alarmingly large per capita utilization

> > increases. We

> > > should all be aware that, concomitant with the profession's

push

> > for more

> > > status, physical therapy utilization has increased even more

> than

> > other

> > > services. From 1999 to 2000 it increased 68 percent, and in

> > subsequent

> > > consecutive years, 35, 28, 16, and 32 percent. (That's without

a

> > significant

> > > increase in submitted claims, i.e. the increased dollars were

> not

> > related to

> > > increased numbers of patients seeking/using services.) We need

> > look no

> > > further to discover why Medicare acted to decrease fee-schedule

> > > reimbursements, and why it placed PT on the 2006 and 2007 OIG

> work-

> > lists.

> > > Most importantly, all that is happening without any real

> evidence

> > that the

> > > extra care is making America any healthier.

> > >

> > >

> > >

> > > Physical therapists have made real efforts to advance and

> advocate

> > > evidence-based practice. We should apply the same evidence-

based

> > approach to

> > > our business and academic models.

> > >

> > >

> > > Dave Milano, PT, Director of Rehab Services

> > > Laurel Health System

> > >

> > >

> > > Re: Professional in the Hospital

> > >

> > >

> > >

> > > As times change and healthcare evolves our profession will

> adapt.

> > Laws will

> > > be changed to ensure safe, efficient, and cost effective

> > healthcare for

> > > society. Physical therapists are responsible for the care of

> their

> > patients

> > > (as are physicians) regardless of whether they are

administering

> > that care

> > > themselves or are directing the care through their assistants.

> > J.

> > > McMenamin, PT said it best, " the economic infrastructure and

> > culture of

> > > physical therapy allow most of the surplus value (profit) of

our

> > service to

> > > be drained [by others] who use it for their purposes not

ours. "

> > Those who

> > > really have the most to lose by allowing physical therapists

to

> > become

> > > autonomous are those who enslave us and profit from our labor.

> We

> > must break

> > > away from the shackles of the practices of the past, and take

> > control of our

> > > future.

> > >

> > > Dr. Sumesh , PT

> > >

> > > Board Certified Clinical Specialist in Orthopedic Physical

> Therapy

> > >

> > > APTA - Certified Clinical Instructor

> > >

> > > Re: Professional in the Hospital

> > >

> > > Hospitals provide a variety of services including medical,

> > surgical,

> > >

> > > nursing, rehabilitative, nutritional, counseling, etc... Only

a

> > fraction of

> > >

> > > these services are revenue generators, although one of the

> biggest

> > revenue

> > >

> > > generators is rehabilitative services (that is why some

> hospitals

> > focus

> > >

> > > soley on rehabilitation services). Most physicians working in

> urban

> > >

> > > environments have privileges in hospitals. Thus, they can

admit

> > their

> > >

> > > private patients into certain hospitals and follow them while

> they

> > are

> > >

> > > there. While their patients are in the hospital they are still

> > allowed to

> > >

> > > provide medical care to their patients and bill their patients

> > (i.e.

> > >

> > > insurance) for their professional medical services. Likewise,

if

> > they

> > >

> > > request a consult by another specialist (e.g. cardiology),

that

> > physician or

> > >

> > > physician group will bill the patient (i.e. their insurance)

for

> > the

> > >

> > > professional services they provided (even though they didn't

> admit

> > the

> > >

> > > patient). Even physiatrists do

> > >

> > > this, even though they don't provide any rehabilitative

> services.

> > They only

> > >

> > > provide medical care to the patient while the patient is in

the

> > rehab unit

> > >

> > > of a hospital or is in a rehab specialty hospital. Physical

> > therapists are

> > >

> > > specialists also. Does anyone know if any hospitals/organizat

> ions

> > in the

> > >

> > > country allow physical therapists or physical therapy groups

to

> > provide

> > >

> > > services in a hospital, rehab center, or skilled nursing

> facility

> > in a

> > >

> > > manner similar to that of medical professionals and bill for

> their

> > services?

> > >

> > > I would imagine that the hospital can still bill the patient

for

> > >

> > > facility/equipment use (e.g. like radiological services).

> > >

> > > Dr. Sumesh , PT

> > >

> > > Board Certified Clinical Specialist in Orthopedic Physical

> Therapy

> > >

> > > APTA - Certified Clinical Instructor

> > >

> > > ____________ _________ _________ _________ _________ _________

_

> > >

> > > Sick sense of humor? Visit Yahoo! TV's

> > >

> > > Comedy with an Edge to see what's on, when.

> > >

> > > http://tv.yahoo. <http://tv.yahoo.> < http://tv.yahoo.

> > <http://tv.yahoo.>

> > > com/collections/ 222> com/collections/ 222

> > >

> > >