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Current Issues Physical Therapy in Evolution Chapter 7: 

Current Issues Physical Therapy in Evolution Chapter 7 PTHA 1301 Profession of Physical Therapy

Objectives: 

Objectives Recognize the shift in education for the physical therapist Describe three practice issues impacting the physical therapist assistant Discuss the practice issues impacting the physical therapist Explain how infringement may have an impact on physical therapy Discuss the importance of evidenced-based practice Identify the core values of professionalism in physical therapy

Issues confronting Profession of PT: 

Issues confronting Profession of PT The driving force in practice issues Managed care BBA Direct access Shift on focus by Vision 2020 Educational transition towards doctorate degree Evidence-based practice Professionalism

The History of Physical Therapy Education: 

The History of Physical Therapy Education Began with reconstruction aide (training required only weeks) & receiving a certificate PT required BS from 1960 to 1999 In 1980, APTA decided master’s degree in physical therapy necessary after 2000 In 1993, APTA started talks on the doctor of physical therapy (DPT) By 2020, all PT’s will be required to graduate with an entry-level DPT (professional degree

Physical Therapist Professional Education: 

Physical Therapist Professional Education Entry level DPT Prepares individuals regardless of degree Post professional education Advanced education for licensed PT Masters or Doctoral level Approximately 98% have transitioned or are in transition Debate by practicing clinicians Bachelor’s vs. DPT Experience vs. knowledge tDPT Awarded to licensed PT Offers augmented knowledge Offers onsite /distance/combined of both

Supply and Demand: 

Supply and Demand PT/PTA job market dwindled in mid 90s APTA commissioned Vector Research Study(1997) Predicted a mild excess of PT’s by 2005 Blamed on the expansion of programs Development of new programs Reimbursement rate with managed care APTA took action 1999-2002 to limit development and expansion of new programs US department of Labor Positive Projections through 2012

Current Issues of the PTA: 

Current Issues of the PTA Current Controversies PTA attending CEU offered to PT’s (Box 7-3) Content beyond the skills of PTA’s Restriction of Interventions (Box 7-4) Mobilization Manipulation Sharp Debridement Recognition of Advanced Clinical Skills (Box 7-5) APTA adopted Recognition of Advanced Proficiency for the PTA (June 2003)

Current Issues in Practice: 

Current Issues in Practice Shift from traditional hospital based to variety of settings Rehabilitation for soldiers and children in hospital or long term care facilities to: Hospitals Private practice Home health care Outpatient care centers Sports clinics Nursing care facilities Adult daycare Rehabilitation Centers Schools Issues in each of these areas

Effects of Managed Care: 

Effects of Managed Care Emphasis on controlling costs and limited number of visits Caused am impact on determining appropriate provider (PT or PTA) 1xwk may lead to : Re-examination Progression of treatment Emphasis on patient education PTA is underutilized

Ambulatory Centers: 

Ambulatory Centers Out patient becoming the norm 38.9 % of PTs vs. 13.6 % acute care (hospital) Less costly to insurers Less costly to consumers Treats patients who are ambulatory Do not need overnight stay

Alliances: 

Alliances Association of practitioners/facilities without merging, in order to negotiate acceptable reimbursement rates Hospitals are now “full-service” facilities who can provide a little bit of everything: IP, SNF, OP, HH Therapists working in each area serve to enhance the continuity of care by recommending when a patient is ready for the next level of care

PT in Hospital Settings: 

PT in Hospital Settings Involved in triage Need to move patients to less expensive levels: Skilled nursing facilities Inpatient rehab Home discharge Re-examining patients Recommending Discharge to Physicians

Guide to Physical Therapist Practice: 

Guide to Physical Therapist Practice Sets parameters of care Describes scope of PT practice Educate legislators and insurance companies role of the PT as a Primary Care Provider (DPT)

Direct Access: 

Direct Access In days of Reconstruction Aides, MD coordinated all aspects of care Today, PT knowledge base & experience make PT’s more expert in certain areas Benefits of direct access: Gives patients a choice to see a PT or MD PT’s can determine when need to refer to primary MD Reduces healthcare costs Currently 45 states allow direct access; Texas has it on very limited basis

Resistance to DPT: 

Resistance to DPT Certain states Physician opposition Concerns over level of knowledge Yet physicians don’t always diagnose Referrals to “Evaluate and Treat” High risk of malpractice No evidence of increase reported Other unspoken concerns ↓ patient numbers under physicians care No supporting documentation Cost Effective Benefits (Box 7-6)

Physician-Owned Physical Therapy Service: 

Physician-Owned Physical Therapy Service POPTS Some physicians own PT clinics Leads to “self-referral” Over use of PT services → Overspending Patients often loose choice of where to receive Rx Prolonged services reported AMA reports: Federal Legislation: Section 1877 of Social Security Act aka physician self-referral law ( StarkII ) Prohibits a physician to make referrals to centers where there is financial gain APTA to oppose these relations Physicians hire PT’s as employees to curtail above Same overutilization tends to occur No restrictions apply

Infringement: 

Infringement Infringement: “to encroach, trespass or intrude on or upon the rights, property, etc of another” In health care When one provider performs the skills of another provider Athletic Trainers ATC Sporting/weekend event OT Toilet/bathtub transfers Infringement resulted from Shortage of PTs prior to BBA

Infringement Continued: 

Infringement Continued Debate Who is infringing on who? Look at State Practice Act OT/PT different outcomes or goals PT/ATC could both treat but billing and reimbursement should differ Use of CPT codes by other professionals Misleading to insurances Attempts by APTA to change regulations had limited success

Continuous Quality Improvement/Total Quality Management (CQI/TQM): 

Continuous Quality Improvement/Total Quality Management (CQI/TQM) Data Management Tools Outpatient Centers Visits/Cancellations, No-Shows Ongoing Patient Surveys Customer Satisfaction

Patient-Focused Care (PFC): 

Patient-Focused Care (PFC) Inpatient Centers Multidisciplinary Teams work together Centralized Units ( orhto -unit, cardiac-unit) This cross-training (due to shortage) brought controversy Affected the profession led to “encroachment” Affects all professions Evaluative and Treatment components are retained by PT Positive developments: More appreciation of the knowledge base of PT Critical Pathways Treatment progression Based on patient response and recovery

Research: 

Research Direct access requires evidence Required to ensure the identity of PT profession Emphasis is on Appropriate measuring of outcomes Efficacy of intervention Contemporary approach to health care All interventions to have scientific research Available to clinicians (APTA members) via Hooked on Evidence Clinicians collaboration Students involved in educational setting (DOCS)

Professionalism in Physical Therapy: 

Professionalism in Physical Therapy Vision 2020 included six key elements for transitioning into a doctoring profession DPT Evidence Based Practice Autonomous Practice Direct Access Practitioner of Choice Professionalism Professionalism in Physical Therapy: Core Values lists seven core values used to measure professionalism (See Table 1-1, pg. 11)

Summary: 

Summary Current issues in physical therapy include education, practice & research Doctor of physical therapy is now the professional degree of the PT Role of the PTA has been clarified Change in practice setting from hospitals to other settings Direct access continues to grow POPTS continue to exist and grow Professionalism important element of new graduates for the common good of the pt