The dilemma facing the physical therapist is to choose between suboptimal care or risk a breach of regulations—and possibly incur a fine—to accommodate the patient’s needs. None of these options is ideal. Regardless of the choice made, documentation must be defensible and proper billing procedures must be in place.
The therapist might consider the following course of action:
- Start by explaining the insurance limitations and promote the importance of a self-managed, home-treatment plan;
- During the initial examination, offer instructions for a home program, stressing continued compliance, back safety and regular exercise;
- Provide written instructions that guide progression of the individualized home program; and
- Suggest available websites and other educational resources related to the identified impairments and offer follow-up phone consultation, as needed.
These actions are time consuming, but may prove helpful with regard to patient satisfaction and treatment outcomes.
Alternatives
In the future, physical therapists will need to use alternatives to traditional education methods, frequency and duration of care plans, and gaining compliance with home exercises to address the changing ethical, regulatory and financial environment.
Physical therapists are already looking to untraditional initiatives, such as telehealth, and promoting the use of technology, including smartphones and electronic communications, to assist in education and compliance efforts. However, payment for such services varies widely and usage is limited. Going forward, practitioners will need to provide Web-based links to quality educational resources and develop user-friendly educational tools to serve disadvantaged patients without adequate rehabilitation benefits.
When it comes to providing rehab services (and many other healthcare services) this version of the Golden Rule often applies: Those with the gold make the rules. Although this may be the unfortunate reality, exploring practical alternatives while balancing priorities and the needs of various stakeholders is essential to ensure the ethical delivery of patient care.
Robert W. Richardson, PT MEd, FAPTA, is a past president of the American Physical Therapy Association and a past president of the ARHP.
Additional Resources
APTA.org and CMS.gov are valuable resources for physical therapists. The following documents and publications can help you avoid fraud, waste and abuse, and gain an understanding of changing regulations.1-4,9
- APTA Core Documents: www.apta.org/Policies/CoreDocuments features links to the Code of Ethics, Guide to Physical Therapist Practice and Guide for Conduct and Professionalism.
- APTA Coding and Billing: www.apta.org/Payment/CodingBilling includes links to courses (also see http://learningcenter.apta.org and http://www.apta.org/Courses/Online/NavigatingCompliance).
- Compliance: http://www.apta.org/Compliance offers information on fraud and abuse, and Medicare audits.
- The federal government’s websites and the Federal Registry publish changes in rules and regulations that affect physical therapy. For example, the U.S. Department of Health and Human Services Centers for Medicare and Medicaid publishes documents that provide an overview of facts and laws regarding Medicare fraud and abuse. Changes are also published in other forms in the public record. Government websites can be useful, but be forewarned that most will induce sleep with a full dose.
References & Recommended Reading
- Centers for Medicare and Medicaid Services. http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html.
- Medicare Claims Processing Manual. Chapter 5—Part B Outpatient Rehabilitation and CORF /OPT Services. http:www.cms.gov/Medicare/Billing/TherapyServices/downloads/clm104c05.pdf.
- Final 2015 Physician Fee Schedule and Physician Quality Reporting System (PQRS) Measures. APTA Information Bulletin. October 2014.
- Code of ethics for the physical therapist. American Physical Therapy Association. http://www.apta.org.
- Purtillo RB, Doherty RF. Ethical Dimensions in the Health Professions, fifth ed. Saunders, an imprint of Elsevier: 2010.
- Scott R. Professional Ethics: A Guide for Rehabilitation Professionals. Mosby: 1998.
- Richardson JK. The challenging roles facing physical therapists. Healthc Trends Transit. 1993;5(1):34.
- Gabard DL, Martin ML. Physical Therapy Ethics. FA Davis, Philadelphia: 2003.
- Guide to Physical Therapist Practice 3.0. American Physical Therapy Association. http://www.apta.org.
