Lec 9 - Supervision And Extenders Of Care Flashcards
PT Decision Making includes:
Refer
Consult
Co-manage
Retain –> Direct/Supervise
In the PT decision making process, if you direct/supervise, who does it go to?
Physical therapist assistants
Physical therapy aides/techs
Decision Making About Involvement of Other Provider: What is co-management?
The PT SHARES responsibility for the individual with another professional who is also managing that individual
Decision Making About Involvement of Other Provider: What is consultation?
In some cases the PT renders professional expert opinion or advice by applying highly specialized knowledge and skills to ID problems, recommend solutions, or produce a specified outcome or product in a given amt of time based on an individual
Decision Making About Involvement of Other Provider: Consultation- at other times, the PT seeks ___________ from another provider to inform the PT POC and/or to obtain services for the individual that are ___________________ of the PT.
In this case, the PT shares ______ for the individual with the consultant
Consultative services
Beyond the professional/personal scope of practice
Responsibility
Decision Making About Involvement of Other Provider: In referral, the PT may:
1) Refer an individual to _________ and _________, or not develop a ___________.
2) Refer an individual to _________ and _________ the POC at the same time
3) Receive an individual referred from another provider who chooses _________________
4) Receive an individual from another provider who __________ to treat the individual
1) another provider, conclude
2) another provider, continue
3) not to continue treating the individual
4) continues
Decision Making About Involvement of Other Provider: What is direction and supervision?
The PT remains ACCOUNTABLE for the services provided when the PT’s POC involves the use of other recognized assistive personnel
Decision Making About Involvement of Other Provider: PTs also coordinate, communicate, and document the services provided throughout the EOC to ensure ___________ of the individual.
Optimal management
PTs are responsible and accountable for ensuring that the provision of services is in accordance with ______
APTA
Working as a PT/PTA Team: The PT retains ________ for the patient throughout the _______
Responsibility
Episode of Care
How are some ways that the physical therapist retains responsibility for the pt through the EOC?
Professional and ethical documents
PTA education and scope of work
State PT practice act
Payer regulation related to PTAs
PTA Education and Scope of Work: Licensed health care providers that are graduates of intensive ___-year (__ semester) PTA education programs accredited by _______.
2 year
5 semester
CAPTE
Licensure/certification and successful completion of PTA _____ is required in all jurisdictions
NPTE
PTA means a natural person who is licensed pursuant to the provisions of this act and who assists a licensed ____ under his direct ______ in accordance with this act and regulations of the ______
PT
Supervision
Board
Direct supervision means what?
The presence of the supervising PT on SITE
Available to respond to any consequence occurring during any treatment procedure
You cannot supervise more PTAs than the Board feels can adequately be supervised… so this generally means ___ per therapist.
You can petition for an exception, but you must insure the _____ and _____ of the public
2
Health and Safety
PTA may only work under the direct supervision of a PT, T/F?
True
T/F: The PTA can initiate treatment ONLY at the direction and under direct supervision of the PT
TRUE
T/F: Documentation by the PTA must be reviewed and co-signed by the PT
TRUE
T/F: The PTA is not allowed to collect data for patient exam, and not allowed to interpret
False: can collect data, but may not interpret
T/F: PTA may not perform a PT examination, eval, Dx or Px, develop or modified POC, or independently engage in PT instruction including recommendations of ADs and modification of pt’s physical environment
TRUE
T/F: If the PTA thinks that the patient is unsafe during ambulation, they can suggest a rolling walker.
False - cannot recommend ADs
PTAs can only work under _________ of a licensed PT
DIRECT SUPERVISION
How many PTs to PTAs?
1 PT to 2 PTAs
Who retains the responsibility of patients when you have a PTA?
The supervising PT
If there is a change of supervising PT, who assumes resposibility?
The subsequent supervisor
In the unanticipated absence of the PT, the PTA may continue for how many business days for patients with established POC, who the PTA has previously participated in intervention with?
ONE
Supervision has to be in the ____ building or ______ building constantly available via electronic communication for recall to area
SAME
CONTIGUOUS
Who is ultimately responsible?
PT supervisor
Who must consign PTA notes contemporaneously?
PT Supervisor
When should a PT review of POC be done?
Before first visit
Before implement new or revised POC
With supervisor change
At least every _____ days, documentation of review
30
The PTA shall not render or continue to render care without obtaining ongoing direction from _______
PT supervisor
The PTA must obtain signature of designated supervisor for ________ review
POC
The PTA needs to review POC and document supervision at least every ____ days
30
Delegation to unlicensed personnel includes: (2)
1) Routine tasks related to cleanliness, maintenance of equipment, physical plant and management of the business aspects of the practice
2) Pt transport, assist with dressing/undressing, positioning
T/F: An unlicensed person is not allow to advise, teach, or instruct patients about their condition
TRUE
T/F: An unlicensed person can carry out testing or evaluation procedures
FALSE
T/F: An unlicensed person can make notations in the patient’s record in relation to clinical treatment
FALSE
T/F: An unlicensed person can place electrodes of any kind on the skin
FALSE
T/F: An unlicensed person is not allowed to administer any modalities!
TRUE
T/F: An unlicensed person cannot instruct and or perform therapeutic exercise
TRUE
T/F: An unlicensed person cannot perform therapeutic activities
TRUE
T/F: An unlicensed person cannot provide therapeutic massage
TRUE
PTs are the only professional who provide ______ interventions
PT
PTAs are the only individuals who provide ______ PT interventions under the direction and at least ______ supervision of the PT
Selected
General
Interventions that require immediate and continuous examination and evaluation throughout the intervention are performed exclusively by the ____
PT
Examples of interventions that require immediate and continuous examination only performed by a PT include:
Spinal and peripheral joint mobs/manips, which are components of manual therapy
And sharp selective debridement, which is a component of wound management
PT eligible to enroll a ______ for a payer/insurer
provider
PTA services are billed by who?
The supervising PT
Regardless of payer, the PT maintains control of the patient’s care; provides the appropriate level of _____ and _______ for the PTA, and can bill for services provided for the _______ team
Direction and supervision
PT-PTA
PT services provided by PTAs are reimbursed under who’s ID number?
The PT’s
Are PTs and PTAs generally paid at the same rate for services?
Yes
Medicare: PTAs are ________ providers when furnishing services under the direction and supervision of a qualified PT, who is working with the _____ scope of practice in the state in which the services are furnished
Qualified
State
Medicare, other payers and plans – may have more specific policies on payment for services provided by a _____, and _____ requirements
PTA
Supervision
Medicare and PTAs: The services of PTAs used when providing covered therapy benefits are included as part of the __________.
There services are billed by the ____________
PTAs may not provide ______ services, make ___________, or take ______ for the service.
They act at the ______ and under the _______ of the treating PT and in accordance with state laws
Covered service
Supervising PT
Evaluation
Clinical judgments
Responsibility
Direction
Supervision
A PT must supervise ____
PTAs
Who are qualified professionals?
PT OT SLP MD NP CNS PA Licensed/certified by state to perform therapy services
(May include PTA and COTA under supervision of qualified therapist as allowed by state law)
Medicare and PTAs: General supervision is required for PTAs in all settings except _______ (which requires ______ supervision) unless state practice requirements are more stringent, in which case state or local requirements must be following
Private practice
Direct
Medicare and PTAs: The services of a PTA shall not be billed as services incident to a physician/NPP’s service, because they do not meet the _______ of a therapist
Qualifications
Medicare and PT aides: Services provided by aides, even if under the supervision of a therapist, are ___________ and are ____________
NOT THERAPY SERVICES
NOT COVERED BY MEDICARE
Although an aide may help the therapist by providing unskilled services, those services that are unskilled are not covered by Medicare and shall be _____ as not reasonable and necessary if they are billed
DENIED
How many models in the continuum of direction and supervision models in PT service delivery?
4
What is model 1?
Examination Eval Dx Px Intervention [PTA, Aide/Tech]
What is Model 2?
Exam Eval Dx Px Intervention [PTA and other recognized assistive personnel, aide/tech]
What is model 3?
Exam [PTA and other recognized assistive personnel]
Eval
Dx
Px
Intervention [PTA and other recognized assistive personnel, aide/tech]
What is model 4?
Exam [PTA and other recognized assistive personnel]
Eval [PTA and other recognized assistive personnel]
Dx
Px
Interventions (PTA and other recognized assistive personnel, aide/tech]
