PT As A Supervisor

Question 1

Who does a PT supervise

Answer 1

PTA
PT student
PTA student
Aides
Other PTs

Question 2

What matters when deciding supervision issues

Answer 2

• Legal — state practice acts, rules, and Regis
• Payers — agreement with third party payers
• Employment — facility policies
• Professional — APTA policies
• Ethical — code of ethics, guide for Profesh conduct, standards of ethical conduct for PTA, guide for conduct for PTA.
• Sound professional judgement

Question 3

Why does the PT act address supervision

Answer 3

This act is enacted for the purpose of protecting the public health, safety, and welfare, and for providing the state administrative control, supervision, licensure, and regulation of the practice of physical therapy.

Question 4

General supervision

Answer 4

The physical therapist is not required to be on site for direction and supervision, but must be available at least by telecommunications

Question 5

Direct supervision

Answer 5

The PT is physically present and immediately available for direction and supervision. The PT will have direct contact with the patient/client during each visit that is defined in the guide to PT practice as all encounters with a patient/client in a 24-hour period. Telecommunications does not meet the requirement of direct supervision.

Question 6

Direct personal supervision

Answer 6

The PT or where allowable by law the PTA is physically present and immediately available to direct and supervise tasks that are related to patient/client management.

The direction and supervision is continuous throughout the time these tasks are performed. Telecommunications does not meet the requirement of direct personal supervision

Question 7

What can not be delegated

Answer 7

1. Interpretation of referral
2. Examination
3. Provide PT diagnosis
4. Develop plan of care
5. Conducting re-exam
6. Overseeing care/documentation/progress
7. Performing discharges
8. Screening — since its a part of the exam.
9. Any intervention requiring immediate/continuous exam and eval must be performed by a PT (joint mobs, sharp debridement, dry needling)

Question 8

Can the PT delegate to a PTA complete measures that are parts of the examinations?

Answer 8

Like ROM, MMT, Balance gait measures — yes the PTA can do that.

Question 9

Responsibility?

Answer 9

• May be difficult to determine if skill is within scope
• Most practice acts are vague and resistant to writing lists
• It is the responsibility of the supervising PT to ensure that the PTA has the required skills for the intervention (safety and technique)

Question 10

Off site PTA supervision

Answer 10

Look at slides 17 and 18 too much to type

Question 11

What is held true in all practice settings?

Answer 11

1. PTs maintain control of and responsibility for patient/client management
2. PTs are legally and ethically responsible for the PTAs under their direction and supervision
3. In patient/client management, PTAs assist with the intervention component ONLY. Exam, eval, dx, px, and outcomes are the sole responsibility of PT
4. PTAs are responsible for following the POC established by the PT, including ensuring patient/client comfort and safety during the intervention and related data collection.

Question 12

What does medicare require

Answer 12

Direct on site PTA supervision for private practice PT

Question 13

How does medicare treat different people differently in PT world

Answer 13

1. Students — Part A is generally covered. Part B is not reimbursable however student can participate in care delivery that is being directed by PT while PT is not seeing any other patient or completing any other tasks at the same time
2. PTAs — covered, however based on location may require direct supervision of PT
3. Aides — in order for services to be reimbursed under medicare part B they may not be provided by an aide regardless of supervision level.