PTP 2 Unit 10 Risk Management/Legal Aspects of PT and Jurisprudence Flashcards
What is Risk Management?
- The process of identifying, analyzing, and addressing areas of existing and potential risk
- This is applicable to both professional and personal life
Why is Risk Management Important?
To reduce worry for yourself and loved ones and also protect assests
- Proactive risk management practice can help avoid or reduce liability, which, if left unmanaged, can have a severe impact in your life
What are 3 ways to manage risk?
- Avoid risk (assess, identify, analyze, reduce, control, transfer)
- Insurance (for claim or potential claim)
- Tools (forms and trainings)
How to we avoid risk - Scope of Practice (assess, analyze, and identify)?
- Review annually your State Practice Act and Direct Access laws
- Review job description(s) annually with manager
- Decline a service outside of Scope of Practice
- Contact state board if need an opinon
- Use chain of command to resolve safety of patient care issure
What are Common Risk Management Issues in Physical Therapy?
- Improper Treatment (Techniques, communication, force)
- Equipment hazards
- HIPPA violations
- Physical injury (you or the patient)
- Psychological strain
- Workplace violence
How to we avoid risk - Supervision of Personnel (Control)?
- Direct support staff (aides or PTAs) to perform only those tasks that are appropriate to state and federal laws, and within their training
- Provide supervision of aides, PTAs and students within compliance of all laws and practice acts
- Documented and updated competencies on file for aides
- Report a complaint to Board Violations of supervision that cannot resolve internally
How do we avoid risk - Documentation (Control and Transfer)?
- Authenticate all documentation and all handouts to the patient.
- Document every single encounter and non-encounter (cancellation/no-show).
- Correct errors per current guidelines.
- Avoid late entries, documenting as you go (concurrently).
- Refrain from documenting slander, inappropriate opinions, conclusions or derogatory statements about patients, colleagues, or the healthcare team members.
- Contact manager, risk manager, or legal department for assistance with documentation concerns.
Why is documentation important?
Quality and thorough documentation is as important as the quality of the care that is delivered to patients, since medical records are legal documents and serve as valuable evidence as to what transpired between patients and the healthcare providers.
When should insurance be utilized?
For us, PTs
Immediately contact your professional liability insurance carrier if:
- You become aware of a filed or potential professional liability claim asserted against you.
- You receive a subpoena to testify in a deposition or trial.
- You have any reason to believe that there may be a potential threat to your license to practice physical therapy.
What is Harmful Incident?
A patient safety incident that resulted in harm to a patient, including harm resulting when a patient did not receive his/her planned or expected treatment
- Formally known as an adverse event or sentinel event
What is a Patient Safety Incident?
Any unplanned or unintended event or circumstance which could have resulted or did result in harm to the patient
What is a Near Miss?
A patient safety incident that did not cause harm but had the potential to do so
- aka a close call
What information is on an Incident Reporting Form?
- Patient demographic information
- Description of incident, including time and location
- Persons present
- Patient/Visitor/Employee injuries, if any
- Medical care required
- Contact wiht Physician
What is the Goal of the Investigation process after an Incident Reporting Form?
Improve safety by identifying cause(s) to avoid re-occurrece
What are different ways to De-Escalate Conflict?
Root Cause Analysis
What does Root Cause mean?
- The factor that caused an unexpected or unplanned event (incident)
- The highest level cause of incident
- Process, not individual, related
What is Root Cause Analysis? What is the goal for this?
- The systemic process for identifying “root cause” of problems or events and an approach for responding to them; Prevention as well as response to incident
- Primary goal to discover what, how and why it happened to identify hidden causes and develop actions to prevent reoccurrence
What do Root Cause Analysis focus on?
- On corrective actions
- Focus on why it happened, NOT who made the error
- It identifies both active and latent errors
This is a systemic approach, and accepts the possibility of more than 1 root cause
Describe the Root Cause Analysis process?
- Begins with the data collection
-Reconstructs the event
-Use record review and participant interview - Analyze sequence of events leading to incident
There are several approaches to root cause analysis
With Root Cause Analysis, what is the Fish Bone Diagram?
- 1st develop problem statement
- Figure out major categories of causes
- Brainstrom possibl causes under each category, asking “why did it happen”
- Continue asking “why” about each cause and place under appropriate cause/category
Once the Root causes have been identified, an action plan needs to be developed to address the causes. What are 3 Quality Improvement Approaches that can be used to develop an action plan?
- Plan-Do-Study-Act (PDSA)
- Plan-Do-Check-Act (PDCA)
- FOCUS
With the APTAs Levels of Supervision, what is General Supervision?
With the APTAs Levels of Supervision, what is Direct Supervision (On Site)?
With the APTAs Levels of Supervision, what is Direct Personal Supervision (Line of sight supervision)?
What are Supervision Considerations when working with a PTA?
- State Practice acts
- Third Party Payers Rules and Regulations
-Medicare
-Medicaid
-Other insurance companies - Avoiding Fraud and Abuse
What would a Model PTA do?
- The PTA is the Right hand of the PT and works under his/her supervision
- PTA are Directly involved in patient treatment
- PTA duties may include mobility training, applying modalites
- PTAs also design and carry out exercise programs to build strength, endurance, coordination, and to improve function
What is the difference between Ethics and values?
Ethics: Rational reflecion
Values: Standards for what is right or wrong
What is Jurisprudence?
The theoretical study of law. It seeks to explain the understanding of legal reasoning, legal systems and the role of law in society
What are the 3 elements of Scope of Practice?
- Professional
- Jurisdictional
- Personal
What is the “Professional” Scope of PT practice?
Practice that is grounded in the profession’s unique body of knowledge, supported by educational preparation, based on a body of evidence and linked to existingn or emerging practice frameworks
What is the “Jurisdictional (Legal)” Scope of PT practice?
This is established by a state’s practice act governing the specific PT’s license, and the rules adopted pursuant to that act
What is the “Personal” Scope of PT practice?
This consist of activities undertaken by an individual PT that are situated within a PT’s unique body of knowledge where the individual is educated, trained and competent to perform that activity
What Guides our Profession?
- Individual: Personal values and beliefs based on our culture and religion
- Organization: Code of ethics, core values, standards or practice, APTA policies, APTA position statements, generic abilites and professional
- Society: Practice laws, regulations, statutes, and administrative code
Sources of Law
What is Constitution?
The highest form of law, exist at national and state levels
Sources of law
What are statutes?
What most of us think of as laws, exist as the national level and state level, written by legislators
Sources of law
What is Administrative Code?
Rules and regulations which govern practice, exist at national and state levels
Sources of law
What is Common Law?
This is based on precedence
What is the Mission and Vision of the Federation State Board of Physical Therapist (FSBPT)?
What are the 6 Keys to Practice?
With Licensure, why does the FSBPT develop and administer the NPTE?
What is General Supervision?
The least Restrictive type of supervision. Requires that PT is available for direction via telecommunication, NOT onsite
What is Direct Supervision?
Requires PT to be physically present in the facility and immediately available for face-to-face direction
What is Direct Personal Supervision?
Highest Level of Supervision, PT must be physically present and immediately available to direct, PT must provide continuous direction for the entire duration of treatment
What is Medicare Supervision?
What is the PT Delegation Responsibility?
- What interventions can be delegated and under what conditions
- How those services must be supervised, documented and billed
- To include documentation that the plan of care was reviewed with the PTA and that the PTA is receiving the correct level of supervision
What is the False Claims Act? and the Violations
Violations:
- Finanical penalties- recovery of 3x the amount of the false claim(s) + an additional penalty of $5,500 to $11,000 per claim
- Potential imprisionment
What is the Anti-KickBack Statue?
A criminal statue that prohibits transactions offering, soliciting or accepting of any type of gift of remuneration in exchange for referrals reimbursed by the federal health care programs
With the Anti-KickBack Statue Violations, what are the Criminal and Civil Penalties?
- Criminal Penalties: Can include fines up to $25,000 and a 5 yea prision term “per kickback”
- Civil Penalties: Can include fines as much as $50,000 “per kickback” + 3 times the amount of damages sustained by the government
- Excluded from federal healthcare programs
What is Stark Law?
Any physician who provides care to any federal program recipient, cannot refer the patient for specific health services to any entity which the physician has a financial intrest
What is POPTS?
Physician Owned Physical Therapy Practice (POPTS) refers to a physician practice which provides PT interventions and medical services under a single umbrella practice
