Intro to PT: PT-505-A
modern PT began in
EUROPE
Terms of Practice
Need to have certain points set & clarified in order to treat pts. • Inform pt what services you can provide & what is required of them • Pt should be involved in development of plan of care & set goals • Aware of 3rd party payers • If pt stops care write down why it was against medical advic
Licensure
Need to have graduated from CAPTE approved programs ▪ must pass licensure exam ▪ must be licensed in state youre in (don't usually retake exam but must reapply) ▪ NYS can work 90 days after graduation w/o permit, then must have limited permit & practice under PT til you pass • Limited permit good for 6months
No Fault- Ins. for MVAs
Pt pays nothing o All drivers must carry NF ▪ Usually last as long as Medically necessary
Which of the following determines how many minutes a patient must be seen by PT in an SNF?
RUG
Access/Equity
Recognize health inequities & disparities & work to correct them through innovative models of service delivery, advocacy, attention to influence of social determinations
RAC
Recovery Audit Contractor
Medicare Part C (Medicare Advantage Plan)
Run by private companies, approved by medicare - similar to HMO • Private company contract Medicare A & B • Optional & acts as replacement to traditional medicare • Most charge monthly premiums, no 20% coins. Like Part B, offer prescription drug plans
Compassion/Caring
Feeling of wanting to help someone who is sick, hungry, in trouble, etc. • Things done to keep someone health/safe
Altruism
Feelings & behavior that show desire to help other people & lack of selfishnes
COBRA-- Consolidated Omnibus Budget Reconciliation Act
Former employees, retirees, spouses & dependent children the right to temporarily cont. their health coverage @ group rates ▪ Higher than active employees by less than buying own ▪ 6 months - 3 yrs
Medicaid
Funded by both state & federal governments o Everything covered in FULL o NOT covered 19-64 adults not pregnant
MTG's Medical Treatment Guidelines
Given 30 days to treat patient (3-5x/wk, depending on interventions) ▪ Progress note every 30 days ▪ Must submit variance ▪ Must document functional progress
Medicaid qualifications
High medical bills that are unable to financially cover ▪ Receive supplemental social security (SSI) - disability ▪ Meet certain income, resource, age or disability requirements ▪ Pregnant women & infants ▪ Children ages 1-18 ▪ Parents & caretakers of relatives
DRG's - Diagnosis Related Group:
Hospital classifies patients medical & physical Diagnosis ▪ Assigned based on ICD diagnoses, procedure, sex, age, presence of comorbidities ▪ Determine how much medicare pays
Medicare Part B- enrollment
Initial enrollment starts 3 months after turning 65 & lasts for 7 months o Can only enroll from Jan 1-March 31 (there is late fee) o 20% coins. After ded. Is met o Doctors' visits, PT, OT, Speech, outpt. Hospital care, DME & Prosthetics & Orthotics o Ambulance transportation when medically necessary o Mental health outpt. & inpt. o Clinical research & seeking second opinion b4 medical care/surgery
You tell your PT that you can continue to treat them, but that insurance wont cover their treatment anymore. You will give them a discount, but you will need to still charge them something if they keep coming. Which of the following APTA Core Value does this demonstrate?
Integrity
ICF
International Classification of Function
Value
"health outcomes achieved per dollar spent" • Services provided by PTs will be safe, effective, patient/client-centered, timely, efficient, equitable • Accountability of core characteristics of profession
Part A of Medicare
"hospital insurance"-automatically given if you apply for medicare -inpatient hospitals, critical access hospitals, skilled nursing facilties ( NOT long term), hospice care -most ppl don't have monthly premium bc its paid thru taxes while working - individual or spouse must ahve worked 40 or more quarters of medicare coverd employment -$499/month for those ineligible
Medicare Part B
"medical insurance" OPTIONAL PREMIUM- $170.10 month ( does increase if persons income is higher) highest possible premium $578.30 month -deductible: $233/yr.
Coinsurance
% of costs of a covered service patient pays (20%) after they've paid their yearly deductible
Workers Comp.
- Injured @ work o Pt pays nothing o All employers must carry WC ▪ Strains, sprains, cuts/punctures, contusions, inflammation, fractures ▪ Material handling accidents, slips, trips, falls, struck by/colliding w/ object
When did PT move to the US
- To treat long lasting symptoms of polio and WW1 - reconstruction aids were early PTs primarily with soldiers once home -post WW1 focus shifted from maintaining fighting force to maintaining working force
What does WHO do?
- provide leadership on things related to health -shape the research agenda -set norms and standards and promote and monitor implementation -recommended ethical and evidence-based policy options for countries/organizations to follow -provide technical support + encourage change when needed -monitor health situation and assess health trends around world
How to receive and give constructive criticism: receiving criticism:
- realize that no one is perfect and we can all benefit from constructive criticism to better ourselves as people an in our PT practice -learn to value criticism - look past your initial reaction to criticism; its natural to get defensive -take a deep breath and reiterate what they said -watch how you react, try to think about not causing your arms - mimic the position of the other person - set the tone to be positive first, use a criticism sandwich; one positive thing the person did/does, the criticism, then something else that is positive
OSHA protects employees in what specific ways?
- workplace violence, hazardous materials, eye safety, fire protection, egress, etc.
PART A medicare hospital stays
-$1566 ded. each period -day 1-60 = $0 copay -pay for any days after day 60 -pay totally out of pocket day 101 and beyond
EMR (electronic medical record) Benefits
-CMS has incentive programs allow eligible providers to earn incentive payments by meeting speific criteria for EMR'S - fewer errors, more complete accurate info -less waste - cost saving& quicker reimbursement -ability to decrease unwanted variation in service - ability to compare outcomes quickly& easily w/others -better access to info to diagnose+improve health outcomes -info shared more easily -help empower pts to take a more active role by receiving electronic copies
What does the DOH do?
-administers states Medicaid program (its funded federally but states decide who's eligible) -oversees state health care facilitates& may perform annual inspections
extra HIPPA info
-all other reasons require written authorization except where permitted by law - release of access of privacy to non-covered entities, for other uses in health care , must be de-identified
EMR drawbacks
-breaches in systems breaking HIPPA -HCP'S may have reimbursement denied tied to outcomes thru database - use of medical info by non HC workers (3rd party payers) -decrease patient/PT interactions
Many insurance companies will only cover certain types of treatments and joint commission accreditation facilities....
-makes facilities continually work to provide highest quality services - they are provided expert advice and education from joint commission about quality improvement -able to attract qualified staff because they have more opportunities to develop staff
Medicare who's eligible
-person or their spouse worked at least 10yrs. in Medicare-covered employment, are 65yrs. old and permanent resident of US (elderly) - person has received social security or railroad retirement board disability for 24 months (disabled) ----can get it before 65 if deemed necessary by social security -person has kidney dialysis or kidney transplant patient ( end stage renal disease)
How to receive and give constructive criticism: giving criticism:
-prepare what you want to discuss -respect and professional language -be specific, criticize the action, not the person -state your case -know when to stop; don't give too much info at once
OSHA standard precautions used in healthcare....
-to reduce the risk of transmission of bloodborne and other pathogens -standard or universal precautions are the basic level of infection control precautions which are to he used, as a minimum, in the care of all patients -hand hygiene and PPE should be used as needed to limit/prohibit contact with blood and bodily fluids
HHS contributors
1-center of disease control + prevention (CDC) 2- Centers for Medicare and Medicaid services( CMS) 3- Food and Drug Administration (FDA) 4- National Institutes of Health (NIH) 5- Office of Inspector General (OIG) (1+2 PT's have to follow)
2022
100 yrs of APTA
General Supervision
: PT is not required to be on site for direction or supervision, must be available by telecommunications
Direct Personal Supervision
: PT or PTA is physically present & immediately available to direct or supervise tasks that are related to pt management ▪ Continuous throughout the time these tasks are performed
principle 2
: PT shall be trustworthy & compassionate in addressing rights & needs of pt
Principle 4
: PT shall demo integrity in relationships w/ pts, families, colleagues, students, research participants, other HCPs, employers, payers & public
principle 6
: PT shall enhance their expertise through lifelong acquisition & refinement of knowledge, skills, abilities, prof. behaviors
principle 8
: PT shall participate in efforts to meet health needs of people locally, nationally & globally
Principle 1:
: PT shall respect inherent dignity & rights of all people
Principle 5
: PTs shall fulfill their legal & professional obligations
Aide
: non licensed personnel ▪ NYS doesn't call them aides • Can supervise pts as long as pt is stable • Can watch pt but can't direct or alter exercise program • Can manage environment & caseload
HMO group model
: physician belongs to the "group" of approved providers, has own office, sees any pts they want
All of the following are people that qualify for Medicaid except?
A 22 y/o student receiving health care through their parents' plan
ACO
Accountable Care Organization
first association for PT
American Women's PT Association: 1920s president: Mary McMillan
1960
BS minimum
LMT
Licensed massage therapist
Referral Source
MD, DO, PA, NP, DNP ▪ Podiatrist, midwife, dentist - all can refer to PT but must be in relation to something they treat
Which of the following is related to Medicare?
MDS
SPT,PTA
May only perform tx when on clinical field work placements
Outpatient
Medicare B ▪ No more cap on services ▪ Therapy threshold limits • Once pt hits threshold must have "KX" modifier on each billed code
Your patient has Medicare to cover their PT visits. Which part of Medicare will do this?
Medicare Part B
Medicare Part C plans include
Medicare advantage plans ▪ Medicare cost plans ▪ Demonstration/pilot programs ▪ Programs of all-inclusive care for the elderly (PACE) ▪ Copays for treatments & office visits ▪ May require referral
Accreditation
can be earned by an entire health care organization ( ex. hospitals, nursing homes, office based sx. practice, home care providers, and labs
wound care
can be in acute care, rehab, outpatient, home care
Donut Hole
catastrophic coverage threshold - PT exhuasts the intial coverage of prescription drug plan, then they have to pay HIGHER cost of prescription drugs until he or she reaches catastrophic coverage threshold
CHT
certified hand therapist
COTA
certified occupational therapy assistant
DC
chiropractor
CPT
common procedural terminology
Other PT settings
community clinics sports teams fitness/wellness centers administrative regulatory burn treatments military PT
BCBS
Traditional ▪ Senior Blue (MC pt. C) ▪ Healthy living (similar to Medicaid)
Direct access
Treat w/o referrals PT must have at least 3 years experience or equivalent (4320 hrs) ▪ Can be treated 10 visits or 30 days w/o referral after that referral needed ▪ PT must advise to pt ins. May not cover w/o referral ▪ Notice of advice: • Statement attesting pt is aware of that • Date tx began • Pt name & address • Pt signature & date of signature • Tx pt name & address • PT signature & date of signature
OT
Work WITH OT • Don't get sucked into UE vs LE
collaboration
Working together w/ pts, families, communities, professionals in health to achieve shared goals
You represent:
Yourself ▪ Family/friends ▪ School ▪ Profession ▪ clinic
copay
a fixed amount a patient pays for covered services after they've paid their yearly deductible (if they have a deductible)
MC and MCR
medicare
MDS
minimum data setS
Which of the following is a way in which WHO impacts the global healthcare environment?
monitor and assess health disease trends
RIPS model: individual process
moral sensitivity moral judgement moral motivation moral courage
3000 BC
musculoskeletal treatments began
Medicare program
nations largest health insurer- for 65+ -provide 1/4 Americans with health insurance
PT's responsibilities
o Interpretation of referrals o IE, EVAL, diagnosis & prognosis o Develop or modify POC based on exam findings: short term & long term goals o Determine when care needs to be by PT or other staff o Periodic reveal of pt. in light of goals & changes/revisions to goals o Establish D/C plan from PT & documentation of D/C summary/status
Social Responsibility
obligation to act to benefit society at large
OSHA definition
occupational safety and health administration 1970
OT, OTR/L
occupational therapist
1947
officially became a PT APA became APTA
outpatient
ortho/neuro
DO
osteopath
school based
other peds care non-hospitals -pediatrics
we spend 3.6 trillion dollars on healthcare and we get
other professional services $84 million we fit here -most goes to hospitals
Affordable Care Act
people are not required by law to have health insurance anymore. (patient centered)
1940s
physical medicine became a specialty: "physiatrists" - doctors of rehabilitation medicine
PTA
physical therapist assistant
HMO staff model
physicians are employees of HMO, have offices in HMO buildings only see HMO pts • NOT COMMON ANYMORE
POS
point of service plan
education
post secondary education ( colleges or uni)
HIPPA coverage
privacy, security, transaction, and code sets -privacy: personal health info -security: confidentiality, availability, integrity -transaction and code sets: how data is exchanged electronically
Integrity
quality of being honest/fair
RN, LPN
registered nurse and licensed practical nurse
POS (Point of Service)
resemble HMOs but are less restrictive in that youre allowed to get out of network care under certain circumstances ▪ Require PCP referral for all care whether in or out of network ▪ Network of providers contracted w/ POS company ▪ Pt is managed by PCP - "gatekeeper of pt care" ▪ Network of providers & facilities for pt to use
RT
respiratory therapist
Innovation
▪ Development of patient/client-centered procedures & devices & new technology applications o Consumer-centricity: ▪ Patient values & goals will be central to all efforts in which pt profession will engage
MD JOB
▪ Refer pt back to physician when warranted • Change in symptoms • Further testing needed • Additional impairments • Requests for med changes • Not reponding to tx • Abnorm. Responses to P
Medicare Part c examples
▪ Univera Senior Choice ▪ Highmark BCBS Senior Blue ▪ Independent Health Encompass 65 ▪ Aetna Medicare PPO plans ▪ High ded. Accounts ▪ HSA's
OSHA admins is the....
assistant secretary of labor for occupational safety and health, OSHAs admin answers to the secretary of labor.
TRICARE and CHAMPVA
Civilian health & medical program of uniformed services o Fed. Ins. For retired military CHAMPVA for dependents ▪ Covered active duty, retired & families
Duty
Commitment to providing effective PT services to pts, to serve the profession, positively influence health of society
Identity
Define & promote movement system to improve health of society • Movement system core of PT practice, education & research
MDS - Long Term Care Minimum Data Set
Documentation system in SNF/LTC ▪ Put info into standardized tool to determine pts health status ▪ Measure physical, psychological, psycho-social functioning Section G Functional Status: now section GG (PTs) o Eat function score o Oral hygiene function score o Toileting hygiene function score o Sit to lying functional score o Lying to sitting on side of bed functionl score (PT) o Sit to stand functional score (PT) o Chair/bed-chair function score o Toilet transfer function score o Walk 50' w/ 2 turns function score (PT) o Walk 150' function score (PT)
DME vendors
Durable Medical Equipment vendors
DMEPOS
Durable medical equipment, prosthetics, orthotics, supplies
PPO
POINT OF SERVICE PLAN
Direct supervision
PT is physically present & immediately available for direction & supervision ▪ PT will have direct contact w/ pt during each visit
Collaboration
PT profession will demonstrate the value of collaboration w/ other health care providers, consumers, community organizations, and other disciplines to solve the health-related challenges that society faces
Quality
PT profession will establish & adopt best practice standards across the domains of practice, education & research
Principle 3
PT shall be accountable for making sound professional judgements
principle 7
PT shall promote organizational behaviors & business practices that benefit pt & society
pt CARE
PT, PTA, SPT that is currently on clinical fieldwork rotation & is being covered by schools malpractice ins. ▪ Aide may assist PT, PTA, or SPT as extra hands or supervise
set up and clean up:
PTA, SPT, aide, volunteer, support/office staff
administrative/support work (calls to MD, Insurance company, filling, billing, sched. appts)
PTA, SPT, secretarial/office staff
OFFICE STAFF/SECRETARY
▪ Calls to MD not related to medical issues ▪ Ins. Companies ▪ Billing ▪ Filing ▪ Cleaning ▪ Scheduling
Advocacy
Advocate for pts both as individuals & as population in practice, education, research settings to manage & promote change
1978
American Board of PT Specialities
BCBS Michigan
Branch of BCBS ▪ GM or Ford
CAN, NA
CERTIFIED NURSING ASSISTANT
CPO'S
CERTIFIED PROSTHETIST& ORTHOTIST WHEELCHAIR VENDORS
CMS
Centers for Medicare and Medicaid Services
Medicare—Part D Prescription Drug Plan
Covers brand name & generic meds • Provide protection for both patients w/ high medication costs & unexpected bills in future • Sign up when eligible for medicare, late fee if not • Or you can get part D through your Part C • Monthly premium depending on income ($0-$77.90) o In addition to Part A &/or Part B
2010
DPT by Vision 2020
Accountabilty
Obligation or willingness to accept responsibility or to account for one's actions
Hospitals
all patient types -critical care units -emergency departments ( ED or ER)
Fidelis
State affiliated • Medicare plans • Medicaid plans • Managed care for LTC
deductible
amount patient pays for health care services before insurance plan starts to pay ( usually yearly)
Joint Commission Accreditation
an independent, not-for-profit organization
Certification does....
accredits and certifies health care organizations and programs in the US= shows high levels of standards in care, facilitates, cleanliness, etc.
NOVA
affiliate of IHA
PART A medicare SNF stays
day 1-20 $0 copay day 21-100 pay coins day 101+- pay totally out of pocket -$0 hopsice+home healthcare services
DOH: Department of Health
deals with health issues in each state (unique to each state)
DRG
diagnostic related group
WHO: World Health Organization
directing and coordinating authority for health within the United Nations - largest $ contributions from US+UK
Certification
earned by programs or services that may be based within or associated with a health care organization ( ex. joint commission accredited medical center can have joint commission certified programs or services for diabetes or heart disease care. These programs could be within the medical center or in community)
in 1600s
electrotherapy began
HIPPA main purpose
establish standards of the effective electronic transmission of privacy, while ensuring a minimum federal level of protection for the security and privacy of an individual's health info
American Physiotherapy Association (APA):1921
first journal was published and the American Womens assoc, switched to this name
Homecare
for patients who cant get to an outpatient office-growing
PPO (Preferred Provider Organization)
have a network of providers they prefer that you use but will pay for out of network care ▪ Less restrictive but tend to have higher premiums & copays ▪ Subscription based arrangement ▪ Mbr gets substantial discount below regulary charged rates of designated professionals partnered w/ org. ▪ PPO providers earn money by charging an access fee to insurance company for use of network ▪ Negotiate w/ providers to set scheduled fees
HIPPA: defintion
health insurance portability and accountability act. 1996
HMO
health maintenance organization
CARF: commission on accreditation of Rehab Facilities
independent, nonprofit accreditor of health& human services in: -aging services -behavioral health -opioid treatment programs -business & services management networks - youth and child services -employment + community services -vision rehabilitation - medical rehabilitation - durable medical equipment, prosthetics, orthotics, supplies
RIPS MODEL: Realm
individual organization/institutional societal
ICD
international classification of diseases
RIPS MODEL: situation
issue/problem dilemma distress temptation silence
Medicaid program
low-income people- states sets rules -=provide 1/4 Americans with health insurance
HHS: Department of Health and Human Services
main department for protecting the health of all Americans+ providing essential health services, especially for those who are least able to help themselves
1979
masters minimum
MCD
medicaid
MD
medical doctor
inpatient rehab
medical rehab unit (MRU) nursing homes-skilled nursing facility (SNF), long term care, etc. - nursing homes (head/spinal) -in hospitals
Nursing
▪ Any med. Task in their scope ▪ Med. Admin ▪ Blood draws ▪ BG checks ▪ Toileting, bathing, dressing ▪ Wound care
Professionalism
skill, good judgement, polite behavior that is expected from a person who is trained to do a job well ▪ How you dress ▪ How you act ▪ How you speak ▪ How you write ▪ How you handle yourself ▪ How you interact with others
SW
social worker
SLP
speech language pathologist
Excellence
standard or perfection
You are treating a woman who had gallbladder surgery 6 days ago. She is a PT settings are you treating her in.....
sub-acute rehab PT
HMO (Health Maintenance Organization)
tend to have lower premiums & lower copays but require PCP referrals (to prevent unnecessary services) ▪ Won't pay for out of network except in emergencies ▪ Provide services @ a discount & receive more patients from ins.
1881
the Sargent School was opened in Boston and is the first modern physical education/PT school
OSHA purpose
to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education, and assistance
IHA
traditional medicare (mc part c) encompass 65
niche practices
womens health not in an outpt. practice, lymphedema, etc.
industrial
work site adjustment (ergonomics), works hardening, functional capacity evaluations