Is It Practical to Add a PT to an O&P Facility?

In a field driven increasingly by bureaucracy and documentation, and a steady stream of new regulations and audits, the burden of proof of medical necessity and K-level can weigh heavily on O&P clinicians and their support staff. Previous developments drove home the notion that our profession was heavy with money-hungry opportunists: Our notes were not (until recently) considered part of the medical record, our recommendations tainted by financial gain, and our professional skills belittled and misunderstood. In that environment, practitioners have been punished when the prescribing entity did not sufficiently document the patient's need for prosthetic componentry or include a descriptive narrative of his or her daily life and prosthetic needs. Regardless of whether prescribers knew anything about prosthetic treatment, they were expected to dictate the detailed course of treatment and document it accordingly. And we all know how much of a struggle it has been to ensure appropriate prescriber documentation is in place at all, let alone in a timely fashion. Even now, when our notes are part of the patient's medical record, it is imperative for either the prescriber or a third party to test and document an amputee's K-level and prosthetic prognosis. Our professional word is still not good enough. With those challenges in mind, my company debated how to facilitate obtaining functional level testing for our patients. Should we continue to depend on physicians who already balk at promptly sending basic chart notes? Or should we hire an in-house physical therapist to do the assessments as well as provide prosthetic gait training for our patients? Would the therapist see only our patients, or would they see other patients outside our facility? Hoping to learn from the experience of other O&P clinicians, I posed two questions on the OANDP-L listserv: Have you tried having a physical therapist on staff and/or in your clinic? How did it work out? I received answers in two waves. The first wave consisted of, "No, we haven't, but we've been considering it. Please post the responses." There was one outlier who said the facility he worked for had done it in the 1980s, but he didn't know whether it had worked out in the long run. My follow-up post on the listserv, summarizing those responses, elicited more varied responses. A number of clinicians said they have tried having an in-house physical therapist over the years; it appears that most of them absorbed the cost into their practice to keep the therapist dedicated to the clinic's prosthetics patients. There were no responses indicating that anyone has continued in this vein, and it seems that all practices that at one time had a physical therapist on staff abandoned the trial for unspecified reasons. We discussed the options at length within our clinic but have decided not to pursue hiring our own therapist until it is financially feasible to have a therapist dedicated to treating only our patients in our facility. Even should that circumstance become reality, we would not depend on that therapist for functional level assessments so that we are not accused of having a financial interest in the outcome. While it adds more steps and time to the process, we believe that our lives are ultimately made easier when the person determining a patient's functional level is not considered at risk of having a conflict of interest. Gretchen Wellman, CO, sees patients at Northern Orthopedics, Anchorage, Alaska. She can be reached at gwellman@northo.com .

Is It Practical to Add a PT to an O&P Facility?

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Is It Practical to Add a PT to an O&P Facility?

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NAAOP Names Board of Directors

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VA Announces Access Standards for Healthcare

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