DPT 4th year Lecture no. 13 Administration is the skilled process of planning, directing, organizing, and managing human, technical, environmental, and financial resources effectively and efficiently. Administration includes the management, by individual physical therapists, of resources for patient/client management and for organizational operations. • • • Physical therapists (PTs) have been administrators from the very beginning of the profession. As chief aides, PTs supervised other reconstruction aides in the treatment of wounded soldiers returning from World War I, and they subsequently worked with orthopedists as equal partners to provide rehabilitation services for civilian patients. PTs could work directly with a physician (typically an orthopedist or a physiatrist), providing services in the physician’s office. These positions also involved some administrative functions. In the late 1960s, more entrepreneurial PTs began developing independent private practices, and forprofit corporations were formed to provide outpatient rehabilitation services in numerous centers. • PTs created companies through which they contracted their services to health care organizations. For health care organizations, outsourcing physical therapy services to rehabilitation companies has several advantages, including the following: ● Reducing direct costs and providing flexibility in coping with periods of change. ● Freeing up more time for focusing on organizational tasks rather than supervision of staff. ● Allowing access to a critical mass of expertise not available in-house. • • • • • Physical therapists now have many more opportunities to assume managerial responsibility in a wider range of organizational structures at different levels of management. Management is the process by which an organization meets its goals. Managers are responsible for selecting the procedures to be used and for evaluating the effectiveness and efficiency of these procedures in meeting the stated goals. The arrangement of the management system depends on the size and complexity of the organization and the number of management levels. • • • The management of patients is the common level of management or administration for all PTs. In day-to-day patient/client management, PTs take charge of resources, plan the care of patients, direct support personnel, and organize time and work. Professional issues at this level of management include billing, documentation, and delegation and supervision of support personnel. • • • • The primary financial responsibilities at the patient/client management level of administration is billing for physical therapy services provided. All medical billing is based on the Current Procedural Terminology (CPT), published by the American Medical Association (AMA). The CPT, first published in 1966, is a list of descriptive terms and identifying codes used to report medical services and procedures. Because it provides a uniform language for describing all medical, surgical, and diagnostic services The CPT serves as a nationwide means of communication among physicians, patients, and third-party payers Health professionals may use any CPT code that is within their scope of practice. PTs most often use the 97000 category (i.e., physical medicine and rehabilitation) to bill for their services . Other professionals, such as physicians, occupational therapists, and chiropractors, also may bill for interventions in this category • • In addition to specific procedures, the 97000 category includes services measured in time spent with the patient (e.g., 97530, therapeutic activities with direct patient contact, each 15 minutes). The number of units billed under the 97530 code depends on how long the PT was in direct contact with the patient engaged in therapeutic activities code 97110—exercises for strength/ endurance/range of motion (ROM)/flexibility—would be billed as 1 unit regardless of how long the patient exercised. 97035 Ultrasound, each 15 min 97001 Physical therapy evaluation 97024 Diathermy 97012 Traction (mechanical) 97112 Neuromuscular reeducation of movement/balance/coordination/kinesthetic sense/posture/proprioception “ Any entry into the patient/client record, such as consultation reports, initial examination reports, progress notes, flowsheets, checklists, reexamination reports, or summations of care, that identifies the care or services provided.” Patient is unable to follow one-step commands consistently during gait training. Patient’s responses to simple questions are inconsistent or not relevant to the questions asked. • Patient initiates appropriate conversation and questions. Recall of instructions from previous treatment session now requires only minimal cueing Correct during functional training • Patient is confused and not a good rehabilitation candidate Patient appears to be getting better Incorrect Patient performed 30 repetitions each of active exercise of right shoulder in all planes with no well complaints of pain during exercise. She reported she was able to drive to the treatment session with her husband as passenger to ensure Correct safety Patient received treatment. Tolerated well. Voices no complaints Incorrect Timeliness ● Try to complete documentation during the intervention session or soon after; it saves time and ensures accuracy. Objectivity ● Do not record opinions, conclusions, or personal feelings or make judgments about patients. Also, do not use vague words that can mean different things to different people (e.g., better, worse, withdrawn, confused, appears to, apparently, seems). ● Use words that describe the patient’s actions. Record only what you see, hear, feel, or smell, what you do for the patient, and how the patient responds. State only the facts, and quote the patient. Do not draw conclusions. Legibility ● Illegible writing reduces credibility and arouses suspicion; it implies careless, rushed efforts. Unclear writing is a reflection of unclear thinking. Thoroughness ● Do not leave any blank spaces in the record; if you do not complete a page, draw a large line through the unused space. Be sure to complete any blocks provided to reduce the risk of an addition being made later that could change the information. Use checklists, grids, and flowsheets with caution. ● Mark with your initials rather than check marks to reduce the risk that entries made by others will be taken as yours. Accuracy ● Make sure that all documentation matches billing, attendance grids, and other reports. Inaccurate transferal of dates and numbers reduces credibility and could result in reimbursement and legal problems. ● Use correct spelling and grammar. ● Use abbreviations that are consistent within a work setting and that have a single meaning. Meaningfulness ● Do not write for the sake of writing something. If an item doesn’t mean anything or doesn’t contribute to the information about the patient, don’t waste time writing it down Professional Courtesy ● Do not use the medical record for complaints, criticism, or arguments with other health care team members. Authenticity ● Write your own notes; do not sign someone else’s notes. Co-signing notes arouses suspicion; only the person who provides the service can write the note. Decision-Making Process ● Make sure the documentation reflects the ways patient progress and interventions are linked to examination data and evaluation. ● Document the patient’s response to treatment, as well as modifications of care based on that response. First-line managers in physical therapy may be assigned direct patient care tasks in addition to financial, operations, human resource, and information responsibilities. Their duties include budgeting; hiring, firing, and evaluating staff members; and ensuring that the organization meets accreditation, certification, and other legal requirements. Budgeting is the process of making decisions about revenue and expenses to ensure that funds are available to meet the goals of the organization. A first-line manager may be asked to contribute to this decision-making process, which may occur annually, biannually, or even at 5-year intervals • • First-level managers are responsible for capital equipment decisions Typically, equipment is considered a capital investment at some predetermined cost (e.g., over $1000). Because funds for capital investment frequently are limited, managers often must submit a cost/benefit analysis to determine the potential gain in meeting the organization’s goals • • • The human resource responsibilities of first-line managers include the hiring, firing, and evaluation of staff members In large organizations human resource experts assist in the management of many of these employment factors. However, the first-line manager may have some control over salary negotiations and a great deal of responsibility for assignment and scheduling of staff members, payroll reporting, and evaluation of performance, which usually is linked to salary increases A major responsibility of the first-line manager is training staff members in correct documentation and supervising all record keeping • • • • The APTA’s Code of Ethics rarely refers to the administrative role of the physical therapist. Principle 3 states, “A physical therapist shall comply with laws and regulations governing physical therapy and shall strive to effect changes that benefit patients/clients.” In the APTA’s Guide for Professional Conduct (GPC), addresses direction and supervision, stating that the supervising PT “has primary responsibility for the physical therapy services rendered” “a physical therapist shall never place his/her own financial interest above the welfare of individuals under his/her care” THANKS!
