PT vs DPT vs PTA reimbursement

[NewDPT31]

Am I the only one who thinks its ridiculous that a treatment provided by a PTA is reimbursed the same as a PT or DPT? I think it's crazy a PTA(2 yrs community college) can make 60k in SNF and I make 71(7 years real college). My responsibilities are so much greater. If they want to really reward education, and place a monetary value on education(which the APTA seems to think is the greatest thing since sliced bread) I propose the follwoing(and this also applies to OT vs COTA.
PTA- decrease reimbursement by 25%
Bachelor PT(or OT)-same reimbursement as now
DPT(or Masters OT)-increase reimbursement by 25%

Note that the company or hospital can choose how to spend the money, so a PT with 30 yrs experience isnt inferior to a new DPT. This just levels out the playing field for DPTs vs PTAs. There are studies which show PTA takes longer to get patient back to full strength than a PT. This is not a hate-fest against PTAs. I love the ones I work with but ultimately I am responsible for what they do, and oftentimes I have to correct what they are doing because I know more efficient exercises/treatments.
Thoughts?

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[facetguy]

Am I the only one who thinks its ridiculous that a treatment provided by a PTA is reimbursed the same as a PT or DPT? I think it's crazy a PTA(2 yrs community college) can make 60k in SNF and I make 71(7 years real college). My responsibilities are so much greater. If they want to really reward education, and place a monetary value on education(which the APTA seems to think is the greatest thing since sliced bread) I propose the follwoing(and this also applies to OT vs COTA.
PTA- decrease reimbursement by 25%
Bachelor PT(or OT)-same reimbursement as now
DPT(or Masters OT)-increase reimbursement by 25%

Note that the company or hospital can choose how to spend the money, so a PT with 30 yrs experience isnt inferior to a new DPT. This just levels out the playing field for DPTs vs PTAs. There are studies which show PTA takes longer to get patient back to full strength than a PT. This is not a hate-fest against PTAs. I love the ones I work with but ultimately I am responsible for what they do, and oftentimes I have to correct what they are doing because I know more efficient exercises/treatments.
Thoughts?

Are there data showing DPTs have better outcomes than PTs? Aside from helping pay back higher student loans, why should DPTs get a 25% increased reimbursement? That seems unlikely, especially in today's healthcare climate.

 

[Fiveoboy11]

Clinicians with higher training should be rewarded so I agree with a lot of your post. It is inappropriate for a PTAs services to be reimbursed at the same rate as a PT's. I don't think a BSPT vs MSPT/DPT reimbursement rate would ever be advocated by the APTA. Would insurance companies initiate a better reimbursement rate for MSPT/DPT vs BSPT? Probably not, because they don't have to, and the APTA would oppose it. Physical therapy clinic owners including hospitals, SNF's, inpt rehab all obviously would oppose a lower rate for PTA's.

This is definitely a difficult topic but it would be nice to see better reimbursement for PT's who practice evidence informed PT, have a lower than average episode of care, and have better outcomes.

 

[Fiveoboy11]

Are there data showing DPTs have better outcomes than PTs? Aside from helping pay back higher student loans, why should DPTs get a 25% increased reimbursement? That seems unlikely, especially in today's healthcare climate.

I don't know of a single study to compare. An appropriate study would be to try and make everything else equal and then compare. For example, wouldn't it make sense to compare a BSPT vs a MSPT/DPT with the same level of experience? Versus a BSPT with 20 years of experience to a DPT with 2 years of experience. That would obviously be some type of retrospective study. But, I have no doubt that my outcomes are better now (4 years of experience DPT) than the average PT grad 30 years ago with 4 years of experience.

 

[facetguy]

Clinicians with higher training should be rewarded so I agree with a lot of your post. It is inappropriate for a PTAs services to be reimbursed at the same rate as a PT's. I don't think a BSPT vs MSPT/DPT reimbursement rate would ever be advocated by the APTA. Would insurance companies initiate a better reimbursement rate for MSPT/DPT vs BSPT? Probably not, because they don't have to, and the APTA would oppose it. Physical therapy clinic owners including hospitals, SNF's, inpt rehab all obviously would oppose a lower rate for PTA's.

This is definitely a difficult topic but it would be nice to see better reimbursement for PT's who practice evidence informed PT, have a lower than average episode of care, and have better outcomes.

It seems reasonable that PTAs would be reimbursed at a lower rate than PT/DPTs. (Are PTAs really reimbursed at the same rate as PT/DPT now?)

But unless somehow DPTs are getting better outcomes than PTs (which I don't know for sure but strongly doubt), having paid more for one's education shouldn't be a reason for higher reimbursement. And of course there's the issue of whether a newly minted DPT is as good a clinician as a PT with 20 years experience.

 

[atstudent]

But, I have no doubt that my outcomes are better now (4 years of experience DPT) than the average PT grad 30 years ago with 4 years of experience.

The world has changed a lot in 30 years! I was going through stuff in our office the other day and found ACL post-op instructions. In it, it talked about being kept in the hospital for 1-2 days after surgery.. how often does that happen today???

Your comparison wouldn't work very well...

 

[facetguy]

I don't know of a single study to compare. An appropriate study would be to try and make everything else equal and then compare. For example, wouldn't it make sense to compare a BSPT vs a MSPT/DPT with the same level of experience? Versus a BSPT with 20 years of experience to a DPT with 2 years of experience. That would obviously be some type of retrospective study. But, I have no doubt that my outcomes are better now (4 years of experience DPT) than the average PT grad 30 years ago with 4 years of experience.

But are they better than an MSPT with 4 years experience?

Don't get me wrong, I'm all for furthering one's education. But when it comes to reimbursement, I fail to see why an insurance company would be willing to pay a DPT more than a PT just because.

It would be interesting to see how things would work out in a cash-based system. Would patients be willing to pay a DPT more than they would a PT if the patient was pulling cash out of his own pocket to pay for services? I would say no.

 

[Fiveoboy11]

It seems reasonable that PTAs would be reimbursed at a lower rate than PT/DPTs. (Are PTAs really reimbursed at the same rate as PT/DPT now?)

But unless somehow DPTs are getting better outcomes than PTs (which I don't know for sure but strongly doubt), having paid more for one's education shouldn't be a reason for higher reimbursement. And of course there's the issue of whether a newly minted DPT is as good a clinician as a PT with 20 years experience.

Bottom line, PT's who practice evidence informed PT have better outcomes. Unless an older PT with a BS has kept up to date, they are not practicing evidence informed PT. If you don't practice evidence informed PT, you have poor outcomes and any perceived benefit is probably due to placebo. DPT's have far better baseline education in this respect vs a BSPT. Many DPT's are being trained in "clinicals" and "internships" by PT's who don't know and aren't educated in evidence informed PT. Thus, we're still getting PT's nowadays practicing idiotic PT.

Put the average DPT new grad up against the average BSPT new grad and I think the results would be comical. It's like comparing a foreign trained MD orthopod recent residency grad trained in the early 1980's to a US MD ortho ortho residency grad in 2010. Is the MD from 2010 better now? No. Is he/she better than the 1980's grad was at same time in career? Yes.

 

[facetguy]

Bottom line, PT's who practice evidence informed PT have better outcomes. Unless an older PT with a BS has kept up to date, they are not practicing evidence informed PT. If you don't practice evidence informed PT, you have poor outcomes and any perceived benefit is probably due to placebo. DPT's have far better baseline education in this respect vs a BSPT. Many DPT's are being trained in "clinicals" and "internships" by PT's who don't know and aren't educated in evidence informed PT. Thus, we're still getting PT's nowadays practicing idiotic PT.

Put the average DPT new grad up against the average BSPT new grad and I think the results would be comical. It's like comparing a foreign trained MD orthopod recent residency grad trained in the early 1980's to a US MD ortho ortho residency grad in 2010. Is the MD from 2010 better now? No. Is he/she better than the 1980's grad was at same time in career? Yes.

In principle, I agree. But don't discount the value of experience. My opinion regarding insurance reimbursement remains the same: no special entitlements for DPTs just because they spent an extra year in school.

 

[elmcd77]

I agree with the PT/DPT thing. It would be hard to come out with evidence as such. Also, I agree with what several posters have said about experience. Just because someone came out with a bachelor's and was not originally taught evidence based clinical skills does not mean they have not learned that now. Think about some of the professors in PT school. Many of mine are "just" bachelor degree pt's who don't practice anymore, but do have their PhD's and are amazing professors. Therefore, I agree this would be hard to quantify, and I would feel uneasy when I graduate making more than someone who has been in the field, seeing success for 20 or 30 years.

On the other hand, the PTA/PT thing is ridiculous. I equate this to MD's and PA's being paid the same reimbursement, or MD's and nurses. However, as a result of this, when I need a simple prescription for cough medicine or something simple where I am fairly certain of my own diagnosis, I seek out a PA or NP to give me treatment because I have a high deductible and they treat just as well for fairly basic stuff. Would I want them investigating lets say, a strange rash on my body that appeared for no reason? Probably not. I guess my point here is, yes, we as PT's should be reimbursed more, but then we'd also have to prepare for patient's preference for a PTA given a straightforward injury or circumstance.

 

[Fiveoboy11]

I agree with the PT/DPT thing. It would be hard to come out with evidence as such. Also, I agree with what several posters have said about experience. Just because someone came out with a bachelor's and was not originally taught evidence based clinical skills does not mean they have not learned that now. No, but it means they are less likely to have. Think about some of the professors in PT school. Agreed, but they have had much more education post BS. Many of mine are "just" bachelor degree pt's who don't practice anymore, but do have their PhD's and are amazing professors. Therefore, I agree this would be hard to quantify, and I would feel uneasy when I graduate making more than someone who has been in the field, seeing success for 20 or 30 years. I don't think I should make more than someone with 30 years experience. I do think I should make more than someone with a BS who has the same experience though, i.e. foreign trained or someone who hasn't been practicing for 10 years.

On the other hand, the PTA/PT thing is ridiculous. I equate this to MD's and PA's being paid the same reimbursement, or MD's and nurses. However, as a result of this, when I need a simple prescription for cough medicine or something simple where I am fairly certain of my own diagnosis, I seek out a PA or NP to give me treatment because I have a high deductible and they treat just as well for fairly basic stuff. Would I want them investigating lets say, a strange rash on my body that appeared for no reason? Probably not. I guess my point here is, yes, we as PT's should be reimbursed more, but then we'd also have to prepare for patient's preference for a PTA given a straightforward injury or circumstance. Good point. But, if you ask me PTA is not to PT as PA is to MD/DO.

See above

 

[Fiveoboy11]

But are they better than an MSPT with 4 years experience?

If you control for all other factors, then yes. For example, if you take the exact same person and put them through the best MSPT program in the nation when the MSPT was most typical vs putting them through the best DPT program in the nation now. Then compare that person with the same exact experience. In my opinion, it's pretty obvious.

Comparing degrees with other differing factors, i.e. experience, etc confounds it way too much. I don't see how anyone could argue with above.

PT education is getting better. There is more literature/research to teach, better and updated books. How in the world would anyone expect the same clinician considering above? I'm talking on average. There are outliers of course. As I've said before, the best PT's in the world likely have a BSPT baseline, but they also likely have FAAOMPT after their name.

 

[PTisfun]

It seems reasonable that PTAs would be reimbursed at a lower rate than PT/DPTs. (Are PTAs really reimbursed at the same rate as PT/DPT now?)

Sure they are. And typically anyone else who bills for the same procedure (ther ex, manual therapy, e stim) gets reimbursed the same amount. So a nurse in a physician's office who does ther ex.....reimbursed the same amount as a PT. A tech in a PT clinic...same amount. Clinics negotiate with insurance companies for reimbursed amount...there may be some differences in clinic x and clinic y in reimbursement with insurance company a, but all pretty similar. The only code PTs 'own' (that no one else can bill is PT Evaluation.

 

[jesspt]

Am I the only one who thinks its ridiculous that a treatment provided by a PTA is reimbursed the same as a PT or DPT? I think it's crazy a PTA(2 yrs community college) can make 60k in SNF and I make 71(7 years real college). My responsibilities are so much greater. If they want to really reward education, (Who are they, and why would they want to reward education?) and place a monetary value on education(which the APTA seems to think is the greatest thing since sliced bread) I propose the follwoing(and this also applies to OT vs COTA.
PTA- decrease reimbursement by 25%
Bachelor PT(or OT)-same reimbursement as now
DPT(or Masters OT)-increase reimbursement by 25%

Note that the company or hospital can choose how to spend the money, so a PT with 30 yrs experience isnt inferior to a new DPT. (Not sure how a hospital. base on the reimbursement you proposed, is incentivized at all to employ anyone other than a DPT, regardless of the outcomes they achieve). This just levels out the playing field for DPTs vs PTAs. There are studies which show PTA takes longer to get patient back to full strength than a PT. (Reference please) This is not a hate-fest against PTAs. I love the ones I work with but ultimately I am responsible for what they do, and oftentimes I have to correct what they are doing because I know more efficient exercises/treatments. (If you are responsible for what they do, and also responsible for the patient's outcome, and you supposedly know more efficient exercises/treatments, then why are you delegating the patient's care?)
Thoughts?

In case you're wondering, my thoughts are that your idea is short sighted and foolhardy.

 

[jesspt]

Clinicians with higher training should be rewarded so I agree with a lot of your post. It is inappropriate for a PTAs services to be reimbursed at the same rate as a PT's. I don't think a BSPT vs MSPT/DPT reimbursement rate would ever be advocated by the APTA. Would insurance companies initiate a better reimbursement rate for MSPT/DPT vs BSPT? Probably not, because they don't have to, and the APTA would oppose it. Physical therapy clinic owners including hospitals, SNF's, inpt rehab all obviously would oppose a lower rate for PTA's.

This is definitely a difficult topic but it would be nice to see better reimbursement for PT's who practice evidence informed PT, have a lower than average episode of care, and have better outcomes.

You're discussing two different things - level of training (which may not have to do with the PTs initial degree) and evidence-informed practice, which does not depend on the level of degree obtained. At all.

 

[jesspt]

I don't know of a single study to compare. An appropriate study would be to try and make everything else equal and then compare. For example, wouldn't it make sense to compare a BSPT vs a MSPT/DPT with the same level of experience? Versus a BSPT with 20 years of experience to a DPT with 2 years of experience. That would obviously be some type of retrospective study. But, I have no doubt that my outcomes are better now (4 years of experience DPT) than the average PT grad 30 years ago with 4 years of experience.

Do I really need to outline the flaws with this proposed study?

Of course your outcomes are better now, becuase you have the benefit of many more years of PT research that influence your clinical decision making compared to a PT who graduated with a bachelor's degrees in 1982. If we use your example, that PT's outcomes, using evidence that was available in 1986, should be compared to your outcomes in 2012. That's just silly.

 

[Fiveoboy11]

You're discussing two different things - level of training (which may not have to do with the PTs initial degree) and evidence-informed practice, which does not depend on the level of degree obtained. At all.

Level of training may not have to do with the PT's initial degree. Funny. I have about 300 combined credits from undergrad (B.S. human bio, exercise science) and a DPT. I'm so sure the average BSPT's level of training is close to that As mentioned, I have a B.S., it's not even close to a clinical doctorate in level of difficulty. Grad school vs undergrad. Get serious.

 

[jesspt]

It seems reasonable that PTAs would be reimbursed at a lower rate than PT/DPTs. (Are PTAs really reimbursed at the same rate as PT/DPT now?)

But unless somehow DPTs are getting better outcomes than PTs (which I don't know for sure but strongly doubt), having paid more for one's education shouldn't be a reason for higher reimbursement. And of course there's the issue of whether a newly minted DPT is as good a clinician as a PT with 20 years experience.

Why is that reasonable? Should a sub-acromial injection administered by a PA who practices in an orthopedic surgeon's office be reimbursed at a lower rate than one administered by a primary care physician? Of course not, because we should be reimbursed based on the knowledge and clinical reasoning that we are able to provide, which should lead to better outcomes. Not based on how long we were in school, or how much we paid for our degree.

PT is a profession that is, or at least should be owned by physical therapists. That means that I, as a physical therapist (DPT, MSPT, or BSPT be damned) am responsible for using science, evidence, and clinical reasoning to provide the best care for my patients. I, as the physical therapist, am responsible for my patients' outcomes. Which means, that I don't delgate any of their care unless I am certain that who am delegating their care to can provide an adequate level of service to obtain the best outcome. I, as a PT with a Master's degree, am no different than a BSPT or a DPT. If the OP, with a DPT, isn't sure that the PTA to whom he/she is delegating care can carry out the treatment plan and obtain the predicted outcome, then he/she shouldn't be delegating it to them.

 

[Fiveoboy11]

Do I really need to outline the flaws with this proposed study?

Of course your outcomes are better now, becuase you have the benefit of many more years of PT research that influence your clinical decision making compared to a PT who graduated with a bachelor's degrees in 1982. If we use your example, that PT's outcomes, using evidence that was available in 1986, should be compared to your outcomes in 2012. That's just silly.

That's right. The knowledge base of PT now is far more than it was back then. So, everyone needs to stop implying that the baseline education was just as good. A BSPT with 20 years of experience vs a novice DPT is a lame study, but I would be surprised if there was a significant difference in outcomes in that scenario in favor of an experienced BSPT.

 

[jesspt]

Bottom line, PT's who practice evidence informed PT have better outcomes. (Which has nothing to do with the degree a PT may have obtained in order to sit for the NPTE and obtain a license to practice physical therapy). Unless an older PT with a BS has kept up to date, they are not practicing evidence informed PT. (The same can be said for any PT, regardless of the degree they have obtained). If you don't practice evidence informed PT, you have poor outcomes and any perceived benefit is probably due to placebo. DPT's have far better baseline education in this respect vs a BSPT. Many DPT's are being trained in "clinicals" and "internships" by PT's who don't know and aren't educated in evidence informed PT. Thus, we're still getting PT's nowadays practicing idiotic PT. (But, if their baseline education is so superior, as you suggest, then why would they ever sink so low as to practice idiotic PT just because a clinical instructor who may or may not be have been a BSPT might have suggested practice patterns that are inconsistent with what you consider to be evidence informed PT?)

Put the average DPT new grad up against the average BSPT new grad and I think the results would be comical. It's like comparing a foreign trained MD orthopod recent residency grad trained in the early 1980's to a US MD ortho ortho residency grad in 2010. Is the MD from 2010 better now? No. Is he/she better than the 1980's grad was at same time in career? Yes.

You would think they would be comical. We have no good data to suggest that what you say is indeed true.

 

[jesspt]

Level of training may not have to do with the PT's initial degree. Funny. I have about 300 combined credits from undergrad (B.S. human bio, exercise science) and a DPT. I'm so sure the average BSPT's level of training is close to that As mentioned, I have a B.S., it's not even close to a clinical doctorate in level of difficulty. Grad school vs undergrad. Get serious.

Perhaps the large number of credits just indicates that your initial application to PT schools was unimpressive enough to require you to obtain more to boost your resume. (For the record, I'm not suggesting that this is true). 300 is just a number, and can be interpreted in many ways.

 

[Fiveoboy11]

You would think they would be comical. We have no good data to suggest that what you say is indeed true.

So, current DPT programs are no better preparing PT's than BSPT programs in 1980 ay? Yea, sure thing

If the degree never changed I would still say that today's PT's are better trained, because that would be reality. Add to that the B.S. and more rigorous coursework, far more evidence, etc.

 

[jesspt]

http://www.northendphysicaltherapy.com/craniosacral.html

Uh oh, this guy is a DPT. And a craniosacral practitioner. Obviously just an N of one, but he's not the only one. Should he get a 25% increase in reimbursement for his treatments just because he has a DPT?

 

[Fiveoboy11]

Perhaps the large number of credits just indicates that your initial application to PT schools was unimpressive enough to require you to obtain more to boost your resume. (For the record, I'm not suggesting that this is true). 300 is just a number, and can be interpreted in many ways.

I had a 3.32, undergrad in 3 1/2 years. My PT school was 171 credits. 135 from undergrad.

http://www.atsu.edu/ashs/programs/physical_therapy/documents/PTCurriculumOverview.pdf

I suppose the ortho classes I had in PT school with a fellow were about equal to the 1950's trained certificate holder in PT and ultrasound studies that BSPT's were taught by....

 

[jesspt]

And, in case anyone ias wondering how this proposal would likely turn out in the real world, here's my take if DPTs were to be granted increased reimbursement.

Insurance companies increase reimbursement for DPTs and decrease it for PTAs. Then they ask for data supporting superior outcomes for patient treated by DPTs. When it isn't produced (because we don't have any) they cut everybody's reimbursement down to the PTA level.

Be careful what you wish for - you may get it.

 

[jesspt]

I had a 3.32, undergrad in 3 1/2 years. My PT school was 171 credits. 135 from undergrad.

http://www.atsu.edu/ashs/programs/physical_therapy/documents/PTCurriculumOverview.pdf

I suppose the ortho classes I had in PT school with a fellow were about equal to the 1950's trained certificate holder in PT and ultrasound studies that BSPT's were taught by....

Was the fellow a proponent of the biomechanical model, including palpatory diagnosis? We know the poor foundation on which that type of assessment is based. And, it has been around since the 1950s-1960s. I believe that AT Still university was founded on osteopathic principles, which have shown to be flawed in several studies. I know that you've read some analysis by Huijbregts - I've attached on of my favorites.

 

[Fiveoboy11]

http://www.northendphysicaltherapy.com/craniosacral.html

Uh oh, this guy is a DPT. And a craniosacral practitioner. Obviously just an N of one, but he's not the only one. Should he get a 25% increase in reimbursement for his treatments just because he has a DPT?

http://www.amazon.com/CranioSacral-...6955/ref=sr_1_2?ie=UTF8&qid=1339561817&sr=8-2

Here's a popular book on Amazon "Craniosacral Therapy: what it is and how it works

by
John E Upledger, DO
Donald Ash, PT -- super well educated http://www.donashpt.com/ash/index.php
Richard Grossinger, PhD
Dan Cohen, MD

 

[Fiveoboy11]

Was the fellow a proponent of the biomechanical model, including palpatory diagnosis? We know the poor foundation on which that type of assessment is based. And, it has been around since the 1950s-1960s. I believe that AT Still university was founded on osteopathic principles, which have shown to be flawed in several studies. I know that you've read some analysis by Huijbregts - I've attached on of my favorites.

No, she based her instruction off a book by this guy called Dutton. Ever heard of him? It's one of those books with thousands of references. Oh and by the way AT Still was just credentialed with a orthopedic residency by the APTA, headed by the fellow that taught me.

http://www.atsu.edu/ashs/programs/orthopedic_residency/index.htm

 

[jesspt]

And, I've attached another study that has made the rounds here on SDN. It indicates that board certified PTs have the greatest amount of knowledge regarding management of musculoskeletal conditions. Perhaps they should get paid the most, even if they have a BSPT. Or maybe, we should get paid based on how many letters we have behind our names. That would seem to have as much validity as the entry-level degree obtained.

 

[jesspt]

http://www.amazon.com/CranioSacral-...6955/ref=sr_1_2?ie=UTF8&qid=1339561817&sr=8-2

Here's a popular book on Amazon "Craniosacral Therapy: what it is and how it works

by
John E Upledger, DO
Donald Ash, PT -- super well educated http://www.donashpt.com/ash/index.php
Richard Grossinger, PhD
Dan Cohen, MD

This doesn't help your argument - it just shows that practitioners with degrees above and beyond DPT can still fall prey to practice well outside of what is supported by science.

 

[jesspt]

No, she based her instruction off a book by this guy called Dutton. Ever heard of him? It's one of those books with thousands of references. Oh and by the way AT Still was just credentialed with a orthopedic residency by the APTA, headed by the fellow that taught me.

http://www.atsu.edu/ashs/programs/orthopedic_residency/index.htm

Doesn't mean that it is based on sound science. The institue of Physical Art has an accredited manual therapy fellowship after all...

 

[jesspt]

As an aside, I gotta say - this is the most fun I've had on this forum in ages...

 

[Fiveoboy11]

Doesn't mean that it is based on sound science. The institue of Physical Art has an accredited manual therapy fellowship after all...

Yea, hell we my as well go back to WWI and learn from the experts in physical therapy. Forget all this grad school crap and development of evidence and residencies to teach.

After all, there's absolutely no evidence that a DPT is better...

 

[Fiveoboy11]

As an aside, I gotta say - this is the most fun I've had on this forum in ages...

Yea me too, but I have to get to bed and rest up to compete with all the BSPT's. Think I might take a beta blocker so I don't get intimidated. Peace out homie

 

[NewDPT31]

Wow. Probably one of the greatest groups of overreactions ever collected.
And everything was twisted and turned so many times it felt like I was watching Hannity or Olbermann.

First off, this was never really a legitimate proposal. Was it foolhardy and short-sighted? Yeah...Yeah I could go with that. I understand the politics and that it would never fly, or just end up in cheapening the treatment reimbursements overall. It's a slippery slope because we don't want to give up any ground that we are holding now as far as reimbursement for PT is concerned.

Second-This was never an attack on BSPTs, or hell...even PTAs. Ive got no beef with other PTs. I consider it more like a fraternity of sorts. If you go back to the original-make it +.25 for BSPT and MSPT and DPT for all I care and -.25 for PTA. Do I wish I couldve went to school when they went and it cost 6k/a year for tuition and 4 years? HELL YEAH! But I at least consider them to be independent and educated therapists who don't need supervision. And yes I agree that those certified in say ortho or manual should get paid more, regardless of school degree(and they do!)

Third-The main beef is with the excessive use of PTAs and Aides. Lets take SNF for example. I'm a PT and I have my own caseload of 8-10 people, and each of the 2 PTAs has 8-10 people. Do I know about each patient(evaled, every 10 visit seen by me) and have set a general plan of care? Yeah. Is it realistic for me to delegate each day to each PTA about what they should do specifically with each patient that day? God no. Its just not practical. And when you do your weekly check of each patient and what they have been doing, you find they have been getting tons of god-forsaken diathermy because"a vendor came in with an article that said it works". (before the vultures attack...yes, i know...this isn't every PTA!!!) I've seen in several clinics that, especially with the younger PTAs(19-21 years old)...they are all about "using their judgement" and "extending their scope"(especially thinking they are gods coming right out of their education and rotations) until the MD comes asking anything and then all you hear from them is, "oh i dont know, you will have to ask the PT."
Its one of those"Why did I go to school 7 years and take out mountains of debt(PTAs actually make more than me by a lot after loan payments are made) so that I can be responsible for everything that happens to the patient, do more paperwork, and ultimately get the same level of respect as someone who went to a community college for 2 years @5k a year?"(disclaimer: I'm biased. I'm the former)
Again-I'm not saying all PTAs are bad or I dislike them or they do terrible work. I'd just like to see a larger pay discrepancy for the different levels of responsibility and education. I know it will never happen and I really didn't think people would go as ape**** crazy as they did, considering this forum is usually packed with people asking about stuff like the ethics of door to door ultrasound use.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1797090/

 

[jesspt]

Wow. Probably one of the greatest groups of overreactions ever collected.
And everything was twisted and turned so many times it felt like I was watching Hannity or Olbermann.

First off, this was never really a legitimate proposal. Was it foolhardy and short-sighted? Yeah...Yeah I could go with that. I understand the politics and that it would never fly, or just end up in cheapening the treatment reimbursements overall. It's a slippery slope because we don't want to give up any ground that we are holding now as far as reimbursement for PT is concerned.

Second-This was never an attack on BSPTs, or hell...even PTAs. Ive got no beef with other PTs. I consider it more like a fraternity of sorts. If you go back to the original-make it +.25 for BSPT and MSPT and DPT for all I care and -.25 for PTA. Do I wish I couldve went to school when they went and it cost 6k/a year for tuition and 4 years? HELL YEAH! But I at least consider them to be independent and educated therapists who don't need supervision. And yes I agree that those certified in say ortho or manual should get paid more, regardless of school degree(and they do!)

Third-The main beef is with the excessive use of PTAs and Aides. Lets take SNF for example. I'm a PT and I have my own caseload of 8-10 people, and each of the 2 PTAs has 8-10 people. Do I know about each patient(evaled, every 10 visit seen by me) and have set a general plan of care? Yeah. Is it realistic for me to delegate each day to each PTA about what they should do specifically with each patient that day? God no. Its just not practical. And when you do your weekly check of each patient and what they have been doing, you find they have been getting tons of god-forsaken diathermy because"a vendor came in with an article that said it works". (before the vultures attack...yes, i know...this isn't every PTA!!!) I've seen in several clinics that, especially with the younger PTAs(19-21 years old)...they are all about "using their judgement" and "extending their scope"(especially thinking they are gods coming right out of their education and rotations) until the MD comes asking anything and then all you hear from them is, "oh i dont know, you will have to ask the PT."
Its one of those"Why did I go to school 7 years and take out mountains of debt(PTAs actually make more than me by a lot after loan payments are made) so that I can be responsible for everything that happens to the patient, do more paperwork, and ultimately get the same level of respect as someone who went to a community college for 2 years @5k a year?"(disclaimer: I'm biased. I'm the former)
Again-I'm not saying all PTAs are bad or I dislike them or they do terrible work. I'd just like to see a larger pay discrepancy for the different levels of responsibility and education. I know it will never happen and I really didn't think people would go as ape**** crazy as they did, considering this forum is usually packed with people asking about stuff like the ethics of door to door ultrasound use.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1797090/

I go a little bit crazy when I see posts like the one that started this thread, becuase they usually haven't looked at the long haul. The thread got sidetracked into a DPT vs BSPT outcomes discussion, and let's be frank - we don't have any real data that suggests there is much difference.

I agree with you about the over utilization of PTAs, particularly in the SNF setting. Here is another reference for you regarding use of PTAs and how it can effect outcomes:

http://www.ncbi.nlm.nih.gov/pubmed/18689610

 

[Fiveoboy11]

This doesn't help your argument - it just shows that practitioners with degrees above and beyond DPT can still fall prey to practice well outside of what is supported by science.

DO/MD/PhD education is "above and beyond the DPT" even if they practice garbage. Nice exception to the rule there and double standard. They can practice whatever they want and they're "above" a DPT, but a DPT is no different than a BSPT and they're the same profession with obvious advancements... Makes so much sense to me now.

 

[goyo1010]

There's some talk about concerning reimbursement. I need to look more into it, but my professors who went to the APTA House of Delegates in Tampa last weekend said there's discussion about changing the way we're reimbursed to better reflect the amount "complexity" or amount of skill that goes into a treatment or whatever. Instead of just billing for a certain service, the amount will depend on how much skill was necessary for a certain treatment. I need to ask them more about it as I am having trouble seeing how treatment skill requirements would be quantified, implications for us and the patient, and that lovely stuff.

And it does kinda suck that there are PTAs who do make almost the same or even more than some physical therapists. I don't necessarily agree in decreasing PTA reimbursement, but I do agree that it would be nice if PTs' were to be increased, if possible. As for essentially delineating between DPTs and BSPTs/MSPTs, not so much do I agree with this. As per APTA's Vision 2020, APTA is aiming to have all PTs become "doctors of physical therapy". Although the PT education now is considerably different than when BSPTs/MSPTs were in school, that does not warrant a higher reimbursement for DPTs at the moment. For one thing, reimbursement would just become more complicated than it already is. Also, there are BSPTs who do continuing education, keeping up with current evidence, taking classes, entering residencies, etc. How would you reimburse them as compared to BSPTs/MSPTs who just do the bare requirements to keep licensed? Also, what about BSPTs/MSPTs who hold PhDs? Obviously, they keep up with current evidence. Would you reimburse them differently, too?

 

[PTisfun]

There's some talk about concerning reimbursement. I need to look more into it, but my professors who went to the APTA House of Delegates in Tampa last weekend said there's discussion about changing the way we're reimbursed to better reflect the amount "complexity" or amount of skill that goes into a treatment or whatever. Instead of just billing for a certain service, the amount will depend on how much skill was necessary for a certain treatment. I need to ask them more about it as I am having trouble seeing how treatment skill requirements would be quantified, implications for us and the patient, and that lovely stuff.

http://www.apta.org/APS/Overview/
Alternative Payment System. It has been being discussed for a while. APTA members were surveyed about it over the winter and spring. the survey results are on the APTA web site, but you have to be a member to view. We had a few good discussions about this with the students over the Spring semester.

 

[goyo1010]

http://www.apta.org/APS/Overview/
Alternative Payment System. It has been being discussed for a while. APTA members were surveyed about it over the winter and spring. the survey results are on the APTA web site, but you have to be a member to view. We had a few good discussions about this with the students over the Spring semester.

Ah, thanks! This is what it was. This will make for some good reading. Good thing I'm an APTA member then.

 

[NewDPT31]

I think you guys did a great job of steering this discussion in a better direction. One of the things that amazes me is the reimbursement for units/codes.
Por Ejemplo(as we say in Arizona)

Therex is reimbursed better per unit than Manual therapy and therapeutic activities.
A large amount of therex gets billed under arm bike, LE bike, and Scifit(nustep, biodex, etc). Is this really more skilled as therex to require a higher reimbursement than skilled, hands on manual therapy or reteaching patients functional things like safe transfers with therapeutic activites? I think when I researched it in Wash State(lived there last year) that therex was like 38/unit, theractivites 34/unit, and manual at 32/unit. Neuro re-ed I think was around 33/unit.

And again, I understand my original argument was hasty and flawed. I love my job, my coworkers and my patients. We HAVE jobs and can get them pretty easily.(unlike, unfortunately, some of my business friends). We have to remember that we are SKILLED professionals, and while our services can be expensive, we need to keep demonstrating that they are helpful and not expendable. Unfortunately with Gov. budget cuts being imminent...hard for us to gain any ground.

Lets keep this going!!!

 

[Fiveoboy11]

Anyone get "Diagnosis for Physical Therapists"? Just came out:

http://www.amazon.com/Diagnosis-Phy...-5&keywords=diagnosis+for+physical+therapists

I got it and was reviewing the authors/contributors and just skimming through. 51/59 are PT, DPT. 0/59 are BSPT alone, very interesting....3 of the others are MD's, and the rest PT, PhD. I just can't figure out why the book isn't filled with BSPT authors.

 

[goyo1010]

Anyone get "Diagnosis for Physical Therapists"? Just came out:

http://www.amazon.com/Diagnosis-Phy...-5&keywords=diagnosis+for+physical+therapists

I got it and was reviewing the authors/contributors and just skimming through. 51/59 are PT, DPT. 0/59 are BSPT alone, very interesting....3 of the others are MD's, and the rest PT, PhD. I just can't figure out why the book isn't filled with BSPT authors.

No, but I have Differential Diagnosis for Physical Therapists by Goodman. She's only a PT with a BSPT and an MBA. She also co-authored the text with Snyder, MN, RN, OCN. The text, however, is not inferior because a BSPT and RN wrote it.

 

[Fiveoboy11]

No, but I have Differential Diagnosis for Physical Therapists by Goodman. She's only a PT with a BSPT and an MBA. She also co-authored the text with Snyder, MN, RN, OCN. The text, however, is not inferior because a BSPT and RN wrote it.

I have that book as well, but the 3rd edition and I saw that it is up to 5th edition now. In my opinion it is not even close. The one I cited has 59 authors and 40 reviewers that are PT's with 3 MD's. The book you're talking about has one PT and one RN as the authors and nobody else.

 

[goyo1010]

I have that book as well, but the 3rd edition and I saw that it is up to 5th edition now. In my opinion it is not even close. The one I cited has 59 authors and 40 reviewers that are PT's with 3 MD's. The book you're talking about has one PT and one RN as the authors and nobody else.

True. However, did you find the Goodman text inadequate? It has received pretty good reviews from PTs, including my professors at TWU. I really can't say which is best, as I don't even own the book that just came out with the first edition you mentioned earlier. Only time will tell if the content presented in it and how it's presented is superior. Unless you're just talking about how many people co-authored and reviewed it.

 

[jesspt]

DO/MD/PhD education is "above and beyond the DPT" even if they practice garbage. Nice exception to the rule there and double standard. They can practice whatever they want and they're "above" a DPT, but a DPT is no different than a BSPT and they're the same profession with obvious advancements... Makes so much sense to me now.

My point during this whole discussion has always been that a practitioner's entry level degree has minimal impact on their ability to practice evidence based care. The book you cited as an example highlights my point, that regardless of the practitioners degree, they can choose to abandon science and practice utter and complete woo.

I used the term "above and beyond" as a reply to your posts where you associate number of credit hours to an increased liklihood to practice in an evidence-informed fashion. Here are those posts:

Level of training may not have to do with the PT's initial degree. Funny. I have about 300 combined credits from undergrad (B.S. human bio, exercise science) and a DPT. I'm so sure the average BSPT's level of training is close to that As mentioned, I have a B.S., it's not even close to a clinical doctorate in level of difficulty. Grad school vs undergrad. Get serious.

and

I had a 3.32, undergrad in 3 1/2 years. My PT school was 171 credits. 135 from undergrad.

http://www.atsu.edu/ashs/programs/ph...umOverview.pdf

I suppose the ortho classes I had in PT school with a fellow were about equal to the 1950's trained certificate holder in PT and ultrasound studies that BSPT's were taught by....

So, the typical MD or DO program will entail a greater number of credits than a typical PT program, yours included. Would it have sounded better if I said "more educated" than a DPT?


You seem to be arguing that "more" is better.

I'm arguing that "better" is better, and that I don't see much of a difference in the entry level degree obtained and a practitioner's ability and/or willingness to commit to science based practice.

 

[Fiveoboy11]

My point during this whole discussion has always been that a practitioner's entry level degree has minimal impact on their ability to practice evidence based care. The book you cited as an example highlights my point, that regardless of the practitioners degree, they can choose to abandon science and practice utter and complete woo. It definitely has an impact on their ability to practice evidence based care. Why? Because students in PT school nowadays are exposed to far more evidence based literature, statistics, research, etc.. I agree with you that a random BSPT vs a random DPT in terms of practice patterns is unknown. BUT, the AVERAGE BSPT vs the average DPT, especially with the same amount of experience would yield practice patterns reflecting their baseline training. Baseline training for a DPT student is far better than a BSPT students was.

I used the term "above and beyond" as a reply to your posts where you associate number of credit hours to an increased liklihood to practice in an evidence-informed fashion. Here are those posts:


That's right, more credit hours in a valid and relevant area definitely yields more LIKLIHOOD of evidence informed practice. No it does not guarantee it in every case, but it makes it far more likely.

and



So, the typical MD or DO program will entail a greater number of credits than a typical PT program, yours included. Would it have sounded better if I said "more educated" than a DPT?

I will concede that MD/DO school graduates are more educated than DPT graduates. Why? Because it is more competitive to get into those schools, thus the AVERAGE student in medical school is higher quality, so the coursework can be made more difficult. Not to mention medicine has far more research and guidelines, history, medical school is longer etc. PLUS they go through residencies in order to practice in a field.


You seem to be arguing that "more" is better.

MORE high quality education is better. Less high quality education is worse. More low quality education is worse as well.

I'm arguing that "better" is better, and that I don't see much of a difference in the entry level degree obtained and a practitioner's ability and/or willingness to commit to science based practice.

I agree that better is better. And DPT school is definitely better than BSPT school was.

 

[Fiveoboy11]

I'm all for it, what does everyone else think?

APTA to Explore Feasibility of Transitioning PTA Education to Bachelor Degree Level

To examine how the physical therapist assistant (PTA) can best support the physical therapist in the current and future health care environment, APTA will collaborate with appropriate stakeholders to conduct a feasibility study to determine whether or not transitioning the entry-level degree for the PTA to a bachelor's degree is indicated. In accordance with the motion adopted by the House of Delegates, the study will identify the following:

• additional/expanded content to be addressed in a 4-year curriculum;
• baccalaureate-level educational models for the entry-level PTA that include a description of the required and elective discipline-specific and liberal arts components of the curriculum;
• a mechanism for PTA programs housed in 2-year institutions to award a baccalaureate PTA degree;
• educational models for PTAs with associate degrees to transition to a bachelor's degree; and
• possible practice act language modifications that could be required as a result of the transition.

A report on the study will be submitted to the 2014 House, with an interim report to the 2013 House. [RC-20]
Draft language adopted by the 2012 House will be available on the House Community next week. Final language for all actions taken by the June 2012 House will be available by September after the minutes have been approved.


http://www.apta.org/PTinMotion/NewsNow/2012/6/15/HODRC20/

 

[Azimuthal]

Wouldn't such a move further the argument for insurance providers to decrease PT reimbursements?

 

[facetguy]

Why is that reasonable? Should a sub-acromial injection administered by a PA who practices in an orthopedic surgeon's office be reimbursed at a lower rate than one administered by a primary care physician? Of course not, because we should be reimbursed based on the knowledge and clinical reasoning that we are able to provide, which should lead to better outcomes. Not based on how long we were in school, or how much we paid for our degree.

I can understand that argument. But as it stands now, I think PAs and NPs are reimbursed a percentage of the physician rate in many instances (I think Medicare pays PAs and NPs at 85% the physician rate). The same is true in accounting, for example, where if my CPA does the work, it bills out at a much higher hourly rate than if his secretary/assistant does it. In legal practice, the senior partner's hourly rate is higher than the new guy's hourly rate. In other words, the person at the top of the food chain commands the higher pay. In similar fashion, the PTA would reasonably be paid at a lower rate than a PT. The added hurdle in healthcare in proving a difference in outcomes, which is why DPTs probably won't get a raise over a MSPT or BSPT.

PT is a profession that is, or at least should be owned by physical therapists. That means that I, as a physical therapist (DPT, MSPT, or BSPT be damned) am responsible for using science, evidence, and clinical reasoning to provide the best care for my patients. I, as the physical therapist, am responsible for my patients' outcomes. Which means, that I don't delgate any of their care unless I am certain that who am delegating their care to can provide an adequate level of service to obtain the best outcome. I, as a PT with a Master's degree, am no different than a BSPT or a DPT. If the OP, with a DPT, isn't sure that the PTA to whom he/she is delegating care can carry out the treatment plan and obtain the predicted outcome, then he/she shouldn't be delegating it to them.

I agree with this and would hope all PTs feel the same way. But 'providing an adequate level of service' and 'being paid the same for that service' are 2 different issues.