Witnessing Questionable Practices as a PT Tech

[redtegu]

I am a tech at an outpatient ortho clinic and am witnessing some questionable practices there. Some things may be illegal while others just seem unfair to patients. As practicing PTs, I would like your opinion on these things...is it the norm?

75 patients per day spread over 4 PTs (9 hour day), double or triple bookings per hour is normal.
6 techs

Techs are occasionally asked to perform massages. The patient is billed for this. Techs are not licensed MTs...in fact we have no training whatsoever on massage!

At least 50% of patients only work with a tech and have no interaction with their PT. This means the tech does the ultrasound, e-stim, and runs them through all thera ex. This has gotten to the point where some of our elderly patients actually think techs are PTs...

Medicare/worker's comp patients sometimes work with techs only. (Not allowed in TX?)

I feel a lot of patients are being cheated...but maybe this is the norm when a clinic is trying to keep up it's productivity. It just doesn't seem right to me.

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[goyo1010]

I don't doubt there are facilities like this out there, where unethical practices are condoned. However, I have been lucky enough to not have experienced something like this myself. The outpatient clinics where I have observed do not hire physical therapy technicians or PTAs at all, as they want to provide the best PT/patient care possible, as they told me after I had asked them if they employed any PTAs or techs. They do accept volunteers though to help clean tables, laundry, ready machines and equipment, etc.

I, too, would like to hear from any PTs, SPTs, PTAs, etc if they have had any experience with these types of situations, and what they did? I personally, would not want to work in that sort of environment.

 

[atstudent]

I don't doubt there are facilities like this out there, where unethical practices are condoned. However, I have been lucky enough to not have experienced something like this myself. The outpatient clinics where I have observed do not hire physical therapy technicians or PTAs at all, as they want to provide the best PT/patient care possible, as they told me after I had asked them if they employed any PTAs or techs. They do accept volunteers though to help clean tables, laundry, ready machines and equipment, etc.

In other words, they save money by using what amounts to slave labor instead of paying somebody. For "best patient care." Do they also have volunteers to handle the scheduling and the insurance too?

 

[CherokeeWahine]

I am a tech at an outpatient ortho clinic and am witnessing some questionable practices there. Some things may be illegal while others just seem unfair to patients. As practicing PTs, I would like your opinion on these things...is it the norm?

75 patients per day spread over 4 PTs (9 hour day), double or triple bookings per hour is normal.
6 techs

Techs are occasionally asked to perform massages. The patient is billed for this. Techs are not licensed MTs...in fact we have no training whatsoever on massage!

At least 50% of patients only work with a tech and have no interaction with their PT. This means the tech does the ultrasound, e-stim, and runs them through all thera ex. This has gotten to the point where some of our elderly patients actually think techs are PTs...

Medicare/worker's comp patients sometimes work with techs only. (Not allowed in TX?)

I feel a lot of patients are being cheated...but maybe this is the norm when a clinic is trying to keep up it's productivity. It just doesn't seem right to me.

Geez. This sounds just like the clinic I work at... We have anywhere from 85-90 patients per day (3 therapists, 2 PTAs, 2 ATCs, 4 aides). Therapists are ALWAYS double booked (even during initial evals), occasionally triple booked.

The ATCs have own patient load and they are acting as PTs and billing as such (which is illegal in CA, where ATCs are recognized as PT aides in a PT setting). Some therapists handle their own patients, but there have been a plethora of situations where the aide was essentially treating the patient (ultrasound, soft tissue mobilization, therex, stim, etc.) with NO input/supervision from the therapist.

They have Blue Cross patients work only with techs (because apparently Blue Cross's reimbursement stinks). And they'll have aides do modalities for Medicare patients (which cannot be billed for if an aide does it), yet they'll bill for it anyway and say that a PTA did it.

I feel the same way you do that it cheats the patients.

 

[TooCool]

http://www.apta.org/Policies/Updates/2011FAQ/

Seems like that is going into effect earlier than it's supposed to be

 

[redtegu]

Cherokee, that is crazy! ATCs billing as PTs. This whole experience of working in a shady clinic has at least enlightened me to the kind of setting I DONT want to find myself in after PT school...

And TooCool, thanks for the link. I am glad that they have set up a task force to address these types of issues.

 

[goyo1010]

In other words, they save money by using what amounts to slave labor instead of paying somebody. For "best patient care." Do they also have volunteers to handle the scheduling and the insurance too?

I don't know how you got that, but no. They accept only one volunteer at a time, so what you're assuming is way out there. The 6 or so PTs and OTs there basically do all the work. And they hire a staff for scheduling and insurance. Looks like somebody isn't very happy this holiday season, atstudent.

 

[redtegu]

Having volunteers isn't such a bad thing, I wouldn't consider it slave labor since it is voluntary, after all. And for most pre-PT students, volunteering is one of the few ways to get their foot in the door and observe. Sure, you do grunt work like folding laundry or wiping mats, but you also get to watch PTs work one-on-one with patients and look at the profession from the inside out.

 

[CherokeeWahine]

Having volunteers isn't such a bad thing, I wouldn't consider it slave labor since it is voluntary, after all. And for most pre-PT students, volunteering is one of the few ways to get their foot in the door and observe. Sure, you do grunt work like folding laundry or wiping mats, but you also get to watch PTs work one-on-one with patients and look at the profession from the inside out.

Only problem with volunteering at the clinic where I work is that they keep the volunteers so busy doing grunt work that they don't have time to observe the PTs.

Definitely NOT the way I want to run a clinic someday if I'm blessed to have one of my own.

 

[atstudent]

Having volunteers isn't such a bad thing, I wouldn't consider it slave labor since it is voluntary, after all.

I guess you could call it voluntary unless of course you remember that pre-PT students HAVE to do a certain amount of it...


And actually I'm quite content at the moment because I work for a PT who recognizes that athletic trainers and PTAs are quite capable of providing excellent care alongside PTs. That's why he sends all of us to continuing education such as Graston Technique and not only the PT staff.

 

[Sheldon]

To the OP,

I had the misfortune of working in a sub-acute/LTAC unit with emphasis on s/p total joint replacement, MVA, TBI, and SCI. I encountered the same type of occurrences there as you are. For example, techs running group therapy, techs running pool therapy, techs treating and changing POC, pretty much techs doing what they wanted with full endorsement of most of the PT/OT staff. Another PT (not my CI) and myself presented an in-service on the state PT/OT practice acts and CMS rules and regulations in an attempt to change the practice patterns of the majority of PTs and OTs in the facility in order to put a stop to the illegal and unethical billing practices. Nothing changed. We documented specific instances and still nothing changed. We reported that facility. They lost millions of dollars.

Long story short: attempt to change the practice environment if you can and if you are sure what is happening is illegal. Document what you see. Get out of there.