Physical Therapy- help me to understand

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Hi. I am one year into my first nursing job in LTC. Can anyone tell me HOW the world of Physical Therapy works in LTC. Keeping in mind I didn't major in Medicare and the World of Reimbursement/Insurance......is there a monetary reason why my facility would "seemingly" (to me) push Physical Therapy on many patients, although they are, say 90 years old and just plain tired (and many ready for Hospice) If you could help me to understand...your comments and insights are appreciated.

I have never been called out for poor nursing ability, nor poor attitude...so thank you very much. Those that deny such things happen are living in fantasy. The are not accusations, sir....those were from a major report regarding fraud. Stop burying your head in the sand. Fraud and abuse happen every day. If you would like a copy of the Governments' prosecution on the matter, I can send you one. Thanks for caring.

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Sam, your accusations toward me are offensive.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

but the therapists were not accused of fraud the facility was....

A Mission Viejo-based nursing-home operator has agreed to pay $48 million to settle allegations that he submitted inflated bills to Medicare for therapy sessions that were unnecessary or never took place, prosecutors said.

The federal settlement agreement with Ensign Group Inc., which operates nursing homes across the West Coast, was unsealed late Monday by a federal judge in Los Angeles.

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Specializes in Pediatrics, Emergency, Trauma.
but the therapists were not accused of fraud the facility was....

This.

Therapy could also have a restoration therapy department, which therapy aides can help with ROM and walking; we have a department at my LTC.

Most long term pts are eligible for State Assistance, which is FAR less than Medicare; but is covered.

On a given shift, I want as MANY of my residents out and about and moving; that is a far more benefit than the $$$.

If anything, your place did a disservice in not discussing MDS, and therapy departments, and the requirement for skilled care for residents.

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Aside from the fact that most SNFs would close yesterday if it weren't for their providing therapy, therapists do plenty of things they can't bill for (meaning they don't get paid for). Evaluating patients for restorative, evaluating patients that have little or not pay source for therapy after falls or other possible changes in condition, helping staff get non-therapy patients out of bed, giving advice for staff on how to maneuver heavy, fragile or otherwise challenging patients, feeding patients when nursing is short staffed, attending care plan meetings, discussing rehab care with family members, and providing therapy that may or may not ultimately be paid for (such as HMO or Medicaid patients).

Above poster brings up two great points about staff education, and the role of the MDS. Therapists should be appreciated for what they do, and staff that don't know what therapy really involved ought to find out.

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Specializes in Short Term/Skilled.

The SNF I worked at would admit pts on the rehab unit, give them as much PT as they could handle and then as soon as their funding ran out they'd be transferred to a LTC unit. What would upset me about this, is sometimes the patients would be paying out of pocket, and they'd be paying much more than they would if they went up the road to the non-profit rehab facility.....they would also pay much more than if they simply went to the LTC side to begin with and were treated over there. Many times I would see a rehab patient become a LTC patient, stay on the rehab unit until their bank accounts were bled dry. Then, they would go over to the LTC unit to have a shared room, with none of the accommodations they had on the "rehab unit".

That being said, the therapists were always wonderful and would say so if they felt the patient wasn't a candidate for therapy. The therapists never had a monetary goal, they were just there to treat the patients in whatever capacity they could tolerate.

It was the facility, not the therapists.

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Specializes in Short Term/Skilled.
Naaw..this is the kind of stuff referring to ...I cut and pasted this ...." The documents also reveal stories of patients, like a "92 year old...dying of metastatic cancer...Two days before [his] death, he was spitting out blood. Therapists, however, still recorded 48 minutes of physical therapy, 47 minutes of Occupational therapy, and 30 minutes of speech therapy that very day."

The other thing is, if therapy is ordered, the therapist has to treat for x amount of hours per day/week. In order to skip the therapy or d/c it they need a doctors order, as you probably know. I know where I was they would even work with the patient in the bed to meet their treatment goals. If that patient were to say, live another month, even a minimal amount of strengthening could have helped him enjoy his quality of life. I've seen terminal patients benefit from therapy many times over. It's not intended to "fix" them. It's just to help with their symptoms, quality of life.

30 min of speech therapy could simply be the patient eating, 45 min of physical therapy can be the patient sitting in the bed getting the knots rubbed out of their muscles. etc.

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The SNF I worked at would admit pts on the rehab unit, give them as much PT as they could handle and then as soon as their funding ran out they'd be transferred to a LTC unit. What would upset me about this, is sometimes the patients would be paying out of pocket, and they'd be paying much more than they would if they went up the road to the non-profit rehab facility.....they would also pay much more than if they simply went to the LTC side to begin with and were treated over there. Many times I would see a rehab patient become a LTC patient, stay on the rehab unit until their bank accounts were bled dry. Then, they would go over to the LTC unit to have a shared room, with none of the accommodations they had on the "rehab unit".

That being said, the therapists were always wonderful and would say so if they felt the patient wasn't a candidate for therapy. The therapists never had a monetary goal, they were just there to treat the patients in whatever capacity they could tolerate.

It was the facility, not the therapists.

If that's your take on your employer, you should not be working there, if for no other reason you claim to admit knowing your employer is robbing it's patients, which makes you complicit by way of cashing your paychecks. You're also guilty of knowingly aiding and abetting kidnapping, and false imprisonment, because you participate in the operation of a SNF that holds its patients hostage by not allowing them to leave to another SNF, or even allowing them the option of remaining in your SNF, which is really what you say goes on there? If I were you I'd report all this stuff to the police, and also to Medicare, the ombudsman, the state, and the FBI- you may be able to claim whistleblower status to avoid prosecution? You may even be able to collect rewards, say from Medicare, for reporting fraud-because your therapy department appears to provide therapy based on ability to pay, rather than skilled need or any other valid reason.

As a CNA, how do you know what patients are paying, for what, and how, why, and where the funds come from, or that admitting a patient to one place or another is based on all kinds of criteria (diagnosis, ability to provide proper care, pay source, availability, staffing, etc.)? You don't, clearly, and in fact its not within the scope of what you do as a CNA, or even your need to know for any reason, except maybe you have a certain procedure to obtain supplies for Medicare/skilled patients, versus LTC patients, for billing reasons?

As far as the non-profit place, do you know what non-profit even means, or that it's likely that place charges more than your place? Or that they may have not had a bed, or the means to treat a certain patient, or might have even refuded a patient? If it's such a great place you should go work there. But it appears your patients won't follow you- because your current employer won't let them leave.

It's nice that you didn't personally bash your therapists, sort of. But no 'wonderful' therapist would work in a place that you describe, that serves only to bleed their patients' bank accounts dry.

You are simply in over your head, and you are doing your employer, your coworkers, your therapy department, and your patients a disservice with your ideas. If nothing else, you might be tainting your employer's image in public, which could possibly cost you your job. Wow.

BTW- to then contradict yourself by claiming the therapists don't have a monetary goal is just that- a contradiction. And you're wrong there as well- of course they do, it's called a paycheck. And they get that for providing professional services that have been ordered by a physician, are necessary, are approved by the IDT and the patient and the family and the pay source, and that are scrutinized on many levels by way of checks and balances that you have no knowledge of, whatsoever.

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Specializes in Short Term/Skilled.
If that's your take on your employer, you should not be working there, if for no other reason you claim to admit knowing your employer is robbing it's patients, which makes you complicit by way of cashing your paychecks. You're also guilty of knowingly aiding and abetting kidnapping, and false imprisonment, because you participate in the operation of a SNF that holds its patients hostage by not allowing them to leave to another SNF, or even allowing them the option of remaining in your SNF, which is really what you say goes on there? If I were you I'd report all this stuff to the police, and also to Medicare, the ombudsman, the state, and the FBI- you may be able to claim whistleblower status to avoid prosecution? You may even be able to collect rewards, say from Medicare, for reporting fraud-because your therapy department appears to provide therapy based on ability to pay, rather than skilled need or any other valid reason.

As a CNA, how do you know what patients are paying, for what, and how, why, and where the funds come from, or that admitting a patient to one place or another is based on all kinds of criteria (diagnosis, ability to provide proper care, pay source, availability, staffing, etc.)? You don't, clearly, and in fact its not within the scope of what you do as a CNA, or even your need to know for any reason, except maybe you have a certain procedure to obtain supplies for Medicare/skilled patients, versus LTC patients, for billing reasons?

As far as the non-profit place, do you know what non-profit even means, or that it's likely that place charges more than your place? Or that they may have not had a bed, or the means to treat a certain patient, or might have even refuded a patient? If it's such a great place you should go work there. But it appears your patients won't follow you- because your current employer won't let them leave.

It's nice that you didn't personally bash your therapists, sort of. But no 'wonderful' therapist would work in a place that you describe, that serves only to bleed their patients' bank accounts dry.

You are simply in over your head, and you are doing your employer, your coworkers, your therapy department, and your patients a disservice with your ideas. If nothing else, you might be tainting your employer's image in public, which could possibly cost you your job. Wow.

BTW- to then contradict yourself by claiming the therapists don't have a monetary goal is just that- a contradiction. And you're wrong there as well- of course they do, it's called a paycheck. And they get that for providing professional services that have been ordered by a physician, are necessary, are approved by the IDT and the patient and the family and the pay source, and that are scrutinized on many levels by way of checks and balances that you have no knowledge of, whatsoever.

I don't work there and I haven't for several years. One of the reasons I left was because of the things I saw. I didn't say it happened all the time, but I did know of cases where It absolutely happened. A patient would be admitted, treated and then allowed to stay on the rehab unit as long as they could pay for it. As soon as they couldn't pay for it they were moved to the LTC unit. Call it what you want to call it, I call it wrong.

I gave examples of things that I have seen happen. I never implied patients or their families weren't free to leave/be transferred. I never said anyone was held hostage! I am sorry if you don't like what you read, but I can't change the fact that It happened.

I never said it happened to every patient or that the other facility could always take them, just that they wouldn't have to pay as much, in many cases. The other facility bills a set amount for each dx code and everything they need comes out of that amount. If they need a special spoon, they get it. If they need a CT, they get that too. Nothing extra is involved or charged. At the SNF, they had to pay additional for everything and if the family said no, (to things such as specialty equipment, etc. ) they didn't get it.

How do I know? I listened to my patients and their families. I also ask questions and pay attention. I may be a CNA, but I am not an idiot. My scope may be limited by there is no limit on what I can learn. I have never discussed finances with a patient, ever. I have been on the listening end of many conversations about billing and I have asked questions and had discussions with those who oversee things pertaining to billing.

OBVIOUSLY I know the therapists are there for a paycheck, I was answering the OPs question. There wasn't an ulterior motive on their part. I do think the facility was in it to make money, I do think they took advantage of people in their time of need. I don't think its necessary to keep someone on a rehab unit when their rehab has ended and charge them twice as much as the LTC wing!

I highly doubt the therapists knew or cared what the patients were paying, and they WERE wonderful. I spent 8 hours a day 5 days a week with these folks, the therapists maybe 30 min at a time a couple times a day in a group setting. I saw things and I know things. I'm sorry if you can't handle that.

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I don't work there and I haven't for several years. One of the reasons I left was because of the things I saw. I didn't say it happened all the time, but I did know of cases where It absolutely happened. A patient would be admitted, treated and then allowed to stay on the rehab unit as long as they could pay for it. As soon as they couldn't pay for it they were moved to the LTC unit. Call it what you want to call it, I call it wrong.

I gave examples of things that I have seen happen. I never implied patients or their families weren't free to leave/be transferred. I never said anyone was held hostage! I am sorry if you don't like what you read, but I can't change the fact that It happened.

I never said it happened to every patient or that the other facility could always take them, just that they wouldn't have to pay as much, in many cases. The other facility bills a set amount for each dx code and everything they need comes out of that amount. If they need a special spoon, they get it. If they need a CT, they get that too. Nothing extra is involved or charged. At the SNF, they had to pay additional for everything and if the family said no, (to things such as specialty equipment, etc. ) they didn't get it.

How do I know? I listened to my patients and their families. I also ask questions and pay attention. I may be a CNA, but I am not an idiot. My scope may be limited by there is no limit on what I can learn. I have never discussed finances with a patient, ever. I have been on the listening end of many conversations about billing and I have asked questions and had discussions with those who oversee things pertaining to billing.

OBVIOUSLY I know the therapists are there for a paycheck, I was answering the OPs question. There wasn't an ulterior motive on their part. I do think the facility was in it to make money, I do think they took advantage of people in their time of need. I don't think its necessary to keep someone on a rehab unit when their rehab has ended and charge them twice as much as the LTC wing!

I highly doubt the therapists knew or cared what the patients were paying, and they WERE wonderful. I spent 8 hours a day 5 days a week with these folks, the therapists maybe 30 min at a time a couple times a day in a group setting. I saw things and I know things. I'm sorry if you can't handle that.

The topic is the benefit versus (real or perceived) cost of therapy. Therapy is a highly skilled area of expertise that benefits all kinds of patients in all kinds of health care settings. It also saves us all billions in health care costs. Nobody said you are an idiot. But you are in fact in over your head, and have a tough enough job as it is without concerning yourself with issues that are not within your scope, and yet you still apparently feel qualified and determined enough to discuss therapy plans of care and billing issues with your patients.

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Specializes in Pediatrics, Emergency, Trauma.
The topic is the benefit versus (real or perceived) cost of therapy. Therapy is a highly skilled area of expertise that benefits all kinds of patients in all kinds of health care settings. It also saves us all billions in health care costs. Nobody said you are an idiot. But you are in fact in over your head and have a tough enough job as it is without concerning yourself with issues that are not within your scope, and yet you still apparently feel qualified and determined enough to discuss therapy plans of care and billing issues with your patients.[/quote']

That's a bit of a miss; unless you work at Glycerine's job, whose to say WHAT they know??? CNAs at my employer ARE educated in MDS in terms of documenting function in terms of movement, bathing, and eating; if Glycerine has that knowledge, has that education then Glycerine COULD and WOULD have that knowledge AND provide that observation.

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