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  • APTA, AOTA, ASHA Combine Voices to Speak Out for Providers' Clinical Judgment

    APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASL) have come together to deliver the message that inappropriate administrative mandates, quotas, and productivity standards should never stand in the way of professional clinical judgment and knowledge of billing and reporting requirements.

    The 3 organizations have released a "Consensus Statement on Clinical Judgment in Health Care Settings (.pdf)" as part of a combined effort to highlight the central role of the clinician in a health care landscape that increasingly looks to patient-centered outcomes as the true measure of quality.

    "Respect for the therapist's clinical judgment and expertise is critical to achieving optimum patient/client care," according to the statement. "Overriding or ignoring clinical judgment through administrative mandates, employer pressure to meet quotas, or inappropriate productivity standards may be a violation of payer rules, may be in conflict with state licensure laws, and may even constitute fraud."

    The statement provides examples of unacceptable practices and reminders on the importance of knowing all rules and regulations, following proper evaluation and treatment protocols, and completing all documentation. Clinicians are encouraged to take action if they encounter a billing process that may be suspect and are provided with possible steps to take in response to employer policies or practices that conflict with clinical judgment.

    The partnership between APTA, AOTA, and ASHA is not new. The 3 organizations have worked together to produce guidelines on cotreatment and engage in advocacy around ending the therapy cap.

    “This is an important step both for APTA, its partner organizations, and the patients we serve,” said APTA President Paul A. Rockar Jr, PT, DPT, MS. “It provides further clarity and framework to help ensure appropriate treatment and it is just one of many steps APTA has taken to ensure patients are receiving the highest quality, most efficient care; care that is skillfully thought out and planned with the patient’s wants and needs at the forefront. This has long been a driving principle for our organization.”

    The statement on clinical judgment follows a charge made earlier this year by APTA’s House of Delegates (RC-16-14) for the association to identify and develop resources that equip physical therapists and physical therapist assistants in negotiations for conceptual frameworks of productivity and performance that ensure the provision of quality physical therapy care.

    This and other resources on clinical judgment contribute to APTA's Integrity in Practice Campaign, and can be found at the APTA Center for Integrity in Practice website. In addition to the consensus statement, the website's resources include information on the Choosing Wisely® list of "5 Things Physical Therapists and Patients Should Question;” a primer on preventing fraud, abuse, and waste; a free course on compliance; and other information on regulation and payment systems, evidence-based practice, ethics, professionalism, and fraud prevention.


    • Hello, I am happy to see this article because it demonstrates ample support for clinicians. As a PT, I have seen too often where productivity standards not only override univalves judgement, but ethical treatment and billing, as well. I worked in a nursing home, which was very stressful. Julie, PT

      Posted by Julie Agbasi on 10/17/2014 5:03 PM

    • Sadly, the undue influence of large, for-profit insurance companies on the provision of health care is a constant. Their bottom line is always maximizing profits and ours is always quality care. Until we can get big money out of politics, we will be charged to fight these giants with our sling-shots. Anything that helps us confront mandates that encourage substandard care (legislative or administrative) and insidiously degrades our profession's reputation is most welcome.

      Posted by Joanne Panzarella on 10/18/2014 12:23 PM

    • Employers of PT's in Nursing Homes will send out letters saying they don't stress productive in evals and treatments, then have talk on productive percentages with the therapist in the same week. They want the evals and treatment notes to get payment approval but want only a few minutes documented for completion of evil and please do not inform them of time spent gathering information to complete or develop the evil. UPOC or progress note.

      Posted by Peggy Strickland on 10/20/2014 8:32 AM

    • Once again we leave the solution in the hands of politicians which are paid on a regular basis by corporations that presently rule the way things are run. I cannot help but laugh at the premise that a clinician's judgement guides service provision. Honestly it is our responsibility to solve this matter, we have the power and control to resolve this. We need to learn to say "NO" when we are asked to do 95% to 100% productivity, keep a patient on program when they have met all goals or pick up Medicare B residents to "use their money" to make up for low sub-acute admissions...it is in our hands...

      Posted by David Arredondo on 1/2/2016 2:15 PM

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