Focus
The focus of this chapter is to identify the ways in
which the physical therapist's role priorities have changed.
Why is it Important to Learn This?
It is important to help
students look at the changing aspects of the role, as the assumptions they hold
may be quite different. My experience has been that if an instructor is aware
that the graduate student is being prepared to take on a role that is clearly
different from the models and ideas that have existed in the past, it becomes
more motivating to embrace some of the strategies and skills that will ensure
success in these new roles. This chapter really sets the stage for the
development of the context for the role, specific practice settings,
professional issues, modes of service delivery, and strategies that are covered
in Chapters 2 through 14.
Focus
This chapter focuses on the presentation of
mechanisms for paying for health care and supplying payment to providers.
Why is it Important to Learn This?
This knowledge
underlies all legislative and policy changes that currently shape health care
delivery. The forces in motion are powerful determinants of practice
priorities, limitations, and resource constraints. The provider needs this
knowledge to develop effective strategies for productive practice in the
current health care environment.
Focus
This chapter focuses on mechanisms for containing
costs from the perspective of the third-party payer and provider.
Why is it Important to Learn This?
Cost-containment
concerns drive health care reform. Many recent prospective payment initiatives
have markedly limited third-party reimbursement for health care services.
Creative intrasystem cost-containment strategies may make it possible to
continue to provide effective services within these restrictions. However,
these solutions must be discussed in light of legal and ethical considerations.
Focus
This chapter focuses on the factors that influence
access to physical therapy in today's health care environment, the relationship
of access and reimbursement, and barriers that may prevent the patient from
accessing physical therapy services.
Why is it Important to Learn This?
Patients benefit from
needed rehabilitation services. Access may be limited due to third-party payer
resource constraints, required referral relationships, or limited availability
of physical therapy services. Identification of access barriers is critical to
planning efficient service delivery for people who need rehabilitation
services.
Focus
This chapter focuses on trends and strategies for
physical therapy practice in acute care settings. Comorbidity, decreased length
of stay, discharge and treatment planning, and trends in acute hospital
restructuring are covered in depth.
Why is it Important to Learn This?
Health care in acute
hospitals has changed markedly in the past two decades. It is important for
physical therapists to understand the continuing evolution of the acute care
setting and how these changes have affected the practice of physical therapy.
By understanding the nature of these changes and factors influencing the focus
of practice, physical therapists can develop effective patient management
strategies.
Focus
This chapter focuses on the definition,
characteristics, and trends of subacute care. This practice setting has
undergone marked changes with the implementation of the Balanced Budget
Amendment of 1997, limiting payment for physical therapy services under both
Medicare Parts A and B.
Why is it Important to Learn This?
This practice sector
comprises a significant portion of physical therapy service delivery. The
continuing evolution of policy change in this setting dictates constant
vigilance on the part of educators, administrators, and clinicians to analyze
implications for rehabilitation service delivery. As it is likely that policies
will continue to change, instructors who use this material should indicate to
students that the latest and most up-to-date information is available via
websites and in active practice settings rather than in textbooks.
Focus
This chapter focuses on the trends and growth in the
home health care industry and the physical therapist's role in providing care
in this practice setting. This practice setting has also been affected by
Balanced Budget Amendment policy changes.
Why is it Important to Learn This?
As pressures increase to
discharge patients from inpatient care settings, more patients are at home
sooner and sicker. The challenges of practice in this setting continue to
change. Exposure to the realities and requirements of clinical practice is
important as students make career decisions and as they refer patients for home
health care services. It is especially important to realize the impact of the
interdisciplinary team in providing home health services.
Focus
This chapter focuses on strategies to identify
priorities, and organize and manage job responsibilities in clinical practice
settings. It presents practical techniques and ideas for implementation in a
variety of clinical settings.
Why is it Important to Learn This?
Perceived lack of time
to address key priorities is a significant source of stress on the job. Reduced
staffing allocations, diminishing resources, and increasing responsibilities
create a high potential for burnout and stress on the health care provider.
Focus
This chapter addresses issues of caseload management
and delegation, specifically in managing clinical duties, carrying out
treatment responsibilities, and in communicating and working with others to
provide clinical services. The chapter includes coverage of ethical and legal
issues involved in providing these services, including supervisory requirements
of support staff.
Why is it Important to Learn This?
Caseload management
presents many dilemmas in clinical practice. Analysis of clinical tasks,
identification of resource constraints, evaluation of support staff
capabilities, and organizational needs are required to carry out ethical,
legal, and efficient service delivery in our complicated health care
environment.
Focus
This chapter covers the fundamental principles of
outcomes measurement, data collection, and analysis. This includes models of
disablement and function, especially as they relate to the selection of outcome
indicators and measures of improvement.
Why is it Important to Learn This?
Outcomes are of
increasing importance to illustrate the efficacy of treatment approaches in
today's health care environment. Both economic and political forces have
greatly influenced current systems of health care delivery. With increasing
emphasis on evidence-based practice, and cost containment and resource
constraints, it becomes imperative that physical therapists are able to
demonstrate the efficacy of their services in improving the function of their
patients and clients.
Focus
This chapter covers the criteria for acceptable
documentation in an evidence-based practice environment. The author explains
acceptable criteria for Medicare documentation and offers many examples, and
do's and don'ts for documentation to facilitate reimbursement.
Why is it Important to Learn This?
Documentation serves as
a legal record of services provided and gives third-party payers sufficient
justification to reimburse providers for those services. Evidence of treatment
efficacy needs to be reflected in physical therapist documentation. In
addition, effective skills in documentation will facilitate clear, consistent
interprofessional communication.
Focus
This chapter presents an introduction to the
utilization management process, including both internal and external review
processes. The conduct and criteria for review are presented.
Why is it Important to Learn This?
Utilization management
ensures that each patient qualifies for the level of care he or she is
receiving through prevention of prolonged lengths of stay, excessive number of
visits, and unnecessary treatment. This process is strongly linked to good
patient care documentation to justify the level of care being provided.
Focus
This chapter defines quality-related processes such
as quality assurance, quality management, and quality improvement as well as
the indicators that are often used in such programs.
Why Is It Important to Learn This?
Quality management is a
critical standard for physical therapy practice and mandatory for most
institutional accreditation certifications. Physical therapists must often
develop mechanisms for measuring quality and strategies for addressing specific
target areas. Quality management interfaces with outcomes management and
utilization review. Together, these processes assure accountability, efficacy,
and continued evidence that physical therapy services are meeting acceptable
standards of care.
Focus
This chapter includes definitions of the physical
therapist's role and strategies for practice in primary, secondary, and
tertiary prevention.
Why is it Important to Learn This?
The American Physical
Therapy Association's (APTA) Model Definition of Physical Therapy for State
Practice Acts includes prevention and wellness in its definition of physical
therapy. Physical therapists often serve as educators, playing a key role in
prevention and wellness in areas such as worksite wellness, osteoporosis
prevention, arthritis intervention, fall prevention, and providing educational
services for patients and caregivers on disease.
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