Page 38 - OPTA Access Spring 2020

Ethics Committee Report Lisa Kohler, PT, DPT – Chair
This year at Transform 2020, the Ethics Committee will be presenting “Reduce Your Stress: Strategies for Smart Documentation.” We decided on this topic because in 2019 the number of OPTA members with disciplinary board action against them increased dramatically . One of the common themes relates to documentation issues, and we will share the reasons in the presentation. We will discuss peer review findings, as well as the legal and ethical issues surrounding documentation in a lively roundtable discussion of real-life scenarios .
38 | March 2020 | OPTA
As a preview, we thought we would share some real-life scenarios:
1. In acute care, we have to be careful how we document as not to make someone look “too good” so they can go to a SNF .
2. At a hospital clinical I was on, I saw
a PT department director try to tell
a new grad therapist to alter her d/c recommendations to make it more likely for the patients to get discharged from the acute care hospital to the affiliated inpatient rehab even if she thought they weren’t appropriate for inpatient rehab (PS: she stood her ground but was still reprimanded .)
I can tell you personally that even with the recent changes to payment, these types of instances are not new . When I was a Director
of Rehab for an acute care hospital in the early 2000s, I went up to the behavioral unit to evaluate a patient for a SNF . The patient was already up walking in the hall independently, so I did the Tinetti test with him . He scored as no fall risk. I informed the staff of my findings and that he was too high level for SNF . They also asked me to change my documentation because they had nowhere else to discharge him . I refused .
The first step in recognizing and defining the ethical issue is the RIPS model:
REALM
Individual - The stakeholder impacted in each of these situations is the physical therapist who has an ethical responsibility to document accurately .
Organizational/Institutional - Due to the decision of the physical therapist, the facility and the social worker/case management personnel is free from misrepresentation to another provider, which assists in maintaining a positive referral relationship . In addition, the payor is not unduly paying for services that are not needed, so as to not drive up healthcare costs .
Societal - As a profession, physical therapists embrace the Code of Ethics which requires accurate documentation and billing, while managing colleagues’ expectations .
INDIVIDUAL PROCESS
This ethical situation requires moral motivation where you as an individual put your ethical standards above the values of your colleague whose motivation is to discharge the patient the easiest way possible .
SITUATION
The issue/problem is that the therapist’s clinical judgement is being challenged .
The second step is to reflect on and interpret the information above, so that you can complete the final step of deciding the right thing to do.
We look forward to seeing you at annual conference!
For more information, please contact Lisa at:
lkohler@cinci.rr.com