Organizations Take Stand to Preserve Clinical Judgment Under Productivity Demands In response to concerns about rehabilitation practices in some health care settings that are based on factors other than clinical judgment and patient needs, three provider organizations—ASHA, the American Occupational Therapy Association and the American Physical Therapy Association—issued a consensus statement on ethical service delivery. “Clinicians are ethically obligated to ... News in Brief
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News in Brief  |   November 01, 2014
Organizations Take Stand to Preserve Clinical Judgment Under Productivity Demands
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Healthcare Settings / Practice Management / Professional Issues & Training / Regulatory, Legislative & Advocacy / ASHA News & Member Stories / News in Brief
News in Brief   |   November 01, 2014
Organizations Take Stand to Preserve Clinical Judgment Under Productivity Demands
The ASHA Leader, November 2014, Vol. 19, 10. doi:10.1044/leader.NIB1.19112014.10
The ASHA Leader, November 2014, Vol. 19, 10. doi:10.1044/leader.NIB1.19112014.10
In response to concerns about rehabilitation practices in some health care settings that are based on factors other than clinical judgment and patient needs, three provider organizations—ASHA, the American Occupational Therapy Association and the American Physical Therapy Association—issued a consensus statement on ethical service delivery.
“Clinicians are ethically obligated to deliver services that they believe are medically necessary and in the client/patient’s best interest based upon their independent clinical reasoning and judgment as well as objective data,” the statement reads. “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.”
ASHA spearheaded the creation of the statement in response to speech-language pathologists’ concerns about supervisors in skilled nursing facilities overriding their clinical judgment to meet productivity goals and to force patients into higher, more lucrative levels of care. Occupational and physical therapists have similar concerns.
The document lists nine examples of “unacceptable” policies and practices:
  • Placing clients/patients on caseload who do not meet Medicare or other payer coverage criteria.

  • Delivering treatment without patient consent.

  • Keeping clients/patients on caseload when skilled care is no longer indicated.

  • Setting inappropriate administrative requirements regarding treatment frequency, intensity or duration.

  • Counting time as treatment that is not permitted by Medicare or other payer regulations as treatment (for example, rest time or time spent traveling to the patient’s room).

  • Inappropriately limiting the time spent on evaluations based on payment policy.

  • Coding services inappropriately.

  • Changing coding without the assent of the treating therapist in an effort to increase payment or conform to internal policies.

  • Falsifying or changing documentation to misrepresent time spent or services delivered.

The statement notes that clinicians may face negative repercussions when they question employer policies or practices that conflict with the autonomy of practitioners’ clinical judgment. It also emphasizes, however, that clinicians have an “ethical duty to support evidence-based practice to achieve effective client/patient outcomes,” and suggests that clinicians use networks, associations and groups to talk about the problems or situations they face and provide feedback to state and national associations.
The statement provides specific guidance for reporting practices that are suspect:
  • Contact the facility or corporate compliance officer or administration point of contact for compliance issues.

  • Immediately stop the questionable practice.

  • Contact your professional association for guidance.

  • When appropriate, consider reporting information to the Office of the Inspector General, particularly in cases in which the compliance officer has not responded appropriately (OIG has a hotline for anonymous fraud reporting: 800-447-8477).

  • Seek knowledgeable legal counsel as appropriate if other efforts are not successful.

The three associations plan to share the statement with health care provider groups, including the American Health Care Association and the National Association for the Support of Long-Term Care.
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FROM THIS ISSUE
November 2014
Volume 19, Issue 11