Ethics

Question 1

General Supervision

Answer 1

The physical therapist is not
required to be on site for direction and supervision, but
must be available at least by telecommunications.

Question 2

Direct Supervision

Answer 2

• The physical therapist is physically present and immediately available for direction and supervision.
• The physical therapist will have direct contact with the patient/client during each visit that is defined in the Guide to Physical Therapist Practice as
  all encounters with a patient/client in a 24-hour period.
• Telecommunications does not meet the requirement of
  direct supervision

Question 3

Direct Personal Supervision

Answer 3

• The physical therapist or,
  where allowable by law, the physical therapist assistant is
  physically present and immediately available to direct and supervise tasks that are related to patient/client
  management.
• The direction and supervision is continuous throughout the time these tasks are performed.
• Telecommunications does not meet the requirement of direct personal supervision.

Question 4

What can NOT be delegated

Answer 4

 Interpretation of referrals
 Examinations
 Provide physical therapy diagnosis
 Develop plan of care
 Conducting re-examinations
 Overseeing care/documentation/progress
 Performing discharges
 Screening (it is a component of an exam)
- Joint Mobs
- Sharp Debridement
- Dry Needling
- Any pt with unstable or unknown response

Question 5

Re-Exam and Discharge

Answer 5

• re exam, evaluation, and interpretation of results is PT
• but a PTA can complete measures that a PT would use for re-exam or discharge
• ROM
  -MMT
• balance/gait

Question 6

Off site PTA supervision

Answer 6

• PT must be accessible by phone at all times
• regularly scheduled and documented conferences with PTA
• Need a supervisory visit by PT as requested by PTA or once a month

Question 7

what does a supervisory visit include

Answer 7

• on site re-exam
• on site review of POC
• Eval of needs and recommendations for utilization of outside resources

Question 8

are PTs legally and ethically responsible for PTAs

Answer 8

yep

Question 9

what is the only thing that PTAs are supposed to assist with

Answer 9

intervention

Question 10

what does Medicare require in private practice

Answer 10

direct onsite PTA supervision

Question 11

how does medicare pay not PTs

Answer 11

• students: typically covered by part A; part B not covered but can participate with direction by PT who is not seeing other pts
• PTA: covered but may required direct supervision
• aides: nope

Question 12

what makes a successful PT/PTA partnership

Answer 12

• Know the strengths of the partner
   Communication is key
   Develop early expectations of each partner
   Mutual respect
   Be available to each other
   If it is an ongoing partnership, develop collaboration
  strategies, methods of communication handoff
   Be aware of the need for each other
   Successfully managing differences when they occur

Question 13

fraud

Answer 13

An intentional deception or intentional
misrepresentation that a person makes to gain a benefit for which that person is not entitle

Question 14

Abuse

Answer 14

Payment for items or services when there is no
legal entitlement to that payment, and the health care
provider has not knowingly and/or intentionally
misrepresented facts to obtain payment

Question 15

waste

Answer 15

Overutilization of services or other practices that directly or indirectly result in unnecessary costs to
the healthcare system

Question 16

false claims act

Answer 16

• Imposes liability on any person who submits a claim
  to the federal government that he/she knows (or
  should know) is false
• ya cant say ya just didnt know
• Criminal false claims - jail and fines
• whistleblower provision- private individual can submit to file lawsuit on behalf of US for violation of act

Question 17

Anti-Kickback Statute

Answer 17

• kickbacks can distort medical decision making, cause over use, increase costs, result in unfair competition
• forbids receiving payment for referring pt for services, equipment, any item that would be covered by medicare
• criminal law- intent matters

Question 18

Physician Self- Referral Law (Stark Law)

Answer 18

• services for Medicare and Medicaid if the physician
  (or immediate family member) has a financial relationship with that entity
• includes ownership, investment interest, compensation

Question 19

exclusion statute

Answer 19

The Department of Health and Human Services is required to exclude health care providers and suppliers who have been convicted of the following crimes from participation in federal health care programs:
 Medicare Fraud
 Patient abuse or neglect
 Felony convictions for health care related fraud, theft, or
misconduct
 Felony convictions for unlawful manufacture, distribution,
prescription, or dispensing of controlled substance

Question 20

Civil Monetary Penalties Law

Answer 20

The Office of the Inspector General may seek civil
monetary penalties for a variety of criminal violations:
 Presenting a claim that the person knows (or should
know) is for a service or item that was not provided
 Presenting a claim that the person knows (or should
know) is for an item or service that is not eligible for
payment
 Violating the Anti-Kickback Statute

Question 21

ethics

Answer 21

systematic rational reflection on issues of right or wrong or regarding what we ought to do

Question 22

values

Answer 22

Subjective standards for what is right or wrong, good or bad

Question 23

laws

Answer 23

includes rules, administrative codes, and regulations created by administrative agencies to interpret or implement legislation

Question 24

4 concepts of ethics

Answer 24

1. autonomy - right to self discrimination
2. beneficence: promote good
3. non-maleficence: preventing harm
4. justice: fairness

Question 25

conflicts of interest

Answer 25

- Exists when competing interests or obligations that prevent fulfillment of primary professional obligations  Professionals wherever possible should avoid conflicts of interest and the perception of conflicts of interest

Question 26

RIPS Model

Answer 26

- Allows for a step by step analysis which is most appropriate for situations in which there are two competing ethical principles at stake - Four steps 1. Recognize and Define 2. Reflect 3. Decide 4. Implement, Reassess, and Evaluate

Question 27

R - Realm

Answer 27

 Individual: Primary concern is the good of the patient/client. Focus is rights, duties, relationships, and behaviors between individuals.  Organizational: Primary concern is good of the organization. Focus is on structures/systems that facilitate the organizational goals.  Societal: Primary concern at this level is the common good. Focus is on legal, financial, constitutional, and cultural goals.

Question 28

IP - Individual Process

Answer 28

- Moral sensitivity: Involves recognizing, interpreting, and framing ethical situations - Moral judgment: Requires deciding on right vs. wrong actions. This process involves generation options, selecting, and applying ethical principles - Moral motivation: Places a priority on ethical values over other values such as self-interests, status, or financial gain. - Moral courage: Involves implementing the chosen ethical action, including development of a plan and perseverance in the face of barriers and adversity

Question 29

Situation

Answer 29

- Issue: Important values are present - Dilemma: Two courses of action may be taken, both of which fulfill a duty, but it is not possible to fulfill both obligations (right vs. right decisions) - Distress: You know the right course of action but are not authorized or empowered to perform it. - Temptation: Involves a choice between a “right” and a “wrong” in which you may benefit from the “wrong” choice - Silence: Ethical values are challenged, but no one is speaking about this challenge to value

Question 30

Kiddler's Approaches to Solving Dilemmas

Answer 30

- Rule-based: Follow the rules, duties, obligations, or ethical principles already in place - Ends-based: Determine the consequences or outcomes of alternative actions and the good or harm that will result for all of the stakeholders - Care-based: Resolve dilemmas according to relationships and concern for others

Question 31

recognizing ethical situations

Answer 31

 Legal test: Is something illegal?  Stench test: Does it “feel” wrong?  Front page test: How would you like this on the front page of your local newspaper?  Mom test: If I were my mother, would I do this?  Professional Ethics Test: Does the Code of Ethics prohibit or discourage this?