Melissa is a third-year, Doctor of Physical Therapy (DPT) st…
Melissa is a third-year, Doctor of Physical Therapy (DPT) student on her last clinical education experience in a Skilled Nursing Facility (SNF). Melissa has enjoyed the experience but has found the documentation aspect challenging at times and she needs to revisit the information. She recalls the acronyms MDS, PPS, and PDPM (for Minimum Data Set, Prospective Payment System, and Patient Driven Payment Model, respectively), but never had really thought about how they apply to patient care until she started this specific patient population experience. Melissa completes an initial evaluation on a 73-year-old man named Walt and determines that he would benefit from physical therapy but has limited rehabilitation potential. Walt barely could participate in the full evaluation even though it only took about 30 minutes. Melissa is concerned over his ability to participate and tolerate rehabilitation at this stage. The next day, Melissa reviews the chart and sees that Walt has been assigned to a PDPM category that she feels is not appropriate for his current level of function. Melissa is certain this is an error, so she approaches her clinical instructor, Wendy, and asks her how to correct it. Wendy responds that the category most likely is not an error. Rather, Wendy tells Melissa, many individuals Walt’s age, with his diagnosis, are placed in this category and are documented as having received individual therapy when the patient really is receiving group therapy. Wendy elaborates, that “The Rest & Recovering facility seeks to do this on some patients because such designations increase reimbursements to make up for the lack of reimbursement on other patient cases. It all kind of balances out, as Medicare doesn’t pay much anyway”. Wendy then suggests that Melissa speak with the department supervisor, who establishes the clinical categories for the patients. Melissa is deeply concerned about this situation and Walt’s rehabilitation, however, on the other hand she does not want to do or say anything that will jeopardize her successful completion of this final clinical education experience. Should she simply do as she is told and rationalize that as a student she may not fully understand what has happened, or should she follow Wendy’s recommendation to speak with a supervisor to advocate and educate for changing the coding culture in the SNF? Considering the ethical decision-making model, identify the cardinal realm in which this situation is occurring.
Read DetailsYou work in a large academic health care facility as a physi…
You work in a large academic health care facility as a physical therapist supervisor of the inpatient cardiac intensive care units (CICU). An 18-year-old patient awaiting a heart transplant recently was treated by a PT on your staff in the department gym area. The patient was not being monitored on telemetry during the treatment, as telemetry was only available on the cardiac unit and the exercise equipment was in the PT gym area. The PT providing treatment instructed the patient to perform walking exercise on the treadmill. The patient indicated that she felt well and voiced that she wanted to continue the walking treatment for a full 30 minutes. During the treatment the PT monitored the patient’s respiratory rate and pulse rate, noted some elevation in both rates but did not have concerns. Once the patient completed the exercise walking treatment, the PT transported the patient back to the CICU and handed off and made report to the nursing staff caring for the patient. By that time, however, the patient was having labored breathing and was not recovering as expected from the walking exercise. Despite all attempts from the nursing and medical staff, the patient coded and later died. Once the event is reported to the State Health Department and The Joint Commission, what must be performed?
Read DetailsDescribe the hydrologic cycle as presented in Chapter 2. In…
Describe the hydrologic cycle as presented in Chapter 2. In your answer, identify the major reservoirs of water in the Earth system and explain the key processes that transfer water between the surface and the atmosphere (including evaporation, condensation, precipitation, runoff, and infiltration). Then explain what is meant by the “residence time” of atmospheric water vapor and why this short residence time is important for weather and climate.
Read Details