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MAKE SURE YOU SIGN IN

• (IF YOU DONT SIGN IN, YOU DONT EXIST)

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Welcome To ThePhysical Therapy Section

• Breakout Session

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What are we doing here?

• The goal of the breakout session is to help
  prevent licensees from endangering their Ohio PT
  license by
• Exploring recent law revisions
• Providing insight into frequently asked practice
  questions
• Reporting recent trends in violations/discipline
  that exist in the practice of physical therapy in
  the State of Ohio.

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Things to consider during this presentation.

• Is YOUR practice in compliance with the laws and
  rules that govern the practice of physical
  therapy in the State of Ohio?
• How do YOU stay current on the laws and rules
  that govern your profession?
• Do YOU understand Ohios continuing education
  requirements?
• Have YOU ever been aware of, or involved in a
  situation that seemed unethical and/or illegal?

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First, Lets Get One Thing Straight
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WE ARE NOT THE OPTA!!

• We ARE the Licensing Board.
• We are NOT the Ohio Physical Therapy Association.
  
• The Board can assist you with the following
  items
• Licensing Issues (Issuing a License, License
  Renewal, License Verification)
• Filing a Complaint
• Public Records Requests
• Clarification of the Laws and Rules
• Address/Name Changes
• Replacing a Wall License or Pocket ID
• Information Regarding Examinations
• Enforcement Actions

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OTPTAT is NOT OPTA

• You should contact the Ohio Physical Therapy
  Association if you have questions regarding
• Promoting the profession
• Obtaining an OH approval number for a CEU course
• Locating OH approved CEU courses

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What Are We Going to Cover?

• Recent law changes
• Continuing education
• FAQs
• Supervision issues
• Duties of unlicensed and other licensed
  individuals in the PT setting
• Appropriate transfer of care methods
• Complaints, violations and discipline

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EXTRA, EXTRA!RULE CHANGES EFFECTIVE 5/1/08

• RULE REVISIONS
• 4755-27-01 Physical Therapy Practice Defined
• 4755-27-02 Physical Therapist Assistant
• 4755-27-03 Delegation
• 4755-27-04 Supervision

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EXTRA, EXTRA!RULE CHANGE EFFECTIVE 3/24/08

• New and Improved Code of Ethical Conduct for
  Physical Therapists and Physical Therapist
  Assistants
• Rule 4755-27-05
• Now theres no reason not to be on your best
  behavior!

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EXTRA, EXTRA! LAW CHANGE EFFECTIVE 4/6/07

• 4755.482 Requirements For Teaching Physical
  Therapy
• A person shall not teach a physical therapy
  theory and procedures course in physical therapy
  education without obtaining a PT license from the
  physical therapy section of the Ohio OTPTAT
  Board.
• Wait, theres more.

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Requirements For Teaching Contd

• Non-Ohio licensed PT shall not teach PT theory
  procedures course for gt1 year w/o obtaining Ohio
  license
• Foreign licensed PT seeking to teach PT theory
  procedures course may apply to PT Section for
  authorization to teach up to 1 year w/o Ohio
  license.
• Proposed rules clarify that these requirements
  apply to faculty of record for the course.

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EXTRA, EXTRA! LAW CHANGE EFFECTIVE 4/6/07

• A person sanctioned shall pay a fee in the
  amount of the actual cost of the administrative
  hearing including the cost of the court reporter,
  the hearing officer, transcripts, and any witness
  fees for lodging and travel, as determined by the
  appropriate section of the board. ORC 4755.031

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EXTRA, EXTRA!LAW AND RULE CHANGES EFFECTIVE MAY
2007!

• Per Ohio Revised Code Section 4755.47(A), the
  Board now has the ability to levy a fine against
  a licensee

• Fines are only used with certain violations
• Purpose is to deter, then to discipline
• Fines are determined by the PT Section of the
  Board
• Fines first utilized with 2007 CE audit

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Stay Tuned to http//otptat.ohio.gov

• The Physical Therapy Section is currently working
  on rule revisions that are planned to go into
  effect on May 1, 2009.
• RememberYou are responsible for ensuring that
  your practice is in accordance with these new
  rules.

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Speaking of Continuing Education..

• Deadline to have your CE completed CHANGED to
  match the renewal deadline of January 31st
• OPTA has been delegated by the Board to issue
  Ohio approval numbers
• THE BOARD DOES NOT ISSUE OHIO APPROVAL NUMBERS

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New Addition!!

• A continuing education tracking form is available
  on the Boards website at http//otptat.ohio.gov.
  It helps makes tracking CE easy and fun!
• .Well maybe not fun

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ATTENTION AUDITEES

• 20-30 of licensees selected for the audit after
  the renewal is completed
• Active licensees randomly selected by the
  computer generated (Board isnt picking on you!)
• If you receive an audit notice letter from the
  Board, you are required to submit COPIES of your
  CE certificates to the Board office
• Failure to respond to the audit notice letter, or
  failure to obtain the required number of CE
  required for license renewal WILL RESULT IN
  DISCIPLINARY ACTION

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Check Your CE Twice!

• If You Are Audited, Make Sure You Have.
• No less than 24 CE (PT) or 12 CE (PTA), earned
  within in your renewal period
• COPIES of all CE certificates which must include
• Name
• Date
• Ohio Approval Number
• Number of CEUs given for the course

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Renewal Period Change

• As of February 1, 2009, both PTs and PTAs will
  be on their new renewal cycles.
• All Ohio licensed PTs will be renewing every
  EVEN numbered year.
• All Ohio Licensed PTAs will be renewing every
  ODD numbered year.
• Make sure all CE is done within the appropriate
  two-year renewal period!

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CE IMPORTANT

• The PT Section views CE as an essential part of
  the practice and has implemented a fining system
  for those who fail the audit and for those who
  fail to respond to the audit notice letter.

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Questions, Questions, Questions

• Commonly asked questions to the Physical Therapy
  Section
• Supervision Issues
• Use of Unlicensed Persons
• Transfer of Care/Abandonment
• Billing For Services

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Lets Start Off With The Basics.Who Are The
People In The PT Clinic?

• Physical Therapist
• Physical Therapist Assistant
• PT/PTA Students
• Other Licensed Personnel
• Unlicensed Personnel

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PT Responsibilities

• The following tasks cannot be delegated,
  regardless of setting
• Interpretation of physician referrals
• Initial patient evaluation
• Developing a plan of care, including short/long
  term goals
• Identifying and documenting precautions, special
  problems, and anticipated progress
• Periodic re-evaluation of the patient

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PT Responsibilities

• The following tasks cannot be delegated,
  regardless of setting
• Selecting and delegating appropriate task in the
  plan of care
• Designating channels of written and oral
  communication
• Assessing competence of assistive personnel
• Directing and supervising assistive personnel
• Adjustment of the plan of care
• Final discharge summary.

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PTA Responsibilities

• Under the supervision of a PT, a PTA may perform
  the following
• Carry out duties appropriate to the established
  physical therapy services
• May adjust a treatment procedure in accordance
  with a change in patient status within the
  established plan of care
• Review medical information and past functional
  ability through contact with medical persons,
  family or the patient

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PTA Responsibilities

• Under the supervision of a PT, a PTA may perform
  the following
• Progress a patient treatment program within the
  parameters of the plan of care as established by
  the supervising PT
• Perform treatment procedures that he/she has
  documented training and demonstrated competency
  in
• May document in the medical record according to
  the established protocols.

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PTAs, LISTEN UP!

• To meet acceptable standards of care, PTAs have
  an obligation in the overall care of the patient
  to ensure the supervising PT performs the
  appropriate reviews and assessments, throughout
  the duration of the patients care.

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Unlicensed Personnel vs. Other Licensed Personnel

• Unlicensed Personnel
• Any person who is on the job trained

• Other Licensed Personnel
• Any person holding an Ohio license to practice as
  a healthcare practitioner other than a PT/PTA

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Other Licensed Personnel

• Category includes individuals such as ATs, RNs,
  OTs, LMTs, etc., providing services pursuant to
  the PT plan of care
• Responsibility for care rendered lies at all
  times with the PT
• Must work under direct supervision of a PT or
  PTA, as delegated by the PT

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Other Licensed Personnel

• Direct supervision PT/PTA in same building
  able to immediately respond to needs of patient
• PT/PTA must have involvement with patient during
  each visit
• Delegation done in accordance with knowledge and
  scope of practice of the other licensed personnel.

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Other Licensed Personnel

• Can Other Licensed Personnel document?
• Yes, as long as the documentation is restricted
  to
• An accounting of the activities provided
• Descriptions of those activities and the
  patients comments (i.e. objective subjective
  information
• The remainder of the documentation is the
  responsibility of the supervising PT/PTA.
• While other licensed personnel may document the
  patients ability to perform or difficulty with
  specific components of the program, only the
  physical therapist may identify a prognosis or
  assess progress

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Unlicensed Personnel

• Responsibility for care rendered lies at all
  times with the PT
• Support the delivery of PT services by personally
  assisting the PT / PTA / Student PT / Student PTA
  while one of these individuals is concurrently
  providing services to the same patient

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Unlicensed Personnel

• May be assigned ROUTINE duties that assist in the
  delivery of PT operations, including
• Maintenance care of equipment and supplies
• Preparation, maintenance, and cleanup of
  treatment areas
• Transportation of patients
• Office clerical procedures
• Assisting patients preparing for, during, and at
  the conclusion of treatment (e.g. changing
  clothes)

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Supervision 101

• The PT has the ultimate responsibility for all
  care and services delivered as physical therapy!
• Direction and supervision are essential in the
  provision of quality physical therapy services.
• The PT shall select the appropriate portions of
  the program to be delegated and shall direct the
  PTA in the delegated functions.
• The PT must assure that care is provided in
  accordance with state law.

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Supervision 102 PTA

• Supervising PT need not be physically on site or
  on location but must be available by
  telecommunication at all times.
• Supervising PT must be able to respond
  appropriately to the needs of the patient.
• Board recommends that supervising PT have
  regularly scheduled documented conferences with
  the PTA. Conferences should be determined by the
  needs of the patient and/or by the needs of the
  PTA.
• It is recommended that conferences should occur
  at least once a month, or at more frequent
  intervals, in accordance with the need of the
  patient and/or PTA.

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Supervision 103 PT/PTA Students

• Students must be enrolled in an accredited entry
  level PT program.
• PT students must function at all times under the
  on-site supervision of a licensed PT.
• PTA students shall function at all times under
  the on-site supervision of a licensed PT OR a
  PTA.
• All documentation must have the appropriate
  countersignature of the supervising PT or PTA.

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Supervision 103 PT/PTA Students Contd

• The supervising PT is required to be on-site
  whenever the student PT is performing patient
  examinations, evaluations and interventions.
• The supervising PT or supervising PTA is required
  to be on-site whenever the student PTA is
  performing patient interventions.

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TRANSFER OF CARE

• A patients care is the sole responsibility of
  the evaluating physical therapist.
• If the evaluating PT can no longer provide and
  supervise physical therapy care, the patient must
  be transferred by that therapist to another PT.
• If no other PT is available or willing to accept
  the transfer of care, the evaluating PT should
  refer the patient to another facility, and/or
  discharge them from their care.

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TRANSFER OF CARE part 2

• A PT should make every attempt to transfer the
  patients to eligible providers.
• A PT should inform their patients if/when they
  can no longer offer care, and in turn provide
  patients with a list of eligible providers.
• Transfer of care must be documented in the
  patients medical record, identifying the new
  physical therapist that has accepted the transfer
  of care.

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DONT LEAVE!!

• Abandonment is alleged when the relationship is
  severed without REASONABLE notice at a time when
  there is still the necessity of continuing care.
• PTs have a legal and ethical obligation to make
  every effort to follow through with the plan of
  care established for any given patient.
• If the patient is not transferred to another PT,
  the evaluating PT is STILL responsible for the
  overall care of the patient.

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DONT LEAVE!!......(Part 2)

• Should a PT fail to transfer the care of a
  patient, he/she would be in violation of rule
  4755-27-05(B)(12), which states
• A licensee shall transfer the continuum of care
  of the patient, as appropriate, to another health
  care provider in the event of elective
  termination of physical therapy services by the
  licensee.

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BILLING AND MEDICARE

• The Board has no jurisdiction over billing or
  Medicare matters, unless fraud is suspected
• The Board does not give billing advice
• The Board cannot assist in clarification of
  Medicare issues---contact Medicare
• For billing purposes, there are only two PT
  codes, (evaluation and re-evaluation), all other
  codes are physical medicine codes

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This Next Series Of Slides Is Sponsored By

• The Enforcement Division

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What Do We Investigate?

• Physical abuse/injuries to a patient
• Patient neglect
• Falsification of documentation
• Billing fraud
• Failure to complete documentation prior to ending
  employment
• Mental impairment issues

• Drug/alcohol abuse
• Competency issues
• Criminal convictions
• Unprofessional behavior
• Unlicensed practice
• Failure to complete CE required for license
  renewal
• Falsifying an application

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Number of Cases Investigated Per Year (since 2000)

• Average of 43 PT cases/year over the last eight
  years
• Not all investigations result in discipline
• PT Section tends to see the most cases per year
• Very small percentage of the licensee population
  is actually involved in an investigation

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Most Common Violations

• CE/Audit violations
• Unlicensed practice
• Practice prior to licensure
• Negligence/gross misconduct
• Practice on an expired license

• Supervision Issues
• Illegal advertising/soliciting of patients
• Fraud Documenting services not provided

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Behave yourself, or else

• All cases are reviewed by the Physical Therapy
  Investigative Review Panel.
• Fining, probation, reprimand, suspension, and
  revocation, are disciplinary remedies utilized by
  the Board.
• No set discipline for specific violations, but
  there are guidelines that the PTIRP does follow
  to maintain consistency in regards to discipline
  for specific violations.
• Discipline IS case specific.

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Tips To Stay Out Of Trouble

• Familiarize yourself with the laws and rules.
• Visit the Boards website to stay abreast of any
  law changes.
• Use the Boards website to verify that your
  license is in good standing.
• Notify the Board of any address or employment
  change within 30 days. (If you dont, you may not
  receive your renewal information and end up
  practicing on an expired license, subjecting
  yourself to disciplinary action).
• DO YOUR CE.
• If you have questions or concerns, contact the
  Board.

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Things To Keep In Mind.

• If you renew your license and do not receive a
  new pocket ID card with an updated expiration
  date, verify your licensure status with the Board
  prior to commencing practice after your
  expiration date.
• As healthcare professionals, you have an ethical
  obligation to report any behavior you believe is
  unethical and/or illegal.
• Disciplinary actions are public record and are
  permanent be aware of your practice act and any
  changes that occur over the years.

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Web Site Overview

• Licensure verification
• Expired license listing
• On-line license renewal
• Laws and rules
• Continuing education requirement grid
• Continuing education tracking form
• Enforcement actions/complaint form
• Change of name/address/employment form

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Were here to help..except on the weekends

• Questions? Concerns? Information is available.
• http//otptat.ohio.gov
• Join the Boards listserv
• Review the laws and rules
• Contact the Board office
• Office Hours are 8am-5pm
• Email
• Fax
• Telephone
• Snail mail

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Just ONE more thing.

• The bottom line Its your license. You determine
  the environment you work in. Dont let the
  company/facility/school you work for, compromise
  the standing of your license.

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Hold On Just A Second, Were Not Quite Done Yet

• Post-Test
• Please take the time to comment on your
  attendance at the Physical Therapy Section
  Breakout Session
• Turn in Post-Test
• Be A Good PT or PTA!