Department of Physical Therapy, Brenau University Ivester College of Health Sciences, Gainesville, GA.
J Am Med Dir Assoc. 2019 Nov;20(11):1458-1461. doi: 10.1016/j.jamda.2019.06.013. Epub 2019 Aug 1.
Reimbursement in skilled nursing facilities (SNFs) is driven by the number of minutes a patient receives rehabilitation. Physical therapists' (PTs) clinical decisions in evaluation and appropriate treatment of patients drive the dosing of rehabilitation services. Many times these 2 dynamics clash. The purpose of this study was to determine how PTs in SNFs viewed their ethical work environment, what primary issues drove their views, and what potential solutions were identified for the issues.
This was a mixed-methods, cross-sectional survey study.
An organizational ethics survey along with 2 open-ended questions were sent to a random sample of 1200 PTs in the state of Georgia; 340 surveys were returned, and the respondents were categorized into 9 typical PT work settings. Twenty eight participants (8.2%) reported they worked in SNFs.
The Ethics Environment Questionnaire was the quantitative measurement tool used for the study. In addition, 2 open-ended questions were asked regarding ethical concerns and possible solutions to those concerns.
Of the 9 workplace settings, therapists working in SNFs had the lowest perceptions of ethical work environment. They were also the only group that scored below the survey cut-off point for positive ethical work environment. Their primary concerns were overutilization issues, productivity standards, and billing and coding issues. The 2 primary themes regarding solutions were allowing PTs to be autonomous in their decision making and decreasing productivity standards.
CONCLUSIONS/IMPLICATIONS: The current Medicare reimbursement system rewards quantity of rehabilitation over quality. PTs are trained to deliver quality care that is dosed appropriately, and this may conflict with organizational objectives. The primary implication in this study is that clinicians and administrators should engage more in open, honest dialogue on how to share responsibility and balance organizational goals with clinical ethics.
熟练护理设施（SNF）的报销取决于患者接受康复治疗的分钟数。物理治疗师（PT）在评估和对患者进行适当治疗方面的临床决策决定了康复服务的剂量。很多时候，这两个动态会发生冲突。本研究的目的是确定 SNF 中的 PT 如何看待他们的道德工作环境，哪些主要问题驱动他们的观点，以及为这些问题确定了哪些潜在的解决方案。
这是一项混合方法、横断面调查研究。
向佐治亚州的 1200 名 PT 随机样本发送了一份组织伦理调查以及两个开放式问题，共收回 340 份调查，受访者被分为 9 个典型的 PT 工作环境。28 名参与者（8.2%）报告说他们在 SNF 工作。
伦理环境问卷是用于研究的定量测量工具。此外，还询问了两个关于道德问题和这些问题的可能解决方案的开放式问题。
在 9 个工作场所设置中，在 SNF 工作的治疗师对道德工作环境的看法最低。他们也是唯一得分低于调查截止点的群体，表明对积极道德工作环境的看法。他们的主要关注点是过度使用问题、生产力标准以及计费和编码问题。关于解决方案的两个主要主题是允许 PT 在决策方面具有自主权以及降低生产力标准。
结论/意义：目前的医疗保险报销系统奖励康复治疗的数量而非质量。PT 接受的培训是提供适当剂量的高质量护理，这可能与组织目标冲突。本研究的主要意义是临床医生和管理人员应该更深入地参与关于如何分担责任以及平衡组织目标与临床伦理的开放、诚实的对话。
