Shenda's Blog 

The views and opinions expressed within posted comments do not necessarily reflect the views or positions held by the College of Physiotherapists of Ontario.

A Bedtime Story

Apr 27, 2018

Once upon a time there was a physiotherapist and a massage therapist working together in the same clinic.
 
One day, a man in his thirties came in with lower back pain. He was sad to report that he had to cut back on his running because of his discomfort in his hip.
 
He saw the physiotherapist who assessed him and said, “Your legs are slightly different lengths. I think that this is because your pelvis is tilted. I will treat you with muscle stretching around the hip area, adjustment first and then follow it with feedback on your posture when you run.”
 
The patient saw the physiotherapist 6 times and started to feel much better. The physiotherapist felt the patient could benefit from some massage therapy but the patient's benefits did not cover massage and he couldn’t afford to pay out of his own pocket.
     
The physiotherapist suggested that the patient could receive massage therapy and not have to pay out of pocket, they could just adjust the books a little. The invoices could be issued by the physiotherapist but the massage therapist would see the patient. If anyone asked, the massage therapist was acting in the capacity of a physiotherapist assistant.

The patient used up his physiotherapy benefits, but by that time his pain had resolved. He gave the clinic five stars on Yelp.
 

What Do You Think? OK or Not OK?

First of all, a massage therapist or even a physiotherapist CAN work as an assistant to a physiotherapist—really anyone can work as a PTA.
 
But when anyone works as an assistant, they MUST work under the supervision of someone else. The treating professional must have assessed the patient, established goals and a treatment plan, assigned and supervised the treatment being provided and must periodically reassess the patient. If those things have not happened, it cannot be billed as “physiotherapy”. Oh, and it actually has to be physiotherapy that is being provided.
 
This is exactly the same in a gym setting. An athletic trainer might be acting as a PTA, but only if the conditions (PT diagnosis, treatment plan, supervision and reassessments) set out in the Standard are met. The trainer should not be developing or independently adjusting treatment plans.
 
In the situation above, the physiotherapist should have handed the patient off to the massage therapist for treatment, if they needed that service. The RMT would have assessed the patient, and developed a treatment plan, and billed for the services.
 
The bottom line is that if it’s billed under your number, you must use your own clinical expertise to oversee every element of patient care. Otherwise it looks a lot like you’re trying to rip off an insurance company.
 
Fees, Billing and Accounts Standard

Working with Physiotherapist Assistants Standard

Questions? Contact the Practice Advisor

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