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Institutional types & practice environments
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Institutional types & practice environments


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  • 1. ACUTE CARE (SHORT-TERM HOSPITAL) Treatment for a short-term illness or health problem Average patient length of stay is <30 days. Usual length of stay is <7 days Provider may be a physician, physician assistant, nurse, physical therapist, etc. Rapid discharge for next level of care makes the PT’s role in patient and family education and in discharge planning increasingly important
  • 2. PRIMARY CARE Basic or first-level, health care Provided by primary care physicians Including primary practice physicians, pediatricians, internists, and sometimes obstetric/gynecologic physician specialists Provided on an outpatient basis PT’s support primary care teams through examination, evaluation, diagnosis, prognosis and prevention of musculoskeletal and neuromuscular disorders Often the PCP is the “gatekeeper” to other subspecialists, including PT
  • 3. SECONDARY CARE (SPECIALIZED CARE) Second-level medical services Provided by medical specialists, such as cardiologists, urologists and dermatologists, who do not have first contact with patients This care often requires inpatient hospitalization or ambulatory same-day surgery such as hernia repair
  • 4. TERTIARY CARE (TERTIARY HEALTH CARE) Highly specialized, technologically based services (heart, liver or lung transplants and other major surgical procedures) Provided by highly specialized physicians in a hospital setting PT’s respond to requests for consultation made by other health-care practitioners
  • 5. SUBACUTE CARE An intermediate level of health care for medically fragile patients too ill to be cared for at home Provided by medical and nursing services as well as rehabilitative services; (PT, OT, ST) at a higher level than is offered in a skilled nursing facility on a regular basis Provided within the hospital or SNF setting
  • 6. TRANSITIONAL CARE UNIT Hospital-based skilled nursing facility (SNF) Care provided by medical, nursing and rehabilitation services on a daily basis Patients are often discharged home, to assisted living facilities or SNF’s
  • 7. AMBULATORY CARE (OUTPATIENT CARE) Includes outpatient preventative, diagnostic and treatment services Provided at medical offices, surgery centers, or outpatient clinics Providers may be physicians, physician assistants, nurse practitioners, PTs and others Less costly than inpatient care. Favored by managed-care plans Outpatient rehabilitation centers, or PT clinics, out-patient satellites of instructions or privately owned outpatient clinics
  • 8. SKILLED NURSING FACILITY (EXTENDED CARE FACILITY) Free standing or part of a hospital Care provided by continuous nursing, rehabilitation and other health-care services on a daily basis Medicare defines “daily” as 7 days a week of skilled nursing and 5 days a week of skilled therapy Patients are not in an acute phase of illness, but require skilled care on an inpatient basis SNFs must be certified by Medicare, and meet qualifications including 24-hour nursing coverage, availability of PT, OT and ST
  • 9. ACUTE REHABILITATION HOSPITAL Facility that provides rehabilitation, social and vocational services to disabled individuals to facilitate their return to maximal functional capacity Rehabilitation involves the coordinated services of medical, rehabilitative, social, educational and vocational services for training or retraining
  • 10. CHRONIC CARE FACILITY (LONG-TERM CARE FACILITY) Long-term care facility provides services to patients equal or beyond 60 days Medical services provided to patients with permanent or residual disability caused by a nonreversible pathological health condition May require specialized care/rehabilitation
  • 11. CUSTODIAL CARE FACILITY Patient care that is not medically required but necessary for the patient who is unable to care for him/herself Custodial care may involve medical or nonmedical services that do not seek a cure This type of care is usually not covered under manage-care plans Daily care is delivered by nonmedical support staff
  • 12. HOSPICE CARE Care available for dying patients and their family at home or inpatient settings Hospice team includes: nurses, social workers, chaplains, volunteers and physicians. PT and OT services are optional Medicare and Medicaid require at least 80% of hospice care to be provided at home Eligibility for reimbursement includes: Medicare eligibility Certification by physician of terminal illness (less than or equal to 6months of life)
  • 13. HOME HEALTH CARE Health care provided to individuals and their families in their homes Provided by a home health agency, which may be governmental, voluntary, or private nonprofit or for-profit Patient eligibility includes:  Homebound or has great difficulty leaving the home without assistance or any assistive device  Health risk leaving the ho9me  Requires skilled care from one of the following services: nursing, PT, OT or ST  Physician certification  Potential for progress  More than housekeeping deficits
  • 14. HOME HEALTH CARE Environmental safety is consideration of PT like proper lighting, securing of scatter rugs, handrails, wheelchair ramps Supplemental equipment may be necessary like raised toilet seats, grab bars, long-handled utensils, if delivered by a licensed durable medical equipment vendor to the home at the time of discharge from the hospital
  • 15. HOME HEALTH CARE Adaptive equipment ordered in the home is not reimbursable except for items such as wheelchairs, commodes, hospital beds Substance abuse should be reported immediately to the physician Physical abuse should be communicated immediately and directly to the proper authorities specially if child abuse is suspected The laws that mandate reporting of abuse of an elder, disabled individual or minor may vary from state to state
  • 16. SCHOOL SYSTEM The PT serves as a consultant to teachers who work with students with disabilities in the classroom Major goal of PT treatment is the child’s functioning in the school setting Recommendations are made for adaptive equipment to facilitate improved posture, head control and functions like using a computer viewing a blackboard, improving mobility from class to class
  • 17. PRIVATE PRACTICE Entrepreneurial PTs that work for or own a free standing independent PT practice May accept all insurances if they have provider numbers Settings may vary from sports physical therapy and orthopedic clinics, rehabilitation agencies, occupational health Must document every visit and complete reevaluation at least every 30 days for reimbursement purposes