We’ll just call this Selena Unleashed part 1 (because I know there’s a part 2 brewing). Buckle in for the ride… Just as I feel fun and run really shouldn’t be used together, ancillary physical therapy services shouldn’t be used together.
If I take the definition of ancillary, what do I get? Supplementary… of secondary importance… and servant.
- Do physical therapists truly supplement a physician office visit? Heck no! In quite a few cases a physician office visit is an extraneous factor. Physical therapists can independently deliver or supervise physical therapy services. Vitamin D supplements calcium. Without Vitamin D, calcium absorption is limited. Physical therapists don’t help physicians be more effective. Physical therapists can make a physician look good in the eyes of a patient. From a patient’s perspective, there isn’t anything better than getting back to life. The patient may credit the physician for the good recommendation. The patient wouldn’t say a physical therapist was supplemental to the outcome. If a physical therapist doesn’t provide physical therapy services supplementary to a physician’s services, ancillary just isn’t the right term.
- Are physical therapists of secondary importance? So, let’s pretend physical therapists didn’t exist. The physician or surgeon keeps the person alive. Breathing and having a body in one piece is a good thing… a good first step and highly important. There you go… you got your body and you’re breathing. Job well done! <physician patting self on back> Is that what patients want? Is that what organizations want? I’d say from an inpatient hospital perspective no… saving $818,000 in a year isn’t some ancillary service.
- Are physical therapists servants? I never grew up with servants, but I’ve watched a few shows with them. What strikes me is the relationship between the master and the servant. The master demonstrates and describes in detail the activities the servant is to accomplish. The servant doesn’t think and just does. The things the servant does typically become routine in nature and automatic. Have you ever experienced a physician who could vividly describe and accurately demonstrate activities for a treatment session? Is a physical therapist on autopilot during the day doing a routine with every single patient and not needing to think? This just doesn’t fit servant, does it? Again, reality doesn’t fit the term ancillary.
Physical therapists are practitioners.
~Selena
Agreed. Same goes for other improper terms such as “script” (is physical therapy “scripted”?), and “orders” (are physical therapists orderlies?), and “incident to” (what does that even mean?). The system PT’s work in is certainly antiquated and not nearly a reflection of our training, expertise and patient outcomes. Our healthcare system thinks patient education, exercise, functional mobility, return to independent living, etc is “ancillary” or “secondary.” Neat. Dear Government, please explain in detail.
I wonder… Do we ask for consults? Do we suggest a referral to a physical therapist? Do our staff use “consult” and “referral” in every day language?
All great points Selena!
I recently wrote a letter to a physician who sent a prescribed treatment for a patient. I said that our clinic was based on a “referral for physical therapy consultation model” and that I had designed my clinic where the physical therapist would design and implement a plan of care based on the PT assessment. We get very few referrals from doctors these days, mostly self referral so I didn’t really care if the doc was insulted.
Herb, I agree completely. Would a PCP make a referral to an orthopedic surgeon (a specialist) and write down instructions with what they would like done? Absolutely not! I find it rather insulting that we are treated like ancillary workers when we are the musculoskeletal specialists. We are just as good, or better in some cases, at arriving at a PT diagnosis and implementing a proper plan than other specialists are withink their fields. To win the battle, I think we need to focus on educating doctors on the services we can provide. We just did an inservice at one of our clinics for TMJ/TMD and the surgeon and staff were astounded at the great lengths we go to to evalute and treat.
But, the term ancillary applies to many professions… the Anesthesiologist that puts the patient to sleep before the surgeon operates is considered in billing as an “ancillary” charge. The radiologist that reads the x-ray and gives report to the ER doctor (who then goes and tells the patient what their diagnosis is based on the info given) is also titled “ancillary”.
Could it be that Ancillary applies to the order of billing? Right now PTs do operate vastly under referrals.. So, their PCP or referring physician is the first point of contact billed about this particular diagnosis, and the PTs charges are subsequent. (Or, it’s how it began and now insurnce companies and the medical world are set in their ways)
I agree it is antiquated terminology, but I used to work in a hospital billing dept- it’s such standard phrasing, I must be desensitized to it’s implications.