Can occupational therapists and physical therapists share patients when working together in the same hand therapy clinic?
The short answer is a qualified “Yes”. It takes some extra diligence and communication on the part of both professionals as well as your support staff, but it can be done. Legally, occupational and physical therapy are separate professions, and the requirements must be met for each profession. As an OT, I have shared patients with PT colleagues in an outpatient facility attached to a physician group as well as a freestanding therapist owned clinic. I have not done so in a hospital facility, and there may be facility considerations or rules in addition to the following things.
And there's always a longer answer..... with more to think about.
Both disciplines are qualified to treat the patient independently, and if you are both caring for the same patient in an overlapping time period, you are essentially treating in parallel... 2 separate evaluations and treatment plans. When considering documentation requirements and systems to facilitate this arrangement, I try to consider that each discipline should have a clear evaluation, plan of care and supporting documentation that could stand alone if it were considered independent of the other discipline.
There are several possible scenarios; two common ones would be:
- Two CHTs (OT and PT) treating the same patient for the same condition. Maybe the primary therapist is on vacation and their colleague is covering their caseload.
- Another might be a patient with several areas of concern, with one discipline focusing on one area and the other focusing on another.
Here are some areas to consider that might vary in a shared discipline scenario.
Scheduling: It may be best practice to schedule OT and PT on different days, which would likely be the case if you are both treating the patient for the same condition.
Documentation: The physician referral is usually written for one discipline or the other. A referral to “hand therapy” can mitigate this problem, although occasionally can cause payment or authorization issues. We sent all of our evaluations (in this case both occupational and physical therapy for the same patient) to a physician or provider for signatures, and I believe that meets the requirement for a "referral" or "prescription". In the scenario above, two evaluations would be signed, so you would have a "prescription" (signed plan of care) for each discipline.
o There are no changes to billing. Each discipline charges as they would any other course of treatment, with the appropriate modifiers to identify which discipline treated the patient for a particular visit.
o One possible exception is the evaluation. When I have done this before, we did not charge for the 2nd evaluation, and it was a "light" version that made some reference to the first discipline’s existing measurements/status/conditions... but enough that if the 2nd discipline's treatment was reviewed, it would be clear that there was a clear evaluation and progression of treatment if those notes were reviewed in isolation of the first discipline.
o I don't know that it would be "technically" illegal or inappropriate for both disciplines to charge for the evaluation, but for me, it did not pass the “sniff test” in explaining it to the patient, regulators, or payers.
Payment: It is important to remember that the disciplines may or may not be sharing the patient’s insurance benefits. Some plans have a combined benefit, and some have a separate “bucket” of benefits for each discipline. This is a possible benefit to the patient if they are separated.
Communication: It is important to be clear with the patient and the referring physician as needed to prevent or respond to any questions or concerns.
Regulatory: I don't know of any specific concerns... each discipline must follow their own standards of care, state and insurance regulations.
Some facilities will “cross over” or share upper extremity patients only when they have multiple diagnoses or if they feel there is a more proximal (i.e., cervical or thoracic) component to the patient’s distal conditions. It largely depends on the skill set of each practitioner and how to get the best outcome for the patient.
This question definitely goes in the frequently asked questions category! Hand therapy is an advanced practice area that blends the basic knowledge of both professions to care for people with upper extremity conditions. Certified Hand Therapists (CHTs) have traditionally been 85% occupational therapists and 15% physical therapists. Often it is a beautiful collaboration, and I love working with colleagues from both backgrounds!