Alex Bendersky (00:00) always.

Dana Strauss (00:00) Hello everyone and welcome to episode 9 of the Future Proof PT podcast. I am here with my co-host Alex Bendersky, our guest who has joined us willingly for a second round, Ben Gallin. And today we're going to talk about the role of physical therapist assistants and certified occupational therapy assistants

We're going to talk about our experiences in working with them in the past, all of us being more mature therapists who've had windy careers and a chance to experience different work environments. And then thinking about what the career ceiling looks like that some therapist assistants talk about, sort of what we think the different options are that maybe they should be thinking about What kind of different paths have we seen work? So.

Let's start it there. Before we started Ben, you had brought up something that I think might be great to talk about, and that was how it shouldn't be a cookie cutter way of utilizing therapist assistants in an outpatient setting. So if you want to start, that would be awesome.

Ben Galin (01:04) Sure, I mean, I've worked alongside therapist assistants since my internships in the hospital setting, SNF setting, home health setting, outpatient setting. I have worked in some settings where there aren't any for one reason or another, but I'd say majority of the time, yes. And I'd say the pitfall.

that tends to gotten into where there kind of is a, are we utilizing PTAs and COTAs correctly is when no different than a pitfall of three times a week for four units as we were discussing the last time, is this concept of I'm gonna operationalize a PTA or COTA where I just, I being some management position says,

PTs do the evals, PTs do the progress, PTs do the discharge, research, and then I'm gonna stick a PTA in between that model because it brings my cost down, which obviously in an outpatient world with a 15 % cut, if you do the math, usually actually you're better off not bringing your cost down, but bringing your revenue up, but not using the PTA. But in most models, home health, facility-based stuff where it makes sense, the pitfall that I've seen is it's really this operational model where it's all in or all out.

We use PTAs, we don't use PTAs. We use coders, we don't use coders. And in those models, is literally like I do the eval and I will see them again, even though the law is at least the 10th visit, magically just like SNFs, know, 21 days and all the fun stuff, home health. I will magically see them on the 10th visit. And...

I would say even if there was a concern from the PTA earlier than that, the likelihood of us texting about it may be high, assuming that we're using secure text, But the likelihood of someone doing something about it's low because there wasn't a scheduling operational pattern of saying, should this patient not?

be stable and the care plan looks like it needs to be adjusted frequently, then I should be contacting the patient earlier. And what I say to the end of this is it's really about the right provider at the right time, which is upon that evaluation, like on my care plans, I usually put something like the patient's appropriate to be followed by a PTA. And I kind of write a little statement.

But I probably sign that on every single document. And the reality should be, there are some patients who are so unstable and unpredictable in the beginning, that really what's the harm of going like, I'm gonna hold onto this patient for four visits to make sure that they're stable enough to a point where I'm like, you know what? I now believe that it's still skilled care, but it's predictable skilled care. I can write up a care plan that can be modified and adjusted so it falls in the bounds of the-

I'll write up a plan that's going to be adjustable and fluctuating based on the progress that I'm expecting. Instead of only waiting till an escalation of that 10th visit or whatever.

that I'm following that makes me see them, there should be a mantra of like the right person at the right time, but that means that the care plan needs to be steered to be the right person at the right time, which is hard to operationalize when every single patient I see, I don't know if I need to see them three or four times, two or three times, or once every tenth visit, but that's probably the way that it should be.

Alex Bendersky (04:09) I think it's like anything else where by design the PTA, COTA are supposed to be the extension of care services. So by design, the PT and OT writes up the plan of care and then the execution is done by well-trained clinician who is an extension of service. So then they deliver this type of care. So then the PT does the triage, the screening for red flags and identifies

opportunities for the optimal care delivery and then the care delivery occurs from the PTA OTA right. The reality though is that I have met some really brilliant PTAs and COTAs that probably a pound for pound are exponentially more valuable to the

clinical community than any PT. And so the question here is that the level of autonomy and the level of agency that PTAs experience and the COTA experience is determined and defined by each organization rather than having some kind of a global appreciation understanding. So based on setting, based on...

platform, right? You have a PTA that's going to be taken on just a majority of responsibility and then PT just signs off in the notes. Or you have settings which really I think do a really good job operationalizing it where they would have a ratio of PT to PTA where a PT has a core responsibility of onboarding patients and screening. PTA has core responsibility of care delivery and then there's a documented pacing for when

this occurs, whether it's 10th visit or 8th visit in order to be in compliance, but also in order to provide best care. I think that is the gist, and I think as we continue to have this conversation we can explore how this discipline, this wonderful discipline, can be leveraged to optimize care delivery,

Dana Strauss (05:58) Something that you said reminded me of something in nursing that I've been told is a challenge for hospitals and I'm thinking there may be a parallel here. So let me know what you think guys. So in some hospitals that are looking for Magnet designation, are you guys familiar with that term? Magnet designation has to do with the quality of their nursing care.

It designates a hospital as very high quality nursing. And one of the requirements for that is I believe it's 80 % of the RNs have to be BSNs.