Ethics for Physiotherapists

Post-op Physio Classes

Mrs. Smith just had a total knee arthroplasty (TKA) and she has no private insurance to cover the costs of post-op rehabilitation. She’s not sure what to do, but she knows that her knee is getting more stiff by the day. On her daughter’s recommendation, she phones a couple of nearby physiotherapy clinics, and finds out that one is offering a program for patients who have had total knee replacements.

Mrs. Smith is right to seek post-operative physiotherapy care. The scientific literature supports post-op rehabilitation for TKA, however our province no longer funds this service. Providing post-op care in a private setting is a good option in order to have this service remain available. In order to make the fee for this service more affordable, it is reasonable to offer a program that includes treatment sessions with a physiotherapist supervising more than one client at a time. If you or your clinic decide to offer this type of program, there are a few important things to keep in mind in order that you ensure you are on side with referring to your program as a physiotherapy service and billing insurance for a physiotherapy session.

  • The program that you deliver must include an individual physiotherapy assessment with the findings properly documented. Clients may come together for treatment, but they must each have an individualized treatment plan. There must be regular documentation of the treatment and the response to treatment. These are not simply “fitness classes.”
  • The assessment and treatment must be carried out by a physiotherapist.
  • If you are providing the treatment sessions in a group setting, the client should be informed of and consent to that manner of supervision.
  • It is ethical to bill third party payers for physiotherapy sessions for medically indicated exercise supervised by a physiotherapist in a group setting. It is reasonable to set a reduced fee schedule for a service in a group setting.
  • The physiotherapist must provide individualized discharge planning with the client. The client will be discharged when appropriate, based on their progress. Discharge plans need to be documented.

As physiotherapists, we need to be responsive to the changing healthcare environment. We want to provide evidence-based, appropriate, cost-effective care to serve the public’s needs. This requires that we are constantly responding to perceived needs of the public. Historically, physiotherapy services have been charged to clients following a recommended fee schedule which included one fee for a treatment session, no matter what that included. Then it was suggested that having a fee schedule could be perceived as price fixing, and that was frowned upon as perhaps unethical. So every physiotherapy provider set their own fee schedule. Then physiotherapists started to acknowledge that some services we provide are more costly and the fee for those services should reflect that. Third party payers have accepted this expanded fee schedule. Now we are in a position where we can provide a valuable service to, in this example, a group of persons have undergone similar surgical procedures, in a therapeutically effective and cost-efficient manner. This solution allows us to remain dedicated to our most important ethical value – our duty of care to our clients, by providing timely, competent, appropriate care.

This case study was published in CPM’s In-Touch Newsletter  in May 2018