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A group rate?
A variety of circumstances regarding payment for services can challenge the ethical decisionmaking skills of physical therapists (PTs) and physical therapist assistants (PTAs) regardless of practice setting. This month's scenario is the last of three exploring ethical issues related to reimbursement.12 Look for an analysis of all three scenarios in next months issue of PT.
As you read, use the Realm-Individual Process-Decision Making (RIPS) model of ethical decision-making3 to decide if the behavior is inappropriate and if those who become aware of the behavior have ethical challenges they must address.
To Halve or Halve Not?
After reading the following scenario, look at the accompanying boxes-Components of the RIPS Model (at right) and the APTA Code of Ethics on page 54-consult the Ethics in Action column "Ethical Decision Making: Terminology and Context,"4 and use the guiding questions within each of the steps to ethical decision-making to help crystallize your thoughts.
Mrs Smith is sent to physical therapy by her physician for two problems. She finds it curious that both things are occurring on the right side of her body. The first is cervical pain she has been experiencing for months. It doesn't seem to be lessening significantly despite the fact that she has tried a variety of sleeping positions and recently purchased an expensive special pillow.
Over the past 3 weeks she also has felt pain in her right elbow. Since she is right handed and this was beginning to affect her job, she alerted her doctor. He diagnosed a cervical strain and elbow tendinitis.
She's hesitant to begin multiple physical therapy sessions because she must leave work early to meet her appointments and is using vacation time for the visits.
As her PT, you assess Mrs Smith's cervical problem and determine that she actually may have a cervical impingement-which certainly would cause elbow pain. Because the policy at your facility is to treat only one diagnosis per day, however, she is scheduled for appointments on Monday, Wednesday, and Friday for her cervical problem and on Tuesday, Thursday, and Saturday for her elbow pain.
Your patient accepts this rigorous schedule but you know it is difficult for her. If the interventions for Mrs Smith can be delivered effectively in three sessions...