Practice area 173 CLINICAL PRIVILEGE WHITE PAPER Background Physical therapist Physical therapy involves the evaluation and treatment of patients recovering from injury or disease. Physical therapy practitioners provide these patients with services that restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities. Services include examining patients medical histories as well as testing and measuring strength, range of motion, balance and coordination, posture, muscle performance, respiration, and motor function. Physical therapists (PTs) then develop treatment plans that often include exercise for patients who may lack flexibility, strength, or endurance. They encourage the patients to use their own muscles to increase flexibility and range of motion before finally advancing to other exercises that improve strength, balance, coordination, and endurance. The goal is to improve how an individual functions at work and at home. They also help determine patients ability to be independent and reintegrate into the community or workplace. PTs should be able to demonstrate that they have completed an accredited program in physical therapy and that they have passed a state-administered licensure examination. Some PTs choose to specialize, and they may obtain certification from the American Board of Physical Therapy Specialties (ABPTS). The ABPTS coordinates and oversees the certification process in the following physical therapy specialties: Cardiovascular and pulmonary Clinical electrophysiology Geriatric Neurologic Orthopedic Pediatric Sports Beginning with the 2001 examinations, the ABPTS amended the policy on minimum practice eligibility requirements to 2,000 hours of direct patient care in the specialty area within the last 10 years. Twenty-five percent of this patient care must have occurred within the last three years. This change was made so that clinicians with less experience in specialty areas, or those PTs who do not engage in full-time clinical A supplement to Briefings on Credentialing 781/639-1872 6/04 1
practice, can take the examination if they feel they have the appropriate level of knowledge and skill. The standards for the specialist certification examination have not been affected by the change in eligibility requirements. Positions of societies and academies APTA In regard to educational programs for physical therapy students, the American Physical Therapy Association (APTA) advocates a postbaccalaureate degree. APTA believes that a postbaccalaureate program more adequately prepares the graduate to meet the expectations of the profession and the healthcare needs of society. This is because the volume of scientific technology and literature included in PT education programs has grown well beyond what can be reasonably included in a baccalaureate degree program. APTA also points out that as of January 1, 2002, the Commission on Accreditation in Physical Therapy Education, which is recognized as the accrediting agency for education programs in physical therapy by the U.S. Department of Education and the Council for Higher Education Accreditation, no longer accredits baccalaureate professional programs. The majority of physical therapy programs offer a master s degree, but a growing number of programs offer the doctor of physical therapy degree. Currently, more than 200 colleges and universities nationwide offer professional education programs in physical therapy. Positions of other interested parties ABPTS The ABPTS has established minimum eligibility requirements to sit for one or more of the seven specialty-area certification exams. In addition to holding a current license to practice physical therapy in the United States or any of its possessions or territories, applicants must satisfy the requirements for each of the following specialty areas in which they seek certification: Cardiovascular & pulmonary physical therapy Applicants must be currently certified in advanced cardiac life support by the American Heart Association. have completed 2,000 hours of direct patient care in the area of cardiovascular and pulmonary physical therapy within the last 10 years, 25% of which must have occurred 2 A supplement to Briefings on Credentialing 781/639-1872 6/04
within the last three years. submit written evidence of participation in a research process directly related to the specialty area within the last 10 years. This submission should be in the form of a brief statement that describes specific involvement and an abstract that summarizes the project in which the applicant participated. The submission should be written in standard form; e.g., purpose, methods, results, conclusions. Acceptable research processes include single-subject studies, treatment efficacy studies, surveys, and formal clinical trials. The Cardiovascular & Pulmonary Specialty Council recommends that direct patient care include patient/client management of individuals with a primary injury, disease, or other condition involving the cardiovascular and pulmonary system in both acute and rehabilitation settings. Clinical electrophysiologic physical therapy Applicants must have completed 2,000 hours of direct patient care in the area of clinical electrophysiologic physical therapy within the last 10 years, 25% of which must have occurred within the last three years include evidence of performing a minimum of 500 complete electroneuromyography examinations during their hours of direct patient care submit evidence of clinical education in electrophysiologic testing, preferably under the direct supervision of a clinical electrophysiologist who meets the requirements for specialist certification submit actual patient reports that have been completed within the last three years, including the entrapment of a peripheral nerve, a proximal lesion such as a root or plexus, and a polyneuropathy that demonstrates sampling of at least three extremities A supplement to Briefings on Credentialing 781/639-1872 6/04 3
Geriatric physical therapy Applicants must submit evidence of one of the following: 2,000 hours of direct patient care in the area of geriatric physical therapy within the last 10 years, 25% of which must have occurred within the last three years 2,000 hours of direct patient care in the specialty area within the last 10 years to include completion of an APTAcredentialed clinical residency in geriatric physical therapy The Geriatric Specialty Council strongly recommends that specialty area experience be obtained in more than two areas of practice such as acute care, outpatient, long-term care, homehealth care, subacute rehabilitation, short-term rehabilitation, or wellness center. Neurologic physical therapy Applicants must submit evidence of one of the following: 2,000 hours of direct patient care in the specialty area within the last 10 years, 25% of which must have occurred within the last three years 2,000 hours of direct patient care in the specialty area within the last ten years to include completion of an APTAcredentialed clinical residency in neurologic physical therapy Orthopaedic physical therapy Applicants must submit evidence of one of the following: 2,000 hours of direct patient care in the specialty area within the last 10 years, 25% of which must have occurred within the last three years Successful completion of an APTA-credentialed postprofessional clinical residency that has a curriculum plan reflective of the publication Orthopaedic Physical Therapy: Description of Specialty Practice 4 A supplement to Briefings on Credentialing 781/639-1872 6/04
Pediatric physical therapy Applicants must submit evidence of 2,000 hours of direct patient care in the specialty area within the last 10 years, 25% of which must have occurred within the last three years Sports physical therapy Applicants must be currently certified in cardiopulmonary resuscitation (CPR) by completing the American Heart Association s BLS [basic life support] Healthcare Provider Course or the American Red Cross course CPR for the Professional Rescuer. first aid. Acceptable training includes the American Red Cross Emergency Response course, certification as an emergency medical technician, paramedic, or certification by the National Athletic Trainers Association as a certified athletic trainer. Applicants may submit the syllabus and description of an equivalent advanced-level emergency-care training to the Specialty Council for review. The Council will determine whether the training meets this eligibility requirement. In addition, applicants must submit evidence of one of the following: 2,000 hours of direct patient care in the specialty area within the last 10 years, 25% of which must have occurred within the last three years 2,000 hours of direct patient care in the specialty area within the last 10 years to include completion of an APTAcredentialed clinical residency in sports physical therapy Applicants who wish for certification in more than one specialty area must submit a complete set of application materials for each specialist certification exam. Certified specialists who apply for certification in a second specialty area are not permitted to submit the same direct patient care hours that they submitted for certification in the first specialty area. JCAHO The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has no formal position on the delineation of privileges in physical therapy. However, in regard to qualifications for physical therapists, hospitals must comply with the following human resources (HR) and leadership (LD) A supplement to Briefings on Credentialing 781/639-1872 6/04 5
standards from the 2004 Comprehensive Accreditation Manual for Hospitals: LD.3.70 The leaders define the required qualifications and competence of those staff who provide care, treatment, and services and recommend a sufficient number of qualified and competent staff to provide care, treatment, and services HR.1.10 The organization provides an adequate number and mix of staff consistent with the organization s staffing plan HR.1.20 The organization has a process to ensure that a person s qualifications are consistent with his or her job responsibilities HR.2.10 Orientation provides initial job training and information HR.2.20 Staff members, licensed independent practitioners, students, and volunteers can describe or demonstrate their roles and responsibilities, based on specific job duties or responsibilities, relative to safety HR.2.30 Ongoing education, including in-services, training, and other activities, maintains and improves competence HR.3.10 Competence to perform job responsibilities is assessed, demonstrated, and maintained HR.3.20 The organization periodically conducts performance evaluations CRC draft criteria When a hospital receives a request from a physical therapist to become a member of the hospital staff or to work within the hospital at the request of a physician, a patient, or a patient s family member, or to do volunteer work within the hospital, it should not be the first time the hospital considers whether this type of practitioner should be granted privileges. The policy covering physical therapists should be drafted ahead of time by the board to resolve any liability, peer-review, and reimbursement issues. In addition, the board should review federal laws, state laws, and state and local licensing requirements. The advice of the medical staff should be considered as 6 A supplement to Briefings on Credentialing 781/639-1872 6/04
well as the needs of the community and the hospital s mission and strategic plan. In addition to referencing JCAHO standards for the required qualifications and competence of PTs, the board should also reference what the Commission on Accreditation of Rehabilitation Facilities requires for PTs. In addition, the board should reference any standards for PTs that payers such as Medicare, health maintenance organizations, and workers compensation programs may require. Criteria should be in place covering qualifications, scope of practice, and physician supervisory requirements. The following draft criteria are intended to serve solely as a starting point for the development of an institution's policy regarding this practice area. Minimum threshold criteria for requesting core privileges in physical therapy References Core privileges in physical therapy Basic education and minimum formal training: Applicants must have successfully completed an accredited physical therapy educational program and passed a state-administered licensure examination. Required previous experience: Applicants must be able to demonstrate that they have provided at least 2,000 hours of direct patient care in the physical therapy area in which they are seeking privileges. In addition, applicants should have provided physical therapy services to at least 50 patients in the past 12 months. A letter of reference must come from the director of the applicant s physical therapy training program. Alternatively, a letter of reference regarding competence should come from the chief of physical therapy at the institution where the applicant most recently practiced. Core privileges in physical therapy include but are not limited to the following: Review and evaluate the conditions and medical records of patients Perform tests and/or measurements and interpret findings A supplement to Briefings on Credentialing 781/639-1872 6/04 7
Develop programs for treatment plans in accordance with a physician s directions Help patients attain maximum muscle strength and motor skills as well as accept and adjust to the limiting effects of disabilities Employ methods such as electrical stimulation, hot packs or cold compresses, and ultrasound to relieve pain and reduce swelling Utilize traction or deep-tissue massage to relieve pain Instruct patients in the use of assistive and adaptive devices, such as crutches, prostheses, and wheelchairs Consult and practice with other professionals, such as physicians, dentists, nurses, educators, social workers, occupational therapists, speech-language pathologists, and audiologists Reappointment Reappointment should be based on unbiased, objective results of care according to the organization s existing quality-assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided physical therapy services to at least 50 patients annually over the reappointment cycle in the physical therapy area in which they are seeking to renew privileges. In addition, continuing education related to physical therapy techniques and equipment should be required. For more information For more information regarding this practice area, contact: American Physical Therapy Association 1111 North Fairfax Street Alexandria, VA 22314-1488 Telephone: 703/684-2782 Fax: 703/684-7343 Web site: www.apta.org 8 A supplement to Briefings on Credentialing 781/639-1872 6/04
American Board of Physical Therapy Specialties 1111 North Fairfax Street Alexandria, VA 22314-1488 Telephone: 703/684-2782 Fax: 703/684-7343 Web site: www.apta.org/education/specialist/abptscert/ Commission on Accreditation of Rehabilitation Facilities 4891 East Grant Road Tucson, AZ 85712 Telephone: 520/325-1044 Fax: 520/318-1129 Web site: www.carf.org Joint Commission on Accreditation of Healthcare Organizations One Renaissance Boulevard Oakbrook Terrace, IL 60181 Telephone: 630/792-5000 Fax: 630/792-5005 Web site: www.jcaho.org A supplement to Briefings on Credentialing 781/639-1872 6/04 9
Privilege request form Physical therapist In order to be eligible to request clinical privileges in physical therapy, an applicant must meet the following minimum threshold criteria: Basic education and minimum formal training: Applicants must have successfully completed an accredited physical therapy educational program and passed a state-administered licensure examination. Required previous experience: Applicants must be able to demonstrate that they have provided at least 2,000 hours of direct patient care in the physical therapy area in which they are seeking privileges. In addition, applicants should have provided physical therapy services to at least 50 patients in the past 12 months. References: A letter of reference must come from the director of the applicant s physical therapy training program. Alternatively, a letter of reference regarding competence should come from the chief of physical therapy at the institution where the applicant most recently practiced. Core privileges: Core privileges in physical therapy include but are not limited to the following: - Review and evaluate the conditions and medical records of patients - Perform tests and/or measurements and interpret findings - Develop programs for treatment plans in accordance with a physician s directions - Help patients attain maximum muscle strength and motor skills as well as accept and adjust to the limiting effects of disabilities - Employ methods such as electrical stimulation, hot packs or cold compresses, and ultrasound to relieve pain and reduce swelling - Utilize traction or deep-tissue massage to relieve pain - Instruct patients in the use of assistive and adaptive devices, such as crutches, prostheses, and wheelchairs - Consult and practice with other professionals, such as physicians, dentists, nurses, educators, social workers, occupational therapists, speech-language pathologists, and audiologists Reappointment: Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided physical therapy services to at least 50 patients annually over the reappointment cycle in the physical therapy area in which they are seeking to renew privileges. In addition, continuing education related to physical therapy techniques and equipment should be required. I understand that by making this request I am bound by the applicable bylaws or policies of the hospital, and hereby stipulate that I meet the minimum threshold criteria for this request. Applicant s signature: Typed or printed name: Date: 10 A supplement to Briefings on Credentialing 781/639-1872 6/04
Clinical Privilege White Papers Advisory Board James F. Callahan, DPA Executive vice president and CEO American Society of Addiction Medicine Chevy Chase, MD Sharon Fujikawa, PhD Clinical professor, Dept. of Neurology University of California, Irvine Medical Center Orange, CA John N. Kabalin, MD, FACS Urologist/Laser surgeon Scottsbluff Urology Associates Scottsbluff, NE Publisher/Vice President: Suzanne Perney sperney@hcpro.com Executive Editor: Dale Seamans dseamans@hcpro.com John E. Krettek Jr., MD, PhD Neurological surgeon Vice president for medical affairs Missouri Baptist Medical Center St. Louis, MO Michael R. Milner, MMS, PA-C Senior physician assistant consultant Phoenix Indian Medical Center Phoenix, AZ Senior Managing Editor: Edwin B. Niemeyer eniemeyer@comcast.net Beverly Pybus Senior consultant The Greeley Company Marblehead, MA Richard Sheff, MD Chair and Executive Director The Greeley Company, a division of HCPro, Inc. Marblehead, MA The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Copyright 2004 HCPro, Inc., Marblehead, MA 01945. A supplement to Briefings on Credentialing 781/639-1872 6/04 11