Physical Therapists' Ethical Dilemmas in Treatment, Coding, and Billing for Rehabilitation Services in Skilled Nursing Facilities: A Mixed-Method Pilot Study.

OBJECTIVES: Reimbursement in skilled nursing facilities (SNFs) is driven by the number of minutes a patient receives rehabilitation. Physical therapists' (PTs) clinical decisions in evaluation and appropriate treatment of patients drive the dosing of rehabilitation services. Many times these 2 dynamics clash. The purpose of this study was to determine how PTs in SNFs viewed their ethical work environment, what primary issues drove their views, and what potential solutions were identified for the issues. DESIGN: This was a mixed-methods, cross-sectional survey study. SETTING AND PARTICIPANTS: An organizational ethics survey along with 2 open-ended questions were sent to a random sample of 1200 PTs in the state of Georgia; 340 surveys were returned, and the respondents were categorized into 9 typical PT work settings. Twenty eight participants (8.2%) reported they worked in SNFs. MEASURES: The Ethics Environment Questionnaire was the quantitative measurement tool used for the study. In addition, 2 open-ended questions were asked regarding ethical concerns and possible solutions to those concerns. RESULTS: Of the 9 workplace settings, therapists working in SNFs had the lowest perceptions of ethical work environment. They were also the only group that scored below the survey cut-off point for positive ethical work environment. Their primary concerns were overutilization issues, productivity standards, and billing and coding issues. The 2 primary themes regarding solutions were allowing PTs to be autonomous in their decision making and decreasing productivity standards. CONCLUSIONS/IMPLICATIONS: The current Medicare reimbursement system rewards quantity of rehabilitation over quality. PTs are trained to deliver quality care that is dosed appropriately, and this may conflict with organizational objectives. The primary implication in this study is that clinicians and administrators should engage more in open, honest dialogue on how to share responsibility and balance organizational goals with clinical ethics.

The Spanish Adaptation of the Interpersonal Sexual Objectification Scale (ISOS) / Adaptación española de la Escala de Cosificación Sexual Interpersonal (ISOS)

BACKGROUND: Sexual objectification of women is a subtle manifestation of gender violence. The aim of this study was to adapt the 15-item Interpersonal Sexual Objectification Scale (ISOS) to Spanish to obtain a valid instrument to evaluate this construct. METHOD: After its adaptation, the questionnaire was administered to 771 women from the general population. Subsequently, the psychometric properties of the questionnaire were evaluated from both the classical perspective and item response theory. RESULTS: The data obtained were very similar to those of the original version. The ISOS showed good internal consistency and a two factor structure: body evaluation and unwanted explicit sexual advances. In addition, the ISOS showed correlations with benevolent sexism, state anxiety and self-esteem. CONCLUSIONS: The Spanish version of the ISOS is a reliable and valid measure of sexual objectification of women in the interpersonal context

ANTECEDENTES: la cosificación sexual de la mujer es una manifestación sutil de violencia de género. El objetivo de este estudio fue realizar la adaptación al español de la escala Interpersonal Sexual Objectification (ISOS) de 15 ítems para contar con un instrumento adecuado a la hora de evaluar dicho constructo. MÉTODO: tras adaptar el cuestionario se aplicó a 771 mujeres de población general. Posteriormente se evaluó las propiedades psicométricas del cuestionario desde la perspectiva clásica y de Teoría de la Respuesta a los Ítems. RESULTADOS: los datos obtenidos fueron muy similares a los de la versión original. La ISOS mostró muy buena consistencia interna y una estructura bifactorial: evaluación corporal y aproximaciones explícitas no deseadas. Además, la ISOS mostró correlaciones con sexismo benévolo, ansiedad-estado y autoestima. CONCLUSIONES: la versión española de la ISOS se muestra como una medida fiable y válida de cosificación sexual de la mujer en el contexto interpersonal

Ethical and educational considerations in coding hand surgeries.

PURPOSE: To assess treatment coding knowledge and practices among residents, fellows, and attending hand surgeons. METHODS: Through the use of 6 hypothetical cases, we developed a coding survey to assess coding knowledge and practices. We e-mailed this survey to residents, fellows, and attending hand surgeons. In additionally, we asked 2 professional coders to code these cases. RESULTS: A total of 71 participants completed the survey out of 134 people to whom the survey was sent (response rate = 53%). We observed marked disparity in codes chosen among surgeons and among professional coders. CONCLUSIONS: Results of this study indicate that coding knowledge, not just its ethical application, had a major role in coding procedures accurately. Surgical coding is an essential part of a hand surgeon's practice and is not well learned during residency or fellowship. Whereas ethical issues such as deliberate unbundling and upcoding may have a role in inaccurate coding, lack of knowledge among surgeons and coders has a major role as well. CLINICAL RELEVANCE: Coding has a critical role in every hand surgery practice. Inconstancies among those polled in this study reveal that an increase in education on coding during training and improvement in the clarity and consistency of the Current Procedural Terminology coding rules themselves are needed.

Codificación clínica con la CIE9MC / No disponible

No disponible

Treatment of refractory headache: potential conflicts of interest in coding.

Issues directly or indirectly related to the increasing costs of health care services have the potential to adversely affect physicians' fiduciary responsibilities to their patients. Coding deception in response to perceived unfairness in reimbursement practices represents one of these potential adverse influences. This case discussion addresses the potential motivations underlying coding deception and the reasons it cannot be supported from either a legal or ethical perspective.

A model of a code of ethics for tissue banks operating in developing countries.

Ethical practice in the field of tissue banking requires the setting of principles, the identification of possible deviations and the establishment of mechanisms that will detect and hinder abuses that may occur during the procurement, processing and distribution of tissues for transplantation. This model of a Code of Ethics has been prepared with the purpose of being used for the elaboration of a Code of Ethics for tissue banks operating in the Latin American and the Caribbean, Asia and the Pacific and the African regions in order to guide the day-to-day operation of these banks. The purpose of this model of Code of Ethics is to assist interested tissue banks in the preparation of their own Code of Ethics towards ensuring that the tissue bank staff support with their actions the mission and values associated with tissue banking.