Delay in Initiation of PT/OT Services Due to Authorization Lapse
Penalty
Summary
A deficiency occurred when a resident with impaired mobility and diagnoses of muscle wasting, atrophy, and muscle weakness was not provided with timely physical therapy (PT) and occupational therapy (OT) services as ordered by their physician. The resident required moderate assistance with activities of daily living, including toileting, bathing, dressing, and transfers, and used a manual wheelchair. The Minimum Data Set (MDS) confirmed the resident's intact cognition and functional limitations. The physician's order for PT and OT services was placed, but there was a 30-day delay before the therapies were initiated. The delay was attributed to the rehabilitation department not following up on the required authorization for therapy services. The Director of Rehabilitation (DOR) acknowledged responsibility for tracking and following up on therapy orders and authorizations but did not act until a month after the initial order. The Clinical Chief Officer (CCO) confirmed that the facility's process requires the rehabilitation department to ensure timely authorization and implementation of therapy orders, which typically should not exceed one week. Facility policy and procedure documents reviewed indicated that the DOR is responsible for tracking residents' therapy needs and ensuring timely and accurate clinical documentation. The policies also outlined the responsibilities of the supervising occupational therapist to confirm and implement therapy orders, consult with physicians, and coordinate care. Despite these policies, the resident's therapy services were delayed, resulting in a 30-day gap between the order and the initiation of PT and OT evaluations and treatments.