What expectations should I have for a PTA student as compared to a PT student?
Confusion related to expectations for PTA student performance typically fall into one of two categories. Either (1) the SPTA is expected to exhibit competency with skills appropriate for the SPT and beyond the training and education of the SPTA or (2) the SPTA is held to expectations more consistent with PT technician training and is not challenged to perform to their level of education.
Some of the more common issues or examples are outlined below. Clinical instructors are encouraged to contact the PTA Program’s ACCE with any specific or additional questions related to appropriate SPTA supervision, practice and goals/expectations for performance.
|Expectations too HIGH for PTA level education/training||JUST RIGHT||Expectations too LOW for PTA level education/training|
What are the current LA PT Board rules regarding clinical education/supervision of PTA students?
Student PTAs may be supervised by a licensed Physical Therapist or by a licensed Physical Therapist Assistant. That supervision must be continuous and if a PTA is serving as the clinical instructor that PTA must have 1 year practice experience and the supervising PT must be readily accessible.
From Title 46, Part LIV, Subpart 2, Chapter 3, Sub-chapter C, Item 337.
A. A clinical instructor shall provide on-premises supervision to a PT student in all practice settings. A clinical instructor shall provide continuous supervision to a PTA student in all practice settings. A PTA may act as a clinical instructor for a PTA student in all practice settings provided that the PT supervisor of the PTA is available by telephone or other communication device.
B. A PTA can be a clinical instructor for the PTA student provided the PTA has one year practice experience.
Continuous Supervision is defined as observation and supervision of the procedures, functions, and practice by a supervisor who is physically within the same treatment area.
Service as a primary clinical instructor for a PT or PTA student may be used for continuing education hours/credit.
From Title 46, Part LIV, Subpart 1, Chapter 1, Sub-Chapter J, Item 195, 4:
B. A maximum of five hours credit for clinical instructors serving as the primary clinical instructor for PT and PTA students or provisional licensees. One hour credit may be earned per 120 hours of clinical instruction during the renewal period. Proof of clinical instruction shall be documented on a form provided by the board and shall be signed by two of the following:
- clinical instructor,
- center coordinator clinical education; or
- academic coordinator clinical education
You can access the full Practice Act and Rules on the LA PT Board website at laptboard.org
What are the Medicare rules that I should be aware of when supervising PT/PTA students?
Updated September 2011
Medicare reimbursement for student services differs between Medicare Part A and Part B. Services rendered by students in the hospital, SNF and IP rehab environments (part A) are reimbursable and no longer require “line of sight” supervision. However, in those settings the student is still considered an extension of the qualified practitioner (PT/PTA), not an individual practitioner and as such the supervising PT or PTA cannot be treating or supervising other individuals (patients or students) during the time in which the student is rendering services to the Medicare part A patient.
Student services under Medicare part B (outpatient, non-SNF nursing home, private practice) continue to not be reimbursable. However, the student may still be present and participate in the care of the part B patient so long as the qualified practitioner is present in the room directing and guiding the service delivery.
More detailed examples including those related to delivery of care in “group therapy” treatments are described below the chart.
|Practice Setting||PT Student||PTA Student|
|Part A||Part B||Part A||Part B|
|PT in Private Practice||N/A||X1||N/A||X1|
|Certified Rehab Agency||N/A||X1||N/A||X1|
|Comprehensive OP Rehab Facility||N/A||X1||N/A||X1|
|Skilled Nursing Facility||Y1||X1||Y2||X1|
|Home Health Agency||NAR||X1||NAR||X1|
|Inpatient Rehab Facility||Y4||N/A||Y4||N/A|
X: not reimbursable
N/A: not applicable
NAR: not addressed in regulation. Please defer to state law.
|Y1: Reimbursable: The minutes of student services count on the Minimum Data Set. Medicare no longer requires that the professional therapist (the PT) provides line of sight supervision. It is now the authority of the supervising therapist to determine the appropriate level of supervision for the student, but the student is still considered an extension of the therapist, not an individual practitioner. In addition, the rules from FY2011 regarding the student services based on PT/PTA supervision and whether minutes can be recorded as individual, concurrent, or group therapy minutes remain the same (RAI Version 3.0 Manual, September 2011).
Under Medicare Part B, when a therapy student is involved with group therapy treatment, and one of the following occurs, the minutes may be coded as group therapy:
Documentation: APTA recommends that the physical therapist co-sign the note of the physical therapist student and state the level of supervision that the PT determined was appropriate for the student and how/if the therapist was involved in the patient’s care.
|Y2: Reimbursable: The minutes of student services count on the Minimum Data Set. However, Medicare requires that the PT/PTA provide line-of-sight supervision of physical therapist assistant (PTA) student services as appropriate within their state scope of practice. See Y1
Documentation: APTA recommends that the physical therapist and assistant should co-sign the note of the physical therapist assistant student and state that the PT/PTA was providing line of sight supervision of the student and was involved in the patient’s care. Also, the documentation should reflect the requirements as indicated for individual therapy, concurrent therapy, and group therapy see Y1.
|Y3: This is not specifically addressed in the regulations, therefore, please defer to state law and standards of professional practice. Additionally, the Part A hospital diagnosis related group (DRG) payment system is similar to that of a skilled nursing facility (SNF) and Medicare has indicated very limited and restrictive requirements for student services in the SNF setting.
Documentation: Please refer to documentation guidance provided under Y1.
|Y4: This is not specifically addressed in the regulations, therefore, please defer to state law and standards of professional practice. Additionally, the inpatient rehabilitation facility payment system is similar to that of a skilled nursing facility (SNF) and Medicare has indicated very limited and restrictive requirements for student services in the SNF setting.
X1: B. Therapy Students
2. Therapy Assistants as Clinical Instructors
Can a PTA be a clinical instructor for a PTA student and if so, should the supervising PT still be involved?
The LA PT Board rules allow a PTA with at least 1 year of experience to serve as a clinical instructor without continuous on-site supervision by a PT (supervising PT must still be available by phone or other communication device). Experienced PTAs serve as a valuable resource for SPTA clinical education and can make excellent clinical instructors. Specifically PTA students benefit from having a PTA as a CI because (1) they are able to role model the work practices of a PTA and (2) they are typically very familiar with the educational requirements/curriculum of PTA programs.
In situations, however, in which a PTA is serving as a primary clinical instructor it is still required that a supervising PT (1) is consulted and approves of student placement with the PTA as the clinical instructor and (2) is willing to participate in the clinical education of the student.
Some recommendations for ways in which the supervising PT can/should participate when not acting as the primary clinical instructor include:
- providing opportunities for the SPTA to observe and/or participate in the PT’s initial patient assessment process
- prompting the SPTA to communicate regularly with the supervising PT regarding changes in pt status, pt progress toward goals, requests for modifications in POC, etc..
- allowing for feedback (formal in PTA MACS and verbal/informal) from PT on observed student performance
Based on data collected each year, BPCC PTA students normally are assigned a PT as a primary clinical instructor 50% of the time and a PTA as a clinical instructor the other 50% of the time (with, in the vast majority of cases, a supervising PT on-site). We are pleased with this diversity and encourage our PT/PTA teams of clinical educators to continue providing opportunities for students to learn from what each member of the team has to offer!