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Physical Therapy in Skilled Nursing Facilities: A Clarification of HCFA Policy-Reply

Bruce C. Vladeck, PhD
JAMA. 1994;272(15):1170. doi:10.1001/jama.1994.03520150035031.
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In Reply.  —We appreciate the opportunity to clarify our policy. We did not intend our column to create the impression that therapy assessments or treatments are considered appropriate for a nursing home resident only when they will improve the resident's condition and not when they are needed to maintain the resident's existing functional status and prevent decline.We wrote the column to put physicians on notice about egregious instances of program abuse in which widespread therapy assessments and treatments were being performed indiscriminately in the absence of any medical indications whatsoever. Only a minority of therapists engage in these deplorable activities, and they know who they are. Their unscrupulous endeavors represent a blot on their entire profession as well as a disservice to the beneficiaries whom they subject to unnecessary medical interventions and expense. The column was intended to inform physicians of the problem and to enlist their aid in


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