District Employees versus Contract Staff Districts considering hiring their own physical and occupational therapists as employees of their district may wish to consider the following: 1. Recruitment of qualified therapists with advanced training and experience in school based pediatric practice is an extreme challenge and requires ongoing efforts and resources. 2. Therapists require multiple standardized assessment test kits and therapy supplies. These materials cost many thousands of dollars and need to be updated as new editions become available. These materials are presently provided by the contracting agency, and would be an additional and ongoing expense to the school district. 3. Providing coverage during absences and extended leaves is an extreme challenge and may interfere with IEP compliance. 4. Performance evaluations and supervision of therapists, who are medical professionals, can be a challenge for school administrators. There are additional requirements and standards of care for medical professionals that are beyond those required in the educational environment. 5. There may be a significant increase in the cost of Professional Liability Insurance and Workman s Compensation Insurance premiums to the district when they employ medical professionals due to the increased risk exposure that their services pose to the district. 6. Obtaining medical prescriptions, release of information permissions, and maintenance of clinical, Medicaid and educational records is time consuming and will require additional resources by the school district. 7. Occupational and physical therapy services from an outside contract agency are provided and managed by a single source. 8. When using a contract agency, the district only purchases the amount of services that they need. Employees must be paid their negotiated salary regardless of the number of students on their caseloads. Contracting for professional services also relieves school districts from providing employee benefits, tenure, pension plans, and complying with state and federal employment regulations. 9. According to the most recent American Physical Therapy Association survey, the 2008 median gross income of physical therapists in the Northeast Region was $80,000 + benefits. 10. Race to the Top initiatives may result in unexpected salary increases for school employees.
EMPLOYEES Pathology Services, PLLC currently employs 26 therapists, 3 psychologists, an office manager, and 3 support staff. We are able to provide uninterrupted coverage during maternity leaves or other unexpected absences. All employees receive extensive and ongoing training in the specialized area of school based practice. They receive annual OSHA, FERPA, CPR with AED, and HIPPA Confidentiality Training, and have individual budgets to attend continuing education conferences. All therapists have attended the mandatory Medicaid training held in Syracuse. We perform reference checks and criminal background checks on all employees. All therapists are fingerprinted and photographed prior to treating students in the school district. Health and immunization records are maintained and updated as needed. RECRUITMENT Recruitment and retention of licensed therapists with advanced training and experience in pediatric school based practice is a significant challenge and the shortage of qualified therapists will increase as our population ages. Our recruitment efforts are continuous and we have an outstanding retention rate of experienced pediatric trained therapists. We have a clinical education program that is affiliated with 6 universities that provides clinical fieldwork training to physical therapy, occupational therapy, and speech and language pathology students. Our association with these programs provides a continual source of graduates for staffing purposes. Dana Mandel, PT, PCS is also an Advanced Credentialed Clinical Instructor by the American Physical Therapy Association. INSURANCE Therapists are covered with professional liability insurance ($1,000,000/$3,000,000), business general liability insurance including nonowned auto, health insurance, workman s compensation insurance, disability insurance, and unemployment insurance. Districts will be named as additional insured on the General Liability Policy if requested.
SUPPORT SERVICES Our office staff supports all aspects of the care that our therapists deliver. We obtain release forms from parents/guardians of all students receiving related services. We then obtain Medicaid compliant prescriptions for all students. Reports are received, proofed, finalized, and distributed directly to the CSE Chairperson, teachers, therapists, parents, and physicians through our main office. SUPERVISON OF EMPLOYEES Supervision of therapists is a challenge for school districts. All employees receive annual performance evaluations. All evaluation reports are reviewed personally by Dana Mandel, PT, PCS prior to submission to district to insure the educational relevance of recommended services. We have an ongoing Quality Assurance Program that insures compliance with all Federal, State, Medicaid, and other medical legal regulations. Caseload studies are performed on an annual basis to insure the educational relevance of related services. Results of the annual study are provided directly to the CSE chairperson. SINGLE SOURCE PROVIDER Pathology Services, PLLC presently provides related services to 10 school districts. Physical therapy, occupational therapy, and speech and language pathology services can all be provided to the school district through a single source. We are an approved provider of SED4410 Preschool services and NYSDOH Early Intervention Services in a 4 county area, which enables us to provide therapy services to all children 0-21 years old residing within the school district. TECHNOLOGY Pathology Services, PLLC has an extensive network of computers maintained by a network specialist and a software specialist. All therapists are trained in the use of IEP Direct software. All computer data is backed up
continuously on site for uninterrupted daily service. All computer files are also backed up daily off site. We have a fully functional and continuously updated website. Paper records are maintained for 6 years, and then digitally scanned and archived eternally. We have implemented a proprietary custom designed database that tracks all aspects of clinical care, documentation, employee records, and communications specifically designed to meet the needs of special education departments. All therapists have web based access for recording service time and clinical charting. Our database is able to track therapist compliance with IEP recommendations, CSE timeline compliance for student evaluation referrals, notification and attendance of therapists at CSE meetings, the receipt and distribution of all reports including IEP progress notes, daily clinical charting, and all mandatory Medicaid reporting. FISCAL RESPONSIBILITY Pathology Services, PLLC has a strong commitment and concern for the fiscal constraints of our school districts. Caseload management is the key to fiscal responsibility when providing related services in the school district. Caseload studies are performed on an annual basis to insure the educational relevance of related services. Results of the annual study are provided directly to the CSE chairperson. Annual costs for related services, as well as monthly year-to-date comparisons, are monitored and analyzed. To support the claim of fiscal responsibility, I have listed the annual cost of physical therapy services of an unnamed school district since 1998 and occupational therapy services since 2005 in Appendix A. The school district paid less for physical therapy services during the 2009-2010 school year than they did in the 1998-1999 school year despite increases in the cost of living and the exponential growth of students receiving special education services in the district. The cost for occupational therapy fluctuated and grew only 5% annually when comparing 2005-2006 figures with 2009-2010. LEGAL IMPLICATIONS Pathology Services, PLLC has a perfect record of avoiding and protecting school districts against legal litigation that can be costly, time consuming, and
damaging to a school district s reputation. Impartial hearings can easily cost a school district $40,000.00. Please refer to Appendix B to review an analysis prepared by an attorney retained by our practice that specializes in school based law. Mission Statement At Lifespan Physical Therapy, Occupational Therapy, and Speech and Language Pathology Services, PLLC, our mission is to be the preferred provider of therapy services based on superior service and our demonstrated commitment to optimal patient functioning. We accomplish this mission by: 1. Providing services that meet or exceed the standards of practice for our profession(s); 2. Incorporating the unique needs of each patient into our treatment recommendations; 3. Limiting our service recommendations to those interventions that will promote optimal patient functioning and dignity in the least restrictive environment; 4. Charging fair and competitive fees for our services; 5. Providing easy access for receipt of our services; and 6. Delivering our services in a timely, cost effective, respectful, confidential, and responsive manner. Our practice strongly believes that our outstanding record of protecting school districts is due to: 1. a true commitment to customer service ; 2. open and frequent communication with parents, physicians and school administrators; 3. attention to detail; 4. a deep understanding of school based practice in addition to medically based practice, with over 25 years of experience in the educational setting; 5. the extensive use of technology and highly trained consultants that are experts in their fields; 6. the commitment, years of experience, and ongoing training of our staff.
PROPOSED RATES FOR SERVICES Pathology Services, PLLC is fully aware of the present fiscal crisis facing school districts across the country. We are prepared and willing to contribute and continue to provide services in a fiscally responsible manner. Respectfully, Dana Mandel, PT, PCS
Appendix A Unnamed School District OT and PT Annual Cost Report School Year PT Total Cost 1998-1999 $32,830.00 1999-2000 $31,011.48 2000-2001 $29,568.75 2001-2002 $25,116.00 2002-2003 $33,117.27 2003-2004 $42,567.72 2004-2005 $36,780.96 2005-2006 $30,762.61 2006-2007 $43,497.03 2007-2008 $45,956.72 2008-2009 $37,257.08 2009-2010 $31,403.75 School Year OT Total Cost 2005-2006 $66,717.51 2006-2007 $70,886.40 2007-2008 $83,889.94 2008-2009 $92,789.91 2009-2010 $84,729.50
Appendix B Cost of Litigation to School Districts 1) Payment for the Impartial Hearing Officer, who is typically an attorney. Anticipate that payment for his/her services which is paid by the district, would be at least $100 per hour for the actual hearing, researching and writing the decision, plus phone conferences, etc. (Note that $100/per hour is probably on the low side). If the IHO is not local, add travel and lodging expenses. 2) The Court Reporter. The district is also responsible for this cost, which runs approximately $6.10 per page (this includes enough copies for the district, parent and IHO). A full day of hearing might run 150-200 pages according to one Court Reporting firm that I spoke with recentlymeaning $915.00 to $1,220.00 per day. By way of example, if the hearing goes 4 days that could be $4,880.00 just for the court reporter. 3) Attorney s Fee. It is difficult to quantify, but for a full blown hearing (witness prep, record reviews and hearing time) the cost is likely to be in the many $1,000s. If the parents prevail, the district may also have to pay the cost of the parents attorney s reasonable fees. When the parents attorney seeks attorney s fees, the action is brought in federal court (more legal expenses for the district). One could reasonably assume that this is a great incentive for the attorney for the parent to not settle prior to IHO involvement. (Note that in cases where it is found that the parents or parents attorney brought a frivolous or unreasonable action it is in theory possible for the state/district to recover reasonable attorney s fees, but this is not a scenario one should count on in considering the likely costs of proceedings brought under the IDEA). 4) After the Impartial Hearing. The more contentious and complicated disputes can lead to an appeal by the non-prevailing party to the State Review Officer and after that, to actual litigation in court (in both scenarios the legal fees can be quite high). 5) Intangible Costs. Impartial hearings can be emotionally draining on staff, other educators as well as the parents. Teachers may be called away from the classroom and substitutes will need to cover classes. The CSE chair may become distracted from other day to day issues during the impartial hearing. Laurel E. Baum, Esq. Hancock Estabrook, LLP 1500 AXA Tower I 100 Madison Street Syracuse, New York 13202 Phone: 315.565.4500 Fax: 315.565.4600 Email: lbaum@hancocklaw.com www.hancocklaw.com