The Case

The College received a complaint from a patient who attended physiotherapy after a motor vehicle accident.

During one of their appointments, the patient asked the physiotherapist about getting a TENS machine and a large ice pack to use at home. The physiotherapist said they would order the TENS machine and would check to see if the patient’s insurance would cover the cost of an ice pack.

The patient ended up receiving a TENS machine, a heating pad, and a smaller ice pack that was smaller than they had requested. The patient followed up with the physiotherapist to ask why they received a heating pad that they didn’t ask for, and why the ice pack was smaller than the one they wanted. The physiotherapist told the patient that they would need a heating pad eventually, and that there wasn’t enough funding from the insurer to cover the larger ice pack.

Eventually, the patient switched physiotherapists. The new PT told the patient that anything that was purchased through their insurance would need to be fully discussed with them beforehand, including the costs. This prompted the patient to look up the costs of a TENS machine and heating pads on the internet and follow up with their insurance company.

The patient learned that they had $400 in insurance money for equipment purposes. The patient then contacted their previous physiotherapy clinic for an itemized receipt and saw that the physiotherapist charged the insurance company $200 for the TENS machine and $200 for the heating pad. The patient questioned why the physiotherapist was charging excessive prices for products they didn’t want, and why the physiotherapist was not transparent about the costs from the beginning.

The physiotherapist indicated that the clinic sets the prices of products sold through the clinic, and the price is based on several factors including overhead costs, product warranty and education provided to the patient. According to the PT, they played no role in pricing the products.

The physiotherapist denied ordering unwanted products or pressuring the patient into purchasing products or services.

The Standards

According to the Fees, Billing and Accounts Standard, physiotherapists must ensure that the fees they charge are not excessive. While the patient expressed that they were overbilled for these products, the Committee considered the physiotherapist’s explanation that the prices for products sold through the clinic factor in things such as patient education, the clinic’s operating costs and a six-month warranty that the clinic offers on all equipment it sells.

However, the physiotherapist did not have a fee schedule available for the patient to view prior to the products being ordered. According to the College’s Fees, Billing and Accounts Standard, physiotherapists must ensure that they have a written fee schedule that states, among other things, the fees for any products that they sell or dispense to patients.

Regarding the heating pad that the patient didn’t specifically request, the physiotherapist commented that the heating pad was for the patient to use in the future and that it is not advisable to use a heating pad immediately following an accident. This raised some concerns around the necessity of the heating pad, especially considering that the PT used up the remainder of the patient’s insurance allowance to purchase it.

The physiotherapist acknowledged that this situation likely could have been avoided if they had communicated with the patient more effectively. The College’s guidance on communication specifies that physiotherapist should be clear in their communication and confirm understanding with the patient.

In reviewing the patient record, the physiotherapist did not document consent to treatment or information about the services and products that were offered, according to the requirements of the Record Keeping Standard.

The Outcome

The Committee determined that the issues were significant enough to require that the physiotherapist participate in a Specified Continuing Educational or Remediation Program (SCERP) specifically focused on fees and billing, patient communication, consent and record keeping.

All costs associated with the SCERP will be paid by the physiotherapist, and a summary of the SCERP will be posted on the Public Register.

Fees, Billing and Accounts Standard

Communication

Consent

Record Keeping Standard