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Moving From Competency to Proficiency in Rehabilitation Therapy

Therapists working in long-term care or home health rehabilitation settings have a range of skill levels, depending on their education and experience. Given all the changes in how you practice today — shifting documentation requirements; treating medically complex, highly acute patients; becoming proficient in personal protective equipment — it is essential that you continue to build your knowledge base to achieve the best outcomes for your patients.

In order to advance your knowledge and understanding, you need to know your starting point.

Of course, physical therapists, occupational therapists, and speech language pathologists all must meet minimum requirements for entry-level placement. That translates to competency. Your initial training typically covers multiple settings and prepares you for professional autonomy and accountability.

Although the terms “competency” and “proficiency” are sometimes used interchangeably, you should understand the difference when referring to rehabilitation therapy expertise, as Lynda Jennings, OTR, RAC-CT, noted in a recent Relias webinar.

Moving Toward Mastery

Once you begin working in a particular care setting, you will need to build on your competency and establish proficiency for your practice setting and patient population. “It’s extremely important as healthcare professionals that we stay current with the latest techniques, research, and evidence in our specialty areas,” Jennings asserted. Therapists who continue to develop their knowledge and skills can achieve a mastery that qualifies as proficiency.

Proficiency, however, is not just about understanding and applying the most current evidence-based evaluation and interventions. Therapists need specific knowledge of documentation and billing that goes beyond provision of therapy services. Healthcare reimbursement depends on a complicated web of federal and state regulations, payer policies, and facility billing procedures.

Depending on the care setting and the payer type, billing for services may be handled differently. “It is your responsibility to know where to find and validate information related to regulation and funding,” Jennings stressed.

For example, if you’re working in an outpatient setting and you move to a skilled nursing facility, the billing guidelines are significantly different. At the moment, reimbursement for older adult outpatient services falls under Medicare Part B guidelines. But if you are practicing in skilled nursing, you need to be expert at the documentation and policies for the Patient Driven Payment Model. In home health services, you need to work with the Patient-Driven Groupings Model.

Know the Relevant Regulations

As a clinician, you must take into account your state practice act and regulations in the state administrative code for license renewal and continuing education requirements put forth by your state licensing board.

“As professionals, we must justify why we deserve reimbursement for our services vs. a less skilled individual providing that service,” Jennings said. You must understand the guidelines for supervision and the use of assistants or interns in physical, occupational, and speech therapy.

If you are working at the top of your license, you will continue to progress from competence to proficiency through several domains as you provide specialized therapy services. That dynamic and multidimensional process involves maintaining and developing:

  • Knowledge.
  • Performance skills.
  • Interpersonal abilities.
  • Critical reasoning skills.
  • Ethical reasoning skills.

“I feel it’s our responsibility to always challenge ourselves to stay current with best practices in our specialty areas,” Jennings said. “That’s why we’re called professionals.”

Create Your Own Development Plan

Moving forward, you can set a goal to make a professional development plan each year. You can do this in collaboration with your employer or develop one independently.

Start with a skills self-assessment, and then decide which areas can benefit from refreshing or enhancing your knowledge. The next step is to explore options for training to bring your competency level up in those areas.

How do you evolve from competency to proficiency to expert? A therapist can be considered an expert when demonstrating advanced competency that requires a higher level of knowledge and experience, advanced clinical judgment, and specific training and education.

Consider the areas where you can advance from competency to proficiency:

  • Age-specific competencies such as geriatric and pediatric.
  • Equipment-related competencies.
  • Specialized practice competencies such as wound care or low vision.
  • Advanced practice competencies such as dementia care or swallowing disorders.
  • Competencies related to a specific skill set.

Assessing Clinical Competency Levels

A variety of tools can help assess clinical competency levels:

  • Post-tests.
  • Return demonstrations.
  • Case studies.
  • Exemplars.
  • Peer reviews.
  • Self-assessments.

When you identify room for improvement, you can plan targeted learning that supports individual professional growth and strengthens your organization. No matter your current level, competency should not be a static goal, but rather a shifting target.


Take a Targeted Approach to Learning

Make sure staff development plans optimize individual and organization financial results. Use personalized learning to encourage staff to own their training, capture and maintain their attention to learning modules, incorporate tools to boost their motivation, and improve their critical thinking skills.


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