Hello:
In the article "Adjustments to Managed Health Care: Ushing Against IT,
Going With It and Making The Best of It, (AJOT, 55(2) p. 132) a therapist
states the following about the Functional Independence Measure (FIM):
"There are about 12 or 15 sections that are scored ..., probably
about 10 of them are OT areas. Again, they [the payer] are telling
you one message, how OT is so important to the function of the
patient when they go home (by FIM scores), but OT's aren't allowed so
see the patients as much. It's very frustrating. Or, you come in
after PT, like you are second."
I had these exact feelings when I worked in rehab. We used the FIM as our
outcome measure. The FIM was essential to our companies (HealthSouth's)
perceptions of outcomes success, so much so that we routinely had
in-services on how hospitals compared with regards to FIM outcomes. But,
like the above writer states, I almost NEVER felt that OT was given the
clout and authority with regard to patient care even though the majority of
what we were responsible for treating was the majority of FIM. I never
heard our physician or case manager say, this client can't dress themselves
without assistance so let's keep working. Without exception, the single
biggest predicator of progress and discharge was clients ability to walk. In
fact, our physiatrist held a weekly gait clinic to watch clients walk and to
provide treatment suggestions to the PT's. Some times the physiatrist would
actually laugh a clients struggling to dress themselves. On time I actually
talked with the doctor about my concerns. She assured me that she valued
OT's contribution but I never saw any evidence that this was true. Of
course, physiatiry is a combination of physician and physical therapist so
it's little wonder that physical medicine and physical therapy were her
primary concerns.
Now, with PT's expanding scope of practice including training in community
reintegration and home management skills and them having first-line access
to Medicare home health clients, what the heck is OT going to do? If PT can
"do it all" and they are there first, when and why will they refer to OT.
And, let's not forget the dog-eat-dog aspect of this situation.
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