I thought about searching the archives to find maybe one post where we agreed, but I decide that it was a fruitless search <laugh>.
One day, I may just give you a call! Don't forget my name!! Ron ----- Original Message ----- From: Dr. Estelle Breines <[EMAIL PROTECTED]> Sent: Tuesday, March 28, 2006 To: [email protected] <[email protected]> Subj: [OTlist] Disturbing Message, Please Respond DEB> Ron, although we never seem to be able to agree. Someday we should have DEB> a long chat. Estelle DEB> Estelle B. Breines, PhD, OTR, FAOTA DEB> 15 Hibbler Road DEB> Lebanon, NJ 08833 DEB> 908 735-8918 DEB> 908 730-8919 FAX DEB> 908 797-6301 Cell DEB> -----Original Message----- DEB> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On DEB> Behalf Of Ron Carson DEB> Sent: Monday, March 27, 2006 9:44 PM DEB> To: Dr. Estelle Breines DEB> Subject: Re: [OTlist] Disturbing Message, Please Respond DEB> Dr. Brienes, I appreciate your opinion but I see things a little bit DEB> different. >>From my experience with Medicare Part B, insurance companies are DEB> NOT DEB> looking for the language of OT. Of course, we first need to define what DEB> that language is, but I assume (risky, I know) that you are referring to DEB> the language of self-care, productivity and leisure. Insurance does not DEB> demand that clients have difficulty with cooking skills or home care or DEB> even self-care in order for them to pay for therapy. Insurance demands DEB> progress towards measurable outcomes in a timely manner for medical DEB> diagnoses. That progress can be in either ROM, improvement in balance or DEB> decreased assistance with putting on a shirt. Assuming all other DEB> criteria are the same, insurance should pay for someone who has only 1 DEB> degree of wrist flexion and the goal is to improve it to 45 degrees just DEB> the same as they will pay for someone who has 1 degree of wrist flexion DEB> and the goal is to donn their shirt. DEB> I can also tell you that my Medicare Fiscal Intermediary has point-blank DEB> told me that when the goal is to improve leisure activity, therapy is DEB> NOT medically necessary. Now, some OT's don't work in the medical model DEB> of care, but by far, the VAST majority of us do. And for us, this is the DEB> arena in which OT is faltering, at least in my experience. DEB> Another point that I see different is your statement about using cones DEB> to simulate kitchen activity. I don't necessarily disagree with your DEB> statement but from my experience, using cones is the the mainstay of DEB> most (if not all) OT's working in adult physical dysfunction. In all DEB> honesty, I have NEVER been to a rehab department where I did not see DEB> cones in use, have been told that they are used or seen them prominently DEB> displayed. And I have used a fair share of them myself. Now the reason I DEB> mention this point is not to argue about cones' therapeutic benefits, DEB> but to simply point out the gross misalignment of your point of view DEB> with what I see as mainstream physical dysfunction treatment. Again, I DEB> don't advocate the use of cones, but the contrast between your point of DEB> view and the reality that I've experienced is exactly the contrast that DEB> is occurring at the National levels. I firmly believe that OT has a DEB> white elephant syndrome and your comments sort of bring the situation to DEB> light. Any of us can say that using cones is 'wrong' but when the DEB> majority of OT's practicing physical dysfunction (at least in my DEB> experience) are practicing day in and day out using cones, then there is DEB> something missing between perception and reality. There is a white DEB> elephant in what OT says it does and what it really does!! DEB> Lastly, the clients that I work with are not concerned with things like DEB> shopping, cleaning up, planning menus, reading or measuring. By far, the DEB> majority of my adult patients whom I see either in their homes or their DEB> ALF's are concerned with one thing and one thing only. That one thing, DEB> with a few exceptions, is getting from point A to point B in the safest DEB> and least restrictive manner. And you know, when I worked at a rehab DEB> hospital 5 years ago, I noticed the same thing. Patient with whole body DEB> diseases (spinal cord injury, closed-head injury, CVA, etc) were DEB> primarily concerned with mobility not with brushing their teeth, combing DEB> their hair or putting on make-up). It seems to me that there is an DEB> almost 'primitive' drive in each of us to be mobile and when mobility is DEB> compromised, mobility becomes of central importance. >>From my experience when someone's life is globally effected the DEB> first DEB> priority is mobility. Because if mobility is improved, all the other DEB> stuff is also improved, at least in their eyes. Of course, this may not DEB> be reality and I understand that, but then we come back to insurance DEB> which really doesn't care if someone can plan a menu, read a book or DEB> clean up their house. None of these are MEDICALLY necessary. DEB> Regarding education, one's level of education in no way makes a DEB> therapist better prepared to face the myriad of challenges facing OT's. DEB> I've seen PhD, MOT, BSOT and COTA all succumb to the pressure of trying DEB> to be and OT in a non-occupational world. DEB> Ron DEB> ----- Original Message ----- DEB> From: Dr. Estelle Breines <[EMAIL PROTECTED]> DEB> Sent: Monday, March 27, 2006 DEB> To: [email protected] <[email protected]> DEB> Subj: [OTlist] Disturbing Message, Please Respond DEB>> PTs have adopted our language because that is what the insurance DEB>> companies are looking for. However, just saying it doesn't make it DEB>> so! I can't imagine any OT or OTA worth one's salt using cones to DEB>> simulate kitchen activities. Being able to reach is no measure of DEB>> cooking skills. What about reading, processing, measuring, DEB>> determining what is culturally appropriate, etc.? Who is DEB>> responsible for shopping, cleaning up, etc.? Who plans the menus? DEB>> And for whom? And who is guiding the necessary adaptations? There DEB>> is a marked difference between a profession that is holistic and DEB>> one that is Cartesian, medical model. It's parts versus wholes. Now DEB>> I recognize that there are individual therapists who don't fit into DEB>> these diametrically opposite parameters, but the professions do! We DEB>> hold with very different principles. One would hope that the DEB>> schooling this person receives will cover these issues and make DEB>> these issues clearer than a brief paragraph here. That is the DEB>> distinction between technical and professional levels of education. DEB>> If you want citations, email me at the address below. DEB>> Estelle B. Breines, PhD, OTR, FAOTA DEB>> 15 Hibbler Road DEB>> Lebanon, NJ 08833 DEB>> 908 735-8918 DEB>> 908 730-8919 FAX DEB>> 908 797-6301 Cell DEB>> [EMAIL PROTECTED] DEB>> -----Original Message----- DEB>> From: [EMAIL PROTECTED] DEB>> [mailto:[EMAIL PROTECTED] On DEB>> Behalf Of Ron Carson DEB>> Sent: Monday, March 27, 2006 7:15 PM DEB>> To: [email protected] DEB>> Subject: [OTlist] Disturbing Message, Please Respond DEB>> Hello All: DEB>> Recently, I received a 'disturbing' message from a fellow DEB> therapist. I DEB>> say 'disturbing' because I really don't know how to respond. So, I DEB> asked DEB>> the person if I could post there message and they agreed. The DEB> person is DEB>> on the OTlist but I will leave it to them to disclose who they DEB> are, if DEB>> they wish. DEB>> Please take a minute and read this therapists message and DEB> respond DEB>> accordingly. I really feel this person's pain but I don't DEB> have any DEB>> advice off the top of my head. I think the message is a good DEB> catalyst to DEB>> open a much needed discussion. DEB>> Thanks, DEB>> Ron DEB>> <<<<<<<<<<<<<<< Original Message Follows >>>>>>>>>>>>>>>>>>> DEB>> Hi Ron I am a Cota of 10 years practice in LTC. I am in the DEB> work of DEB>> starting the bridge program at [ommited]this year for OTR DEB> program. But DEB>> for the past few months I may be changing my mind. I cannot help DEB> but to DEB>> wonder what makes OT and PT different from each other. AS I do DEB> research DEB>> on scope of practice in each field I read terms of DEB> functional, ADL DEB>> retraining in self care in home, community or work integration DEB> repeated DEB>> over and over again. I find these term in PT scope of practice. DEB> Goals as DEB>> you know are the foundations of OT. ON many occasion as I work DEB> in the DEB>> rehab room I look over in shock as the PT will perform mock DEB> kitchen act DEB>> such as cones in different areas, bathroom transfers. Which make it DEB> very DEB>> hard to explain to the patient the purpose of certain act to DEB> achieve DEB>> function when PT has already address this. I am amazed of how DEB> many DEB>> doctors will order PT for shoulder injuries. So I am trying to DEB> figure DEB>> out what make OT different from PT. I wonder if years from doctors DEB> will DEB>> just order PT service since the scope of practice are pretty DEB> much the DEB>> same. DEB>> <<<<<<<<<<<<<<<< End of Message >>>>>>>>>>>>>>>> DEB>> -- DEB>> Unsubscribe? DEB>> [EMAIL PROTECTED] DEB>> Change options? DEB>> www.otnow.com/mailman/options/otlist_otnow.com DEB>> Archive? DEB>> www.mail-archive.com/[email protected] DEB>> Help? DEB>> [EMAIL PROTECTED] DEB> -- DEB> Unsubscribe? DEB> [EMAIL PROTECTED] DEB> Change options? 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