Hullo Jim and Gina, I wanted to respond briefly about the issue of leisure. I am very careful to aviod writing goals related specifically to leisure, however I have patients where it is essential for them to start engaging in activities--particularly patients following severe strokes where the families want to do everything for the patient and wonder about their decline in function, frequently related to depression and learned helplessness. I have learned that we must always justify the medical necessity for seeing a patient--and it is very difficult to justify leisure activities as a medical necessity. In fact, if I was the patient I might get the wrong ideas about occupational therapy and other therapies if all they were trying to teach me was a leisure activity. I agree with Jim that we use activities therapeutically to work on performance skills.
In low vision rehabilitation, I frequently find clinicians talking about "reading the newspaper" as a goal. I do not think that any insurer would go for that. However, there is essential information that is presented at that print size--consent forms, financial statements, expiration dates, health information--the kind of reading that none of us "loves" but certainly justifies medical necessity. Medicare pays billions of dollars in treatment to "correct" medical errors--resulting from all manner of reasons, but also from low levels of health literacy. Oh well, those are my two cents worth, I must get back to my patient. Best regards -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jim Arceneaux Sent: Sunday, January 07, 2007 7:47 AM To: [email protected] Subject: Re: [OTlist] OTs place in the system Hi Gina, I am familiar with what you are describing in an inpatient rehab. setting. I would like to comment on one part of your message in particular. We have discussed insurance not paying for leisure before. This is true in a sense, but speaking as someone that has reviewed Medicare claims for documentation of medical necessity, it does not tell the whole story. If an OT writes in their note that "today the patient was engaged in Bingo," yes the claim will be denied (if reviewed). The key is to document what you were working on specifically. What performance components (to use practice framework terminology) were you addressing. In the same scenario above if you stated you provided a therapeutic activity with lets say visual cues for scanning strategies in a patient with left neglect, magically you would be paid. The truth is that the bingo isn't the skilled (or payable) service. Its what an OT does to manipulate the activity (grading, etc.) that is skilled. It is not unethical to document in the manner above as it is truthful to what was done. OT does not just play bingo with patients. We don't go paly golf or help a patient play golf. We do however remediate a patient's ability to engage in activities they enjoy. Jimmie [EMAIL PROTECTED] wrote: Hello All, After reading many of the posts on OTs purpose and function. I noticed some things were not mentioned. One being that in most Reahb hospitals OT is slotted to provide 1.5 hours per day and for many pateints functional issues can be addressed more quickly and effieciently and then that leaves a lot of itme available that has to be filled in. For example, after a couple of OT sessions to address dressing equipment, home management, & bathing issues, etc, hip & knee patients need an OT less than they get in Rehab. I think that new students then come away with this idea of OT doing exercise because they have to fill in that time. Also don't forget insurance payors. You start documenting working on leisure skills and they begin to balk. I find that if I really focus on functional issues (and yes I do actually work on leisures skills in conjuction with my treatment for daily living skills) many times I can be out quickly, needing very few treatments or many patients don't want to worry about those issues, preferring to have family cook, etc. So I believe it is a complex problem. I work in home health and do (in home) outpatient OT services and am able to just see patients to address their needs and get out without having to make up things to work on as happens in Rehab & SNF frequently. I have done some PRN work in SNF lately and they did not like my style of treatment as many times after a certain period and goals were met I would try to decrease minutes for the week instead of doing UE exercise to fill in the time. So I do agree that the issue often is about money but it is also about OTs retaining a certain level of hours (workload) either for payments from insurance or to keep their of income at a certain level or lack of patient interest in addressing Daily Living Skills. Out of my home health caseload, I would estimate that about only 25% of my referrals have daily living needs that I can address (or clients want addressed). Frequently one to five visits may take care of any area that need to be addressed. So my caseload is composed of a few clients who I see twice weekly for 9-12 weeks and most who I see one to five visits. While PT can go in and do exercises, etc 3X weekly for 4-9 weeksfor most of their patients. OT generally doesn't need to see as many patients for that length of time. I think sometimes we think quantity more than quality. While I do see many patients who need OT not getting it, I also see patients getting OT services not needed (by that I mean they aren't addressing Daily Living Skills). That means an OTs role may be smaller in quantity compared to other disciplines (but no less important) and many OTs (or facilities) want more time. I realize I am preaching to the choir as most OTs on this lilst understand this or they wouldn't bother to be here. Just my take. Gina Tate -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ************************************************************************************** __________________________________________________ Do You Yahoo!? Tired of spam? Yahoo! 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