Ron, Yes, the new PPS for HH reimbursement structure is complicated, and as mentioned previously I do not fully understand it, nor do I need to/care to either. Since I haven't read any other answers to your original question, "What would YOU do?" I'd like to offer a few thoughts. Assuming that you have a solid clinical background, as I've gathered from your postings, I don't see any need discussing the ABCs of clinical reasoning behind your decision to propose 5X/week OT. I will say, as an a experienced HH OT myself, that is a pretty high level of care and not the norm for HH. Obviously, you feel it is warranted, and the agency should support your expert clinical decision. As I stated in my previous post, I believe the agency would still make a profit if you were able to perform your POC as requested. Perhaps they do not understand the new reimbursement system? At any rate, if this first experience with them looks like it's going to be the norm, I'd take my skills elsewhere. Not sure the size of your town, but here in the Dallas metro area there are over 1,000 HH agencies. There will be no lack of need for OTs in HH, especially with outcomes and pay for performance standards being implemented now. So, if it's an option, just go elsewhere.
Bill Maloney, OTR www.embracelifewell.com ----- Original Message ---- From: "[EMAIL PROTECTED]" <[EMAIL PROTECTED]> To: [email protected] Sent: Thursday, February 14, 2008 2:00:12 PM Subject: OTlist Digest, Vol 37, Issue 11 Send OTlist mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: Home Health ethical dilemma (Bill Maloney) 2. Re: Home Health ethical dilemma (Ron Carson) ---------------------------------------------------------------------- Message: 1 Date: Wed, 13 Feb 2008 18:37:20 -0800 (PST) From: Bill Maloney <[EMAIL PROTECTED]> Subject: Re: [OTlist] Home Health ethical dilemma To: [email protected] Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=us-ascii Ron, I am a full-time HH OT. With the 2008 PPS Refinements for Home Health therapies, I don't understand how the agency will lose money. Of course, there are pieces of this puzzle for which I have not factored: you plan to do 5X/week for how many weeks? How many visits does the PT plan to do? Is ST involved with the patient? On the new OASIS document, item MO826 (replaces the old MO825 which used to ask whether there would be at least 10 combined total therapy visits, i.e. OT, PT, ST) outlines from the outset how many total combined therapy visits are planned. There is an "S" score assigned. The "S" score is a derivative of a calculation based on which episode the patient is in (1st and 2nd, or third or more) and how many combined therapy visits are done for the episode. Unlike the old "10-visit threshold" model, this equation allows for more reimbursement for more visits. For instance, if there are 0-13 visits, depending on the S score there would be anywhere from a base minimum of $1276.66 (S1) reimbursed up to $1771.84 (S5) for that total amount of visits. If there are 14-19 combined visits, the base would be $3467.92 Unless I'm mistaken, and that could certainly be the case since this is new and I'm by no means an expert on this subject, the agency could still make a profit if your plan of 5x/wk is carried out. This newly refined system appears to actually allow us to do more treatment, if the patient needs it, without being penalized (losing money). I hope this helps. Bill Maloney, OTR www.embracelifewell.com ----- Original Message ---- From: "[EMAIL PROTECTED]" <[EMAIL PROTECTED]> To: [email protected] Sent: Wednesday, February 13, 2008 2:00:12 PM Subject: OTlist Digest, Vol 37, Issue 10 Send OTlist mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Quality assurance.... (Cim Viken) 2. Ethical Dilemma? (Ron Carson) 3. Re: Ethical Dilemma? (Johnson, Arley) ---------------------------------------------------------------------- Message: 1 Date: Tue, 12 Feb 2008 16:12:36 -0600 From: "Cim Viken" <[EMAIL PROTECTED]> Subject: [OTlist] Quality assurance.... To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" I know this is a bad word because it means more paperwork. I hate doing QA. I need some ideas. What ideas can people come up with for a Quarterly report in a hospital based, outpatient, and private settings? I administer a survey at time of DC for my outpatient clients and review these for QA to see if there are any areas we need to improve. What are some more ideas???? Thanks in advance. Cimberly Viken, OTR/L ------------------------------ Message: 2 Date: Wed, 13 Feb 2008 11:55:21 -0500 From: Ron Carson <[EMAIL PROTECTED]> Subject: [OTlist] Ethical Dilemma? To: [email protected] Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=us-ascii Hello All: I've been in PP for about 4 years and worked in Rehab/faculty before that. Recently, I started PRN work at a HH agency. After only two weeks, I've run into a dilemma. After eval my first HH patient, I decided he needed 5 day a week OT. Today the HH agency called me to say that I could NOT see patients 5 days a week because they wouldn't make enough money if I did that. I talked at length about my role with the patient, etc. But, the HH nurse told me that I had to cut back my visits. I believe that patient has potential and will benefit from intensive OT. He has made some progress, but it's slow going. I believe it is wrong to cut back my treatment ONLY because the agency is "crying" over not making enough money. But, I am an employee of the agency. So what would YOU do? Thanks, Ron x-posted to AOTA ------------------------------ Message: 3 Date: Wed, 13 Feb 2008 12:08:42 -0500 From: "Johnson, Arley" <[EMAIL PROTECTED]> Subject: Re: [OTlist] Ethical Dilemma? To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="iso-8859-1" In my past life as a home health OT, I faced the same dilemma. I contacted the PT and developed our plan 2 fold. We compared notes and decided that we would see the patient daily OT x 3 and PT x 3(included Saturdays)and that the patient really needed to be in acute rehab. The agency said she was denied acute rehab and if we could show she could tolerate 3hrs of therapy, they would reconsider. After about a month, she was admitted to a rehab hospital for a 4 week stay. I hope it helps. Arley Johnson MS, OTR/L Operations Manager Rehabilitation Services Pennsylvania Hospital O: 215.829.5018 P: 215.422.0174 C: 215.776.4305 ? -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Wednesday, February 13, 2008 11:55 AM To: [email protected] Subject: [OTlist] Ethical Dilemma? Hello All: I've been in PP for about 4 years and worked in Rehab/faculty before that. Recently, I started PRN work at a HH agency. After only two weeks, I've run into a dilemma. After eval my first HH patient, I decided he needed 5 day a week OT. Today the HH agency called me to say that I could NOT see patients 5 days a week because they wouldn't make enough money if I did that. I talked at length about my role with the patient, etc. But, the HH nurse told me that I had to cut back my visits. I believe that patient has potential and will benefit from intensive OT. He has made some progress, but it's slow going. I believe it is wrong to cut back my treatment ONLY because the agency is "crying" over not making enough money. But, I am an employee of the agency. So what would YOU do? Thanks, Ron x-posted to AOTA -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message. ------------------------------ -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED] End of OTlist Digest, Vol 37, Issue 10 ************************************** ------------------------------ Message: 2 Date: Thu, 14 Feb 2008 08:45:04 -0500 From: Ron Carson <[EMAIL PROTECTED]> Subject: Re: [OTlist] Home Health ethical dilemma To: Bill Maloney <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=us-ascii Thanks for the detailed response. You know forgetting about the actual dollars, it's my impression that HH gets paid to provide ALL the necessary care/therapy for a patient. Because of this, I assume that some patients are less profitable than others. Obviously, the HH PPS system is very complicated and I do not have the inclination to try and learn its details. But overall, what is the primary purpose of HH? The CMS Benefit manual discusses "reasonable and necessary". Who determines what is reasonable and necessary? ----- Original Message ----- From: Bill Maloney <[EMAIL PROTECTED]> Sent: Wednesday, February 13, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Home Health ethical dilemma > Ron, > > I am a full-time HH OT. With the 2008 PPS Refinements for Home Health > therapies, I don't > understand how the agency will lose money. Of course, there are pieces of > this puzzle for which > I have not factored: you plan to do 5X/week for how many weeks? How many > visits does the PT > plan to do? Is ST involved with the patient? > > On the new OASIS document, item MO826 (replaces the old MO825 which used to > ask whether there > would be at least 10 combined total therapy visits, i.e. OT, PT, ST) outlines > from the outset how > many total combined therapy visits are planned. There is an "S" score > assigned. The "S" score > is a derivative of a calculation based on which episode the patient is in > (1st and 2nd, or third > or more) and how many combined therapy visits are done for the episode. > Unlike the old "10-visit > threshold" model, this equation allows for more reimbursement for more > visits. For instance, if > there are 0-13 visits, depending on the S score there would be anywhere from > a base minimum of > $1276.66 (S1) reimbursed up to $1771.84 (S5) for that total amount of visits. > If there are 14-19 > combined visits, the base would be $3467.92 Unless I'm mistaken, and that > could certainly be the > case since this is new and I'm by no means an expert on this subject, the > agency could still make > a profit if your plan of 5x/wk is carried out. This newly refined system > appears to actually > allow us to do more treatment, if the patient needs it, without being > penalized (losing money). > I hope this helps. > Bill Maloney, OTR > www.embracelifewell.com > > > ----- Original Message ---- > From: "[EMAIL PROTECTED]" <[EMAIL PROTECTED]> > To: [email protected] > Sent: Wednesday, February 13, 2008 2:00:12 PM > Subject: OTlist Digest, Vol 37, Issue 10 > Send OTlist mailing list submissions to > [email protected] > To subscribe or unsubscribe via the World Wide Web, visit > http://otnow.com/mailman/listinfo/otlist_otnow.com > or, via email, send a message with subject or body 'help' to > [EMAIL PROTECTED] > You can reach the person managing the list at > [EMAIL PROTECTED] > When replying, please edit your Subject line so it is more specific > than "Re: Contents of OTlist digest..." > Today's Topics: > 1. Quality assurance.... (Cim Viken) > 2. Ethical Dilemma? (Ron Carson) > 3. Re: Ethical Dilemma? (Johnson, Arley) > ---------------------------------------------------------------------- > Message: 1 > Date: Tue, 12 Feb 2008 16:12:36 -0600 > From: "Cim Viken" <[EMAIL PROTECTED]> > Subject: [OTlist] Quality assurance.... > To: <[email protected]> > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset="us-ascii" > I know this is a bad word because it means more paperwork. I hate doing QA. > I need some ideas. > What ideas can people come up with for a Quarterly report in a hospital > based, outpatient, and private settings? > I administer a survey at time of DC for my outpatient clients and review > these for QA to see if there are any areas we need to improve. > What are some more ideas???? Thanks in advance. > Cimberly Viken, OTR/L > ------------------------------ > Message: 2 > Date: Wed, 13 Feb 2008 11:55:21 -0500 > From: Ron Carson <[EMAIL PROTECTED]> > Subject: [OTlist] Ethical Dilemma? > To: [email protected] > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset=us-ascii > Hello All: > I've been in PP for about 4 years and worked in Rehab/faculty before > that. > Recently, I started PRN work at a HH agency. After only two weeks, I've > run into a dilemma. After eval my first HH patient, I decided he needed > 5 day a week OT. Today the HH agency called me to say that I could NOT > see patients 5 days a week because they wouldn't make enough money if I > did that. I talked at length about my role with the patient, etc. But, > the HH nurse told me that I had to cut back my visits. > I believe that patient has potential and will benefit from intensive OT. > He has made some progress, but it's slow going. I believe it is wrong to > cut back my treatment ONLY because the agency is "crying" over not > making enough money. But, I am an employee of the agency. So what would > YOU do? > Thanks, > Ron > x-posted to AOTA > ------------------------------ > Message: 3 > Date: Wed, 13 Feb 2008 12:08:42 -0500 > From: "Johnson, Arley" <[EMAIL PROTECTED]> > Subject: Re: [OTlist] Ethical Dilemma? > To: <[email protected]> > Message-ID: > > <[EMAIL PROTECTED]> > > Content-Type: text/plain; charset="iso-8859-1" > In my past life as a home health OT, I faced the same dilemma. I contacted > the PT and developed > our plan 2 fold. We compared notes and decided that we would see the patient > daily OT x 3 and PT > x 3(included Saturdays)and that the patient really needed to be in acute > rehab. The agency said > she was denied acute rehab and if we could show she could tolerate 3hrs of > therapy, they would > reconsider. After about a month, she was admitted to a rehab hospital for a 4 > week stay. I hope > it helps. > Arley Johnson MS, OTR/L > Operations Manager > Rehabilitation Services > Pennsylvania Hospital > O: 215.829.5018 > P: 215.422.0174 > C: 215.776.4305 > ? > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson > Sent: Wednesday, February 13, 2008 11:55 AM > To: [email protected] > Subject: [OTlist] Ethical Dilemma? > Hello All: > I've been in PP for about 4 years and worked in Rehab/faculty before > that. > Recently, I started PRN work at a HH agency. After only two weeks, I've > run into a dilemma. After eval my first HH patient, I decided he needed > 5 day a week OT. Today the HH agency called me to say that I could NOT > see patients 5 days a week because they wouldn't make enough money if I > did that. I talked at length about my role with the patient, etc. But, > the HH nurse told me that I had to cut back my visits. > I believe that patient has potential and will benefit from intensive OT. > He has made some progress, but it's slow going. I believe it is wrong to > cut back my treatment ONLY because the agency is "crying" over not > making enough money. But, I am an employee of the agency. So what would > YOU do? > Thanks, > Ron > x-posted to AOTA > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > Archive? > www.mail-archive.com/[email protected] > The information contained in this e-mail message is intended only for the > personal and > confidential use of the recipient(s) named above. If the reader of this > message is not the > intended recipient or an agent responsible for delivering it to the intended > recipient, you are > hereby notified that you have received this document in error and that any > review, dissemination, > distribution, or copying of this message is strictly prohibited. If you have > received this > communication in error, please notify us immediately by e-mail, and delete > the original message. > ------------------------------ > -- > Unsubscribe? > [EMAIL PROTECTED] > Change options? > www.otnow.com/mailman/options/otlist_otnow.com > Archive? > www.mail-archive.com/[email protected] > Help? > [EMAIL PROTECTED] > End of OTlist Digest, Vol 37, Issue 10 > ************************************** ------------------------------ -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED] End of OTlist Digest, Vol 37, Issue 11 ************************************** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
