Hello everyone and good topic,
I've worked in SNF rehab geriatrics for the better part of 15 years and
doubling/dovetailing has often been part and parcel of business as usual
especially since the PPS RUGs category system was put into place. Coupled with
this RUGs phenomena is a fairly high productivity standard which usually
between 85% to 95% in companies I've known or worked for. ( 8 hour day means
408min or 6.8 hours to 456 min or 7.6 hours of therapy contact and 24-72
minutes to do everything else including meetings, and documentation).
As Jennifer Mc Laughlin OT/L has said "MCR has changed and allows Med A to
be treated concurrently and billed for the minutes engaged in tx as this is a
minutes billing vs a modality treatment billing." The MCR B patients I've seen
have always been one-on-one.
There seem to be a lot of different interpretations of the Medicare
Rules and Regs and different Rehab companies and many therapists/managers are
often convinced that they have it all straight. Curiously, this doesn't explain
the vastly different ranges of accepted practices and policies amongst
different settings and companies.
As a therapist who has done a fair share of doubling/dovetailing...I am
keenly aware of the advantages and limitations of it's use. And yes--there are
times when it is completely inappropriate for conducting skilled intervention
related to occupations.However, there are times when it is appropriate to
double up patient when it is selectively used to conduct treatment efficiently
and free up more time to work one-on-one with a more involved patient in the
same caseload. This takes good treatment planning,time management, and
clinical judgement
The real problem is when the dovetailing/doubling becomes an everyday-all
day practice in which no 1:1 time is available at any time for anybody. Then
caseloads simply become a corporate billing mechanism but not skilled service.
The question I have is (as I play devil's advocate)....Is doublling really
unethical in all circumstances?, or which circumstances? And if it is please
explain what is meant by unethical, in what manner is doubling unethical...that
assertion is one worth specifically articulating.
I'd be interested in hearing from any of you,
Respectfully,
Brent the OT
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