I think doubling and dovetailing in unethical in acute rehab, since it is a rule from medicare.? I have not read the rules for SNFs.
-----Original Message----- From: Brent Cheyne <[EMAIL PROTECTED]> To: Ron Carson <[email protected]> Sent: Tue, 4 Nov 2008 6:16 pm Subject: Re: [OTlist] doubling patient in acute rehab 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 ? ? ? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
