To Ron, Chris and the List, For the sake of continuing the doubling/dovetailing conversation, I'd like to talk about ethics...the labels of "ethical and unethical" situations get freely tossed around a lot in talk about the OT world. To say that something is "unethical" because it is against the rules means if you follow the rules your are supposedly"ethical". However, truly ethical conduct goes beyond the mere act of following the 'rules', and is far more complicated. As we have already observed one clinical setting (acute rehab) may have different "rules" than another (SNF, Peds etc.). And often the rules are hard to find, pin down, verify, or subject to multiple interpretations. Rules change frequently...does that mean our ethics are also constantly in flux based on corporate,medicare, or insurance provider policies? The AOTA has a Code of Ethics (2005) with 7 principles as components: Principle 1.demonstrate a concern for the safety and well-being of the recipients of their services. (BENEFICENCE) Principle 2. take measures to ensure a recipient’s safety and avoid imposing or inflicting harm. (NONMALEFICENCE) Principle 3 respect recipients to assure their rights. (AUTONOMY, CONFIDENTIALITY) Principle 4. achieve and continually maintain high standards of competence. (DUTY). Principle 5.comply with laws and Association policies guiding the profession of occupational therapy. (PROCEDURAL JUSTICE) Principle 6. provide accurate information when representing the profession. (VERACITY) Principle 7. treat colleagues and other professionals with respect, fairness, discretion, and integrity. (FIDELITY) According to the AOTA these are the ethical principles we follow to determine if a situation or even a rule is ethical. Additionally these ethical principles are held in conjuction with the OT Core Values (AOTA 1993): Altruism, Equality, Freedom, Justice, Truth and Prudence. So...Based on AOTA Ethical Principles and Core Values, we take a look back at doubling/dovetailing patients for treatment and we know there are certain rules to follow in a variety of contexts of clinical practice, Questions Come Up: Should doubling/dovetailing (DB/DT) always be considered "unethical" regardless of the clinical setting ? If DBDT is allowed by rule is it still unethical? If it is generally unethical by what ethical principle? Is DBDT only unethical because it is harder (or easier) work for the therapist, or can it be proven to be less (or more) efficient in providing the most effective treatment to the most people for the least cost? I think all these questions should have good answers before we go to our colleagues, managers, and administrators to talk about the ethics of practices and policies such as DBDTing. Any other thoughts or responses? Brent, an OT
--- On Thu, 11/6/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Subject: OTlist Digest, Vol 44, Issue 7 To: [email protected] Date: Thursday, November 6, 2008, 3:00 PM 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: doubling patient in acute rehab ([EMAIL PROTECTED]) ---------------------------------------------------------------------- Message: 1 Date: Wed, 05 Nov 2008 19:05:30 -0500 From: [EMAIL PROTECTED] Subject: Re: [OTlist] doubling patient in acute rehab To: [email protected] Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" 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] ------------------------------ -- 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 44, Issue 7 ************************************* -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
