I think what we are really talking about is ethical dilemmas. By definition an ethical dilemmas occurs when there is more than one correct choice and the dilemma is choosing the most correct. Dilemmas often occur in the face of competing entities, in this case; the patient, payeer, employer and employee.
As health care providers, we SHOULD be compelled to do what is best for the patient. But, there are competing forces which makes this choice very difficult at times. In fact, doing what's right for the patient can cost a therapist their job. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Brent Cheyne <[EMAIL PROTECTED]> Sent: Thursday, November 06, 2008 To: [email protected] <[email protected]> Subj: [OTlist] doubling patient in acute rehab BC> To Ron, Chris and the List, BC> For the sake of continuing the doubling/dovetailing conversation, BC> I'd like to talk about ethics...the labels of "ethical and BC> unethical" situations get freely tossed around a lot in talk BC> about the OT world. To say that something is "unethical" because BC> it is against the rules means if you follow the rules your are supposedly"ethical". BC> However, truly ethical conduct goes beyond the mere act of BC> following the 'rules', and is far more complicated. As we have BC> already observed one clinical setting (acute rehab) may have BC> different "rules" than another (SNF, Peds etc.). And often the BC> rules are hard to find, pin down, verify, or subject to multiple BC> interpretations. Rules change frequently...does that mean our BC> ethics are also constantly in flux based on corporate,medicare, or insurance provider policies? BC> BC> The AOTA has a Code of Ethics (2005) with 7 principles as components: BC> Principle 1.demonstrate a concern for the safety and well-being BC> of the recipients of their services. (BENEFICENCE) BC> Principle 2. take measures to ensure a recipient’s safety and BC> avoid imposing or inflicting harm. (NONMALEFICENCE) BC> Principle 3 respect recipients to assure their rights. (AUTONOMY, CONFIDENTIALITY) BC> Principle 4. achieve and continually maintain high standards of competence. (DUTY). BC> Principle 5.comply with laws and Association policies guiding the BC> profession of occupational therapy. (PROCEDURAL JUSTICE) BC> Principle 6. provide accurate information when representing the profession. (VERACITY) BC> Principle 7. treat colleagues and other professionals with BC> respect, fairness, discretion, and integrity. (FIDELITY) BC> BC> According to the AOTA these are the ethical principles we follow BC> to determine if a situation or even a rule is ethical. BC> Additionally these ethical principles are held in conjuction with BC> the OT Core Values (AOTA 1993): Altruism, Equality, Freedom, Justice, Truth and Prudence. BC> BC> So...Based on AOTA Ethical Principles and Core Values, we take a BC> look back at doubling/dovetailing patients for treatment and we BC> know there are certain rules to follow in a variety of contexts of BC> clinical practice, Questions Come Up: Should doubling/dovetailing BC> (DB/DT) always be considered "unethical" regardless of the BC> clinical setting ? If DBDT is allowed by rule is it still BC> unethical? If it is generally unethical by what ethical BC> principle? Is DBDT only unethical because it is harder (or BC> easier) work for the therapist, or can it be proven to be less (or BC> more) efficient in providing the most effective treatment to the most people for the least cost? BC> BC> I think all these questions should have good answers before we go BC> to our colleagues, managers, and administrators to talk about the BC> ethics of practices and policies such as DBDTing. BC> Any other thoughts or responses? BC> Brent, an OT BC> --- On Thu, 11/6/08, [EMAIL PROTECTED] BC> <[EMAIL PROTECTED]> wrote: BC> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> BC> Subject: OTlist Digest, Vol 44, Issue 7 BC> To: [email protected] BC> Date: Thursday, November 6, 2008, 3:00 PM BC> Send OTlist mailing list submissions to BC> [email protected] BC> To subscribe or unsubscribe via the World Wide Web, visit BC> http://otnow.com/mailman/listinfo/otlist_otnow.com BC> or, via email, send a message with subject or body 'help' to BC> [EMAIL PROTECTED] BC> You can reach the person managing the list at BC> [EMAIL PROTECTED] BC> When replying, please edit your Subject line so it is more specific BC> than "Re: Contents of OTlist digest..." BC> Today's Topics: BC> 1. Re: doubling patient in acute rehab ([EMAIL PROTECTED]) BC> ---------------------------------------------------------------------- BC> Message: 1 BC> Date: Wed, 05 Nov 2008 19:05:30 -0500 BC> From: [EMAIL PROTECTED] BC> Subject: Re: [OTlist] doubling patient in acute rehab BC> To: [email protected] BC> Message-ID: <[EMAIL PROTECTED]> BC> Content-Type: text/plain; charset="us-ascii" BC> I think doubling and dovetailing in unethical in acute rehab, since it is a BC> rule from medicare.? I have not read the rules for SNFs. BC> -----Original Message----- BC> From: Brent Cheyne <[EMAIL PROTECTED]> BC> To: Ron Carson <[email protected]> BC> Sent: Tue, 4 Nov 2008 6:16 pm BC> Subject: Re: [OTlist] doubling patient in acute rehab BC> Hello everyone and good topic, BC> ???? I've worked in SNF rehab geriatrics for the better part of 15 years BC> and BC> doubling/dovetailing has often been part and parcel of business as usual BC> especially since the PPS RUGs category system was put into place. Coupled with BC> this? RUGs phenomena is a fairly high productivity standard which usually BC> between 85% to 95% in companies I've known or worked for.?( 8 hour day BC> means BC> 408min?or 6.8 hours?to 456 min or 7.6 hours of therapy contact and 24-72 BC> minutes?to do everything else including meetings, and documentation). BC> ???? As Jennifer Mc Laughlin OT/L?has said "MCR has changed and allows Med BC> A to BC> be treated concurrently and billed for the minutes engaged in tx as this is a BC> minutes billing vs a modality treatment billing." The MCR B BC> patients?I've seen BC> have always been one-on-one. BC> ????? There seem to? be a lot of different interpretations of the? Medicare BC> Rules and Regs and different? Rehab companies and many?therapists/managers are BC> often convinced that they have it all straight.?Curiously, this?doesn't BC> explain BC> the vastly different ranges of accepted practices and?policies?amongst? BC> different settings and companies. BC> ???? As a therapist who has done a fair share of doubling/dovetailing...I am BC> keenly aware of the advantages and limitations of it's use. And yes--there BC> are BC> times when it is completely inappropriate for conducting skilled intervention BC> related to occupations.However, there are times when it is appropriate to BC> double BC> up patient?when? it is selectively used to conduct treatment efficiently and BC> free up more time to work one-on-one with a more involved patient in the same BC> caseload. This takes good treatment?planning,time management,?and? clinical BC> judgement BC> ??? The real problem is when the dovetailing/doubling becomes an everyday-all BC> day practice in which no 1:1 time is available at any time for anybody. Then BC> caseloads simply become a? corporate billing mechanism but not skilled service. BC> ? BC> ??? The question I have is (as I play devil's advocate)....Is doublling BC> really BC> unethical in all circumstances?, or which circumstances? And if it is please BC> explain what is meant by unethical, in what manner is doubling unethical...that BC> assertion is?one worth specifically articulating. BC> I'd be interested in hearing from any of you, BC> Respectfully, BC> Brent the OT BC> ? BC> ? BC> ? BC> BC> -- BC> Options? BC> www.otnow.com/mailman/options/otlist_otnow.com BC> Archive? BC> www.mail-archive.com/[email protected] BC> ------------------------------ BC> -- BC> Unsubscribe? BC> [EMAIL PROTECTED] BC> Change options? BC> www.otnow.com/mailman/options/otlist_otnow.com BC> Archive? BC> www.mail-archive.com/[email protected] BC> Help? BC> [EMAIL PROTECTED] BC> End of OTlist Digest, Vol 44, Issue 7 BC> ************************************* BC> BC> -- BC> Options? BC> www.otnow.com/mailman/options/otlist_otnow.com BC> Archive? BC> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
