Ron and other colleagues:
I disagre with the statement ... ' OTs meassure what is important to them..." Our reimbursement systems has certain requirements that fulfill medical necessity and reasonable expectation of progress to justify the interventions. If we only had our personal criteria to go by, there would be outstanding evaluations and simply horrible ones out there...never mind we probably would not hold licenses in so many states and would have had billions more services denied because of insufficient justification of necesity. My personal choice of what should be in the evaluations or not is irrelevant when it comes to follow coverage determinations. We all are very invested in our clinical development and perhaps provide clinical support to peers ( OT, PT and ST) in the sectors we practice, we have to be aware of the local medical determinations that require certain info to be provided , some of those non-negotiable. The payor source is not stuck on the language in which the necessity is being presented. Wether the deficit is presented in occupational or physical impairment form is not the main issue. The issue is the logic in your treatment plan and billable tasks to achieve the goals as stated. Restoring ones health is not only a funtion of the occupations I can perform but about quality and my perception of satisfaction and physical safety. My "good enough" is not always my patient's; I don't sell my bias to my patient as much as I don't stop myself from recommending a higher, safer performance even if the client has'n expressed such level upon evaluation. The beauty of our profession is that we, people, work with people and with this, all shades of gray MUST be considered. Our profession has evolved enough to have research support different appoaches to one problem. We may disagree yet have no right to negate it. One absolute way DOES NOT EXIST! Carmen > Date: Fri, 20 Mar 2009 21:32:21 -0400 > From: [email protected] > To: [email protected] > Subject: Re: [OTlist] Elbow Break, Referral... > > Here's another old message I just found. You'll need to read the > original message to make sense of my comments. > > Ron > > ==============================================================>>>> > > Yep, I was trained the same way. But that is not the way I practice > because practicing that way doesn't make sense to me! > > What a therapist measures is what they consider important, right? If > ROM/PAIN is the outcome then measure away. If occupation is the > outcome, they why measure? If an OT can see that decreased elbow ROM > prevents someone from dressing and the goal IS dressing, what are the > advantages of measuring ROM? > > I do think it's important to document ROM, strength, sensation, etc, > but ONLY as it relates to preventing SPECIFIC occupation. For example, > if a patient's goal is dress themselves and they can't because of > pain, they document that patient is unable to dress lower body > secondary to self-reported elbow pain at 3/10. And, if you as an OT > can do something about the pain, then go ahead and treat it. But as > I've stated, reducing pain should NOT be the goal of OT, increasing > occupation should be. Reducing pain (strength, ROM, etc) is a PT > thing, increasing occupation is an OT thing. > > Despite all my ranting, I understand that the line between occupation > and physical factors can be blurry. For example. I just d/c a patient > who was s/p lung cancer . She was very short of breath and unable to > carry out ANY occupation in her home. Initially, we started with just > standing then progressed to ambulation with a walker with a focus on > decreasing her oxygen flow while increasing her endurance. We had > hoped to get her on a demand-flow system but that didn't work out. I > had the patient keep a log of her daily walks and actually charted > them. As she progressed we moved to working in the kitchen, going > in/out of the house, up/down steps, in/out of her car, driving a golf > cart and even went for a drive in her car. There were other things we > did but these are some of the highlights. > > In this case there is a specific and direct link between the patient's > occupational deprivation and her decreased pulmonary function. I > measured and tracked her pulmonary function (i.e. self-reported > fatigue, oxygen sats, pulse rate) but these were never part of our > goals. In fact here are the goals: > > 1. Patient will safely ambulate in/out of home w/ portable oxygen tank > including up/down steps while maintaining adequate oxygen sats > > 2. Safely place/remove portable oxygen tank in/out of car > > 3. Independently complete simple meal prep without a rest break > > 4. Independently complete personal care without a rest break. > > So, while I did monitor the sats, (because you can't SEE oxygen sats > without measuring) they weren't a direct goal. And that's how I feel > all OT should be. Sure, we need to monitor and maybe even measure ROM, > but that should never be our goal. > > > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: L Sloan <[email protected]> > Sent: Sunday, August 31, 2008 > To: [email protected] <[email protected]> > Subj: [OTlist] Elbow Break, Referral... > > LS> Sorry Ron...I totally disagree...in my 20 years I have always > LS> included ROM, pain with function....that is how I was > LS> trained...maybe school has changed since then........to me the ROM > LS> and pain has everything to do with the function...I have always > LS> assessed it when doing an evaluation...that is part of my > LS> assessment as sensation is, coordination, cognition etc. I do not > consider that PT.... > LS> Lisa > > > > LS> ----- Original Message ---- > LS> From: Ron Carson <[email protected]> > LS> To: L Sloan <[email protected]> > LS> Sent: Sunday, August 31, 2008 7:09:48 AM > LS> Subject: Re: [OTlist] Elbow Break, Referral... > > LS> If the goal is increased ROM or decreased pain, why include the > LS> "functional" component? It seems obvious to me that if ROM/pain are > LS> the ONLY things preventing the patient from doing self-care, then > LS> positively impacting these area will directly improve self-care. So, > LS> why even include the the "function". > > LS> If the goal is occupation, then I see no reason for the ROM/pain > LS> component. As and OT, I strongly believe that occupation should be the > LS> goal, but occupation is not always the goal of the patient or MD. And > LS> it's these situations where OT is out on a limb, because we are truly > LS> practicing OT, but PT. > > LS> Ron > LS> -- > LS> Ron Carson MHS, OT > > LS> ----- Original Message ----- > LS> From: L Sloan <[email protected]> > LS> Sent: Saturday, August 30, 2008 > LS> To: [email protected] <[email protected]> > LS> Subj: [OTlist] Elbow Break, Referral... > > LS>> How About.... > LS>> Patient will demonstrate increased active range of motion to ____ > LS>> during upper and lower body dressing activities.....or... > LS>> Patient will demonstrate increased AROM to ___ to allow patient > LS>> to complete upper and lower body selfcare activities safely... > LS>> Patient will demonstrate a decrease in pain from ___ to ___ to > LS>> enable her to complete her dressing activities. > LS>> ??? Lisa > > > > LS>> ----- Original Message ---- > LS>> From: Ron Carson <[email protected]> > LS>> To: OTlist <[email protected]> > LS>> Sent: Saturday, August 30, 2008 3:48:47 PM > LS>> Subject: [OTlist] Elbow Break, Referral... > > LS>> Received a new referral for a elbow fracture. I shouldn't have taken > LS>> it but I did. > > LS>> And here is the dilemma facing our profession. The patient is 95, > LS>> previously living independently. Fractured elbow in a fall. Now living > LS>> with daughter. She is in a large amount of pain. Obviously, she is > LS>> dependent for most of her occupations. She currently uses a cane but > LS>> is not safe. > > LS>> The patient's immediate concerns are her elbow. When pressed, she of > LS>> course wants to go back home, but that is not an immediate goal. > > LS>> So what do I write for goals? For example should I write: > > LS>> Patient will self-report pain as 3 out of 10 > > LS>> Patient's will increase active elbow extension to -20 degrees > > > LS>> These goals seem to direct the patients and doctor's concerns but are > LS>> not occupationally oriented. So, should I write: > > > LS>> Patient will safely and independently dress lower body > > LS>> Patient will safely and independently ambulate to the bathroom > LS>> using the least restrictive mobility aid > > LS>> I like these goals but they don't address the immediate concerns. > > LS>> Ron > LS>> -- > LS>> Ron Carson MHS, OT > > > LS>> -- > LS>> Options? > LS>> www..otnow.com/mailman/options/otlist_otnow.com > > LS>> Archive? > LS>> www.mail-archive.com/[email protected] > > > > LS>> > > > > LS> -- > LS> Options? > LS> www.otnow.com/mailman/options/otlist_otnow.com > > LS> Archive? > LS> www.mail-archive.com/[email protected] > > > > LS> > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] _________________________________________________________________ Express your personality in color! Preview and select themes for Hotmail®. http://www.windowslive-hotmail.com/LearnMore/personalize.aspx?ocid=TXT_MSGTX_WL_HM_express_032009#colortheme -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
