Listened to a medicare teleconference describing why CMS is denying
debility patients from acute rehab stays. When asked why this is so,
the medicare communicater stated that they did not have medical
necessity for occupational therapy. When debating this issue and how
occupational therapy works on a debility patient's occupations, the
communicator stated that she thought that all we did was UE exercise.
I guess from all of her chart audits she has concluded this over the
years. I am starting to slowly see Ron's point of view even clearer
now. I now am recognizing that this is more of a standard practice than
I thought. I think we really need to focus on occupations when the goal
is to get the patient home or to improve their quality of life. I
think it is ok to work on UE strength, fine motor control to an extent
especiallly when the imparment is effecting the individual on a
disability level, but the focus needs to be on the skills that will
allow the patient to go home safelyl. I believe that this move by
medicare CMS will slowly trickle down into other areas of our care. We
need to start now to force our other therapists to treat as
occupational therapists not cone and peg pushers. Managers need to
initiate policies that address these issues now,
-----Original Message-----
From: Ron Carson <[email protected]>
To: [email protected] <[email protected]>
Sent: Thu, 23 Apr 2009 8:24 pm
Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
even
Hello Ilene:
I appreciate your message!
In this case, the pain was caused by probably joint misalignment
resulting from paralysis of the shoulder girdle. I believe I did assist
this patient by providing him my opinion on his shoulder pain, and
referred him to an ortho MD.
I am pretty confident that this patient understood occupation and OT.
Well, at least it was explained to him. In fact, he was discharged
because his only stated goal was, "walking like a man".
Thanks again!
Ron
----- Original Message -----
From: [email protected] <[email protected]>
Sent: Wednesday, April 22, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even
ocn> Ron, IMO there were many things an OT could have done to assist
ocn> that patient even without directly treating his arm. Pain disrupts
ocn> occupational function in all areas. We can work with chronic pain
ocn> patients to learn relaxation techniques. We can educate them and
ocn> their caregivers on how to prevent further pain and deformity (many
ocn> times CVA patients do make things worse because of dysfunctional
ocn> strageties they develop to perfom self-care, poor arm placement
ocn> during transfer, etc) We can help them learn how to find a chronic
ocn> pain support group or how to find assistive devices on the
ocn> internet. I think patients really have no idea all that OT offers,
ocn> nor often what "occupation" really is. The best way to get OT's out
ocn> of the "UE" box, is to show them what we CAN do for them, rather
ocn> than say "there is nothing we can do, refer to PT" for a patient
like that.
ocn> ~Ilene Rosenthal, OTR/L
ocn> From: Ron Carson < [email protected] >
ocn> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
even
ocn> Possible?
ocn> To: [email protected]
ocn> Date: Monday, April 20, 2009, 4:06 PM
ocn> Hello All:
ocn> A couple weeks ago, I worked with a CVA patient who despite having
ocn> multiple occupational deficits, he was unwilling to verbalize any
ocn> OT-related goals. And after a couple of weeks, the patient was
d/c'd.
ocn> The patient's UE and LE were compromised by the CVA. He had almost
no
ocn> active movement in his affected arm. His shoulder was extremely
painful
ocn> during any AROM.
ocn> I initially told the patient that as an OT, I would address his
most
ocn> important occupations but that I could do nothing about his arm.
Over
ocn> the? course of? treatment, his wife reported having difficulty
bathing
ocn> under the patients arm. After doing some gentle PROM, I concluded
that
ocn> there was a possible impingement. I believed an orthopedic
appointment
ocn> was necessary. I conferred? with the PT and? she concurred. I
ocn> also
ocn> confirmed that the treating PTA would address
ocn> the shoulder
ocn> ROM/Pain.
ocn> --
ocn> Options?
ocn> www.otnow.com/mailman/options/otlist_otnow.com
ocn> Archive?
ocn> www.mail-archive.com/[email protected]
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