Monday, September 26, 2005

Mr. Chris goes to Washington

"You think I'm licked. You all think I'm licked. Well, I'm not licked. And I'm going to stay right here and fight for this lost cause. Even if the room gets filled with lies like these..."

I am in Washington, DC tonight. As part of my ongoing doctoral studies I am participating in some lobbying efforts to repeal the payment caps that were placed on Medicare Part B outpatient rehab services as part of the 1997 Balanced Budget Act . Since 1997 the caps have only been imposed for 3 months in 2003 because Congress passed moratoriums delaying the impact of the caps.

Unless Congress takes action again, the current moratorium will expire on December 31, 2005, and the caps will take effect on January 1, 2006. The caps limit Medicare coverage to $1,500 for occupational therapy. What does that mean? Basically it means that people with Medicare will have limited access to OT, and it means that other insurance companies will be likely to follow suit. That's not good for people who need the services.

There is some talk about 'pay for performance' systems - and I don't think that I am opposed to that type of a model - but we probably are a long way from being able to implement that kind of a system as it relates to rehab services.

There are other issues to be discussed, but I will be focusing on the Medicare caps.

Tuesday, September 20, 2005

tooth extraction, as viewed by an OT

It started out as a good day... I was having a little tooth sensitivity yesterday, but I mostly ignored it and tried to focus on the many tasks at hand. Life is busy as a pediatric occupational therapist in September.
Then I jinxed myself. This morning my sister mentioned that my niece was having some pain with her new orthodontia, so my wise comment was - "Well when they find bones in Olduvai Gorge the most common bones they find are jawbones and teeth - which is proof that these structures are built to last and are not designed to be moved." I should have kept my mouth shut, literally, because I scheduled a visit to the dentist to have my own tooth sensitivity looked at.
The dentist decided to pull my offending wisdom tooth, which was quite an experience. It didn't want to be separated from my jawbone, and it was in fact ankylosed. This interested me, because I never before considered that teeth could be ankylosed. The dentist's brow was beaded with sweat and he was smiling nervously about my questioning if he ate his Wheaties that morning. He was not as impressed with the whole experience. The novacaine is still working though, so I still have a certain sense of humor that may not be present in another hour or so.
So besides learning that teeth could be ankylosed, I also had some flashback to kinesiology as the dentist began leaning on my chin to increase his force and gain some mechanical advantage over my stubborn tooth. Then I wondered if dentists experienced repetitive strain injuries if they did too many extractions. Then I distracted myself by staring at his left earlobe, which had a diamond stud in it. I wondered if the money he got from my tooth would go for another piercing or some ink. I decided that most people don't have pierced and inked dentists, but it didn't offend me. I used to tell my students that some people could be put off by ink and piercings - and they generally perceived me as squashing their rights and freedom of expression. Maybe I was wrong about the whole thing though. Having a punk rock dentist leaning on my chin and cranking on my tooth wasn't as upsetting as you might imagine.
Tomorrow is another day. I hope I can function.

Thursday, September 15, 2005

wild grapes

I was driving in my car on my way to see some children for the early intervention program this morning, and I did not feel 'right.' I can't explain the feeling. The radio (my daily companion) was irritating. The sky and earth just didn't seem to meet at their ends. Everything was just 'tilted.' After fidgeting for 15 minutes I called my sister.

She distracted me well enough and we had a pleasant conversation. I was able to refocus and I had wonderful visits with some new children on my caseload. September is always exciting to me because it is all about promise and beginnings.

I spent part of the morning crawling around the gym of a Head Start program. The child that I see there couldn't ride a tricycle like the other children, so instead we parked ourselves near the gas pump and called the children over individually so we could 'fill them up' as they wheeled by. I think he liked it.

I had a bittersweet feeling about that session all day long.

End of the day. Tilt is still here. I need to get some sleep - to let go of the day. Makes me consider a Robert Frost poem -

The mind-is not the heart.
I may yet live, as I know others live,
To wish in vain to let go with the mind-
Of cares, at night, to sleep; but nothing tells me
That I need learn to let go with the heart.

Monday, September 12, 2005

Home stretch

I am now officially into my final semester as a doctoral student in the Nova Southeastern University occupational therapy program. For the past three years I have traveled to south Florida three times a year for the launching and wrapping of classes. In between, I have lived my life on the computer, completing my reading and research, responding to the posts of my colleagues, and participating in long distance chats with other OTs from Spokane to Puerto Rico. I would be remiss if I did not mention the writing - the innumerable research papers that have taken me on a journey from the genesis of occupational therapy all the way to consideration of virtual contexts and how they can be used as occupational therapy tools. Those papers have spawned one article submitted for publication, another article perpetually waiting to be submitted, one presentation at a national conference, and one presentation at a state conference. Not bad.

I don't have too much that is profound to say about it all at this time. The last class still has to be completed and will include a field trip to Washington, DC to lobby our public officials about relevant health policies relating to OT. Then there is also the capstone research project to complete which was supposed to be done by now but life and scheduling seemed to get in the way. I thought I was done with my proposal and the IRB process but small technical and format issues with my proposal still need tweaking. So I thought I would be traveling back home WITHOUT my proposal but I need to place my consent forms on NSU letterhead and make some minor format changes to my forms before it can be resubmitted. The data collection itself will not be too difficult, and I will be happy to move away from planning, formatting, and literature review.

Then there is the larger issue of whether or not I will continue on to the PhD program. Our profession is still a little confused about the clinical doctorate and the OTD credential (which will be hopefully bestowed on me in short order). I have no need for the OTD, and even less need for the PhD. I suppose that if I ever return to teaching the research degree will be helpful. I have contributions to make either way so it is something that I really need to think about. Right now, I am a little tired. I have walked a journey, and realized I am here. There is another summit ahead of me, and I need to decide if it will be worth the climb. Wonderful people are cheering me on, and I appreciate their support in more ways than I can ever express.

The philosophical question that I am left with tonight is this: what does one do with accumulated knowledge? In some ways I hope that I feed it back into the machine, and it results in things like ABC Therapeutics. There still seems to be larger things to do. It seems like a responsibility.

In true Forest Gump fashion, that's all I have to say about that.

Wednesday, September 07, 2005

Rantings of a crazed dynamic systems theorist

R. Buckmister Fuller, my intellectual hero, stated that piano tops can make fortuitous life preservers - but that doesn't mean that the best design for a life preserver is in the form of a piano top. The piano top that I see us clinging to today is the disorganized message board and database system that is being used to help people 'find' each other who were displaced as a result of the recent hurricane.

Because we tend to lack the ability to understand technological applications beyond their immediate design purpose, we lose a lot of opportunity to help real people.

So my proposition of the day, as an OT who likes to view the world from a broad perspective, is to use the SIX DEGREES PATENT or some similar networking system like or to create a searchable and linkable network that will help displaced people find their friends and family members.

It is such an incredibly simple solution, but who will think to apply social networking algorithms to disaster preparedness planning?

I'm tired tonight, folks, so please excuse me for not expanding on why this is totally about occupational-therapy style thinking. I promise you that it is.

Tuesday, September 06, 2005

back again

Sorry for the long absence, everyone. My grandmother passed away last week so we have been spending time with family.

I look forward to posting more adventures. The school year has started again so of course there is a lot of activity at ABC Therapeutics Central!

Talk to you all soon.