Tuesday, November 17, 2009

Student survey: What education level is needed for COTAs?

Please consider helping an OT student by taking this non-scientific survey so she can gather opinions on what education level is needed for COTAs.

The survey is at http://freeonlinesurveys.com/rendersurvey.asp?sid=83x03dmh7libgux672024


Distinctions between health care delivery problems and social policy problems regarding premature births

Today the March of Dimes released their 2009 premature birth report cards for each state. Premature births are an important issue to discuss for occupational therapists because so many of the children who require OT services have a history of prematurity. Even so-called 'late preterm births' where the children are 34 weeks gestation and older have a higher incidence of learning problems.

People will take advantage of the release of this report to politicize the findings as an indictment of the US health care system. This is only partially true because a multitude of social and cultural factors causes this problem, including:
  1. MDs practicing defensive medicine and increasingly using 'late preterm' cesarean delivery.
  2. Couples opting for fertility treatments that inevitably lead to increased incidence of twin/triple/quad pregnancies (and sometimes more).
  3. Poor prenatal care among illegal immigrants and undocumented aliens who do not have health insurance.
  4. Poor prenatal health care among groups who DO have access to Medicaid.
  5. Smoking, obesity, teenage pregnancy, and other lifestyle factors.
The best way to combat prematurity includes several approaches. There should be tort reform to limit the practice of defensive medicine and more education for physicians on best practice for late term pregnancy management. Couples who opt for fertility treatments (and the MDs who facilitate) should be held financially accountable for the costs of the prematurity that they create. Open border and sanctuary city policies need to be re-evaluated because rate of uninsured women is directly related to these factors.

The health care system CAN do more to improve access and quality of prenatal care delivery, particularly to vulnerable or at-risk populations who already have Medicaid coverage. Continued education and outreach to help control the impact of negative lifestyle factors is also critical. Still, the larger indictment is on our social policy and NOT on our health care system. Once preterm infants are born, the care they receive in the US is unparalleled in the world. The problem is in how the prematurity occurred - which is more about social policy than anything else. There seems to be a real confusion in separating out the CARE system from the SOCIAL POLICY. They are quite different from each other and each requires a very distinct approach for improvement.

Monday, November 16, 2009

Good question from a student

From: OT Student
Sent: Sunday, November 15, 2009 11:55 AM
To: info@abctherapeutics.com
Subject: OT student needs help


I just visited your website and found your blog section very interesting. I am a current MOTS student from XXX that is working on a project looking at whether COTAs should be required to have a bachelors degree rather then just an associates.
I am wondering if you are able to post this question on your blog as I need feedback from OTRs and COTAs on how they feel about this issue.

I would be most grateful.

Thank you in advance,

OT Student


Dear OT Student,

If you create an online survey (there are several free survey tools available) I will be happy to put the link on my blog.

I am not aware of any evidence that supported graduate degrees for OTRs - and this is an important question that should be raised. If more schooling is required and this feeds competence that is fine - but I don't know that anyone is able to say that someone trained at the masters level is more proficient or competent than someone trained at a baccalaureate level.

If you apply degree inflation to COTAs then you will undoubtedly price many people right out of the job market. People sometimes participate in associates level degree programs because they can't afford more schooling.

This is a big human resources issue for the profession.

There is a corollary issue to also consider: How is the education and skill set of a COTA suited to meet the needs of people who receive occupational therapy? What level of education is needed to provide occupational therapy services? This is a thorny problem for the profession that most people aren't willing to seriously discuss.

Individual states place limits on COTA practice but the limitations vary widely. There is very little specific guidance from the professional association, presumably because of the way that the issue would alienate some of their potential association participants. In the vacuum of this lack of specificity you will find some rather varied opinions about what COTAs should be able to do. You will find no such vacuum of guidance from our physical therapy colleagues and how they delineate the professional and technical levels of their profession.

Good question though. Please don't stop asking because we need a lot more questioners in order to advance our profession.



Thursday, November 12, 2009

Feedback on alternatives to the therapy cap

Occupational therapy payment restrictions, typically referred to as 'therapy caps' on Medicare Part B, are daily concerns for all occupational therapists working in private practice, outpatient clinics, and nursing facilities. AOTA is participating in a long-term project aimed at finding an alternative to the current cap system. RTI International, the entity that was awarded the government contract to conduct this research, states that "CMS envisions a new method of paying for outpatient therapy services that is based on classifying individual beneficiary’s needs and the effectiveness of therapy services, e.g., diagnostic category, functional status, health status. Currently, CMS cannot evaluate or implement this type of approach because CMS does not currently collect the appropriate data elements."

RTI is proposing assessment tools to describe the characteristics of Medicare Part B clients. The proposed tool for outpatient settings collects demographic data and consists primarily of a patient report of how well they think they are able to participate in tasks. There is a more extensive assessment based on therapist opinion for cognitive, speech, and swallowing functions - no such therapist data is collected for other functional performance areas. It seems that the outpatient tool is potentially very limited - it is rather odd that something as important as determining therapy reimbursement would essentially be dependent on patient opinion of their functional status. The facility-based tool relies more on therapist or professional assessment. For this reason I have fundamental disagreement with the assessment proposal and I don't understand why such different assessment methodologies are in place for the two tools.

I also have some concerns with their data collection and sampling. To begin with, the data collection forms are very long and burdensome - I cannot imagine that many private practitioners will be able to afford to participate because therapists and office staff will not want to wade through so many pages. The outpatient based form is 17 pages long - and when I think about who the Medicare Part B participants are who come into my outpatient clinic I just can't imagine that they are going to want to fill out this long, confusing, small-font form.

The researchers are planning to use a weighting formula during data analysis because of expected frequency and distribution differences between PT (which is a more heavily utilized service) and OT/ST (which are not as heavily utilized). This causes some potential problems with whether or not the OT data will capture the breadth and scope of actual practice. Simple weighting adjustment can really skew data - and weighting only works correctly if you are relatively certain that you have adequately captured a representative sample to begin with. Further confounding this issue is the extreme disparity between the nature of a nursing home Part B population and an outpatient Part B population. I have very little faith that there will be 'enough' correct data in the sample to adequately represent the population of people who come to small private outpatient clinics.

I don't have faith in this data collection tool or the methodology that is proposed for interpreting the data. The outpatient tool is limited to patient perspective on function and is likely to under represent and misrepresent the nature of outpatient Part B OT participation.

I would like AOTA to advocate for a better tool that is based on therapist assessment of patient function (there are already many that already exist) and to advocate for distinct separation between nursing home and outpatient Part B data analysis.

Background reading:

AOTA - Alternatives to the therapy cap update: Need your feedback. Downloaded from http://www.aota.org/News/AdvocacyNews/Feedback.aspx?emc=lm&m=591948&l=44&v=2336991 on November 12, 2009.