Tuesday, November 20, 2012

Letter to a prospective occupational therapy student

I think program directors and faculty can tune in to this as well so they are more aware of what goes on...

Dear Prospective Occupational Therapy Student:

Thank you for contacting me and asking about volunteer opportunities at my facility.  As a part-time occupational therapy educator I understand that most programs have some component of volunteerism associated with application to a program.

I had to complete a similar level of volunteer experience when I applied to my occupational therapy program as well, and I fondly remember my volunteer experiences.  I began those experiences a full year prior to submitting my application, probably because I read the admission requirements and saw that it was something valuable that would help me begin to make choices about a possible occupational therapy career.

My first volunteer experience was exciting and frightening.  I assisted in a crafts group that was run at a long-term institutional setting for veterans who had severe mental health difficulties.  I was so young and it was fascinating to me that combat stress could cause such long term debilitation.  I was frightened a lot of the time.  I also remember that there was another large component to the hospital that had to do with physical rehabilitation, but I committed to the psychiatric program so I never got to see the other OTs.

That made me interested in physical medicine, so when I went back to school the next semester I pursued another volunteer experience at the County hospital on the spinal cord unit.  I did not spend time with the OTs, but instead I visited with the patients, helped with trays, re-filled water containers, and similar tasks.  So many of the patients were angry, and I spent a lot of time listening to people's stories.  It was emotionally draining, and I had absolutely nothing to offer other than re-filling someone's water.  Ugh.  This experience made me really wish I had some OT skills.

When I went back home for the next summer I volunteered some more at a sheltered workshop.  I really can't remember why because I completed all my hours.  It was a different setting - for adults who had developmental difficulties - and there were no OTs there.  I helped set up workstations and for the whole time I was there I wondered where the OTs were.  I really enjoyed the setting and getting to work with all the clients there.

Anyway, when I went on my interview for the OT program I recall talking about these three settings and all the hours I put in.  I remember feeling that perhaps my preparation was not as strong as other people because some of my settings did not have OTs in them, but that didn't seem to matter much to the person interviewing me.  She was genuinely happy that I sought out a number of different places and got to see very different people who had very different needs.

This all makes me think that volunteering is a good thing and I really love having volunteers around.

Unfortunately, when you called me you said, "I am a student at XXXX and I need to get my volunteer hours in so I can apply to the OT program."  There are a few things incorrect about this approach that I want you to be aware of:

1. If you refer to volunteer hours as 'my' volunteer hours then you might be a little confused about what volunteerism is and why is it valuable.

2. If you are trying to fit all of 'your' hours in within a constricted time frame because (a) that is how much time you have off of school or (b) the deadline for getting the application in is two weeks away or (c) because you don't want to commit to a facility for any lengthened period of time then that probably should cause you to pause and not call me.  Just a heads up.

3. If you tell me that the reason why you waited until the last minute is because (a) you tried a nursing home and you left because you 'couldn't stand the possibility of being around old people who might die' or if you have some other similar line of reasoning you might also not want to bother calling me.

I wouldn't normally complain, but I am just getting a little bored with the number of students calling me at the last minute thinking that it is my responsibility to solve their problems so they can 'get their hours in.'  If it was one or two students I would chalk it up the fact that there are silly people on the planet but in truth I get around 15-20 of these calls each time the application deadline approaches and I am just kind of bored with these calls.

So if you want to volunteer here, please consider planning it out well in advance of your deadlines.  Then you could be here on a regular basis, we could actually get to know you, the kids and families could actually get to know you, and who knows - YOU MIGHT EVEN DO SOMETHING GOOD AND WORTHWHILE FOR SOMEONE.

I would love to have some volunteers like that, actually.

Wednesday, November 14, 2012

Health insurance policy and indirect methodologies for cost control


Last week the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2013 Home Health Prospective Payment System. The rule includes rate reductions as well as complex new requirements for re-assessment and coding.

It is only a 298 page document that requires accountants, lawyers, and politicians to interpret but don't worry.

It has been interesting in the last week to read email and press releases from therapy staffing agencies who are struggling to process the changes associated with the new CMS rules in addition to the realities of aspects of the Affordable Care Act which has impact on health benefits they need to offer to their own employees.  These staffing agencies took a double hit this past week so if you know anyone who owns one of these agencies or functions as a manager of these services I strongly suggest you offer them Advil, a shoulder to cry on, or perhaps a long vacation.

Normally I am not a big fan of 'travel' therapy or temporary therapy staffing agencies, but even I am moved to sympathy for these organizations.  Yesterday I received a press release from a staffing company (who will not be named, because it is NOT their fault) and they announced that new hires will be subject to contracts that are less than 30 hours per week as well as reduction in reimbursements.  I called them to ask what their motivation was for the 30 hours per week limitation and the poor person who answered the phone danced and spun in circles trying to explain how they hope to have a more 'flexible' workforce and if a new hire wants more than 30 hours they will have to do it in more than one facility and that may require additional travelling.  Also, if they want those health care benefits they will need to be more 'flexible' with their scheduling and go to multiple facilities.  Now this really confused me because last I knew the Affordable Care Act was going to mean people could keep their health insurance and that it was going to create 400,000 jobs immediately and 4 million jobs in total...

or something like that. Oh well.

Maybe they didn't mean for health care providers?  Maybe they meant jobs for people who write 298 page rules??  And the wizards we all need to hire to interpret the rules???

Anyway, I am thinking that the best answer to all this is for therapists and health care agencies to begin altering their expectations for reimbursement in a broad sense.  After seeing the 298 page document from CMS that tells me how much money I can bill for and what hoops I need to jump through in order to obtain that reimbursement, I am thinking that it will be more profitable to just see people who have Medicare for free.  That way I will avoid the costs with trying to read, understand, and comply with ever-increasing bureaucratic demands and it will leave me free to watch C-Span so I can listen to politicians tell me  how good my life is going to be.

Anyone with me on this???