Process of OT - Key Terms

Expression of strong emotion

The Client’s external displays of internal feelings that are shown with a level of intensity beyond the usual cultural norms for interaction

Intimate self-disclosure

The client’s statements or stories that reveal something unobservable, private, or sensitive about the person making the disclosure

Power dilemmas

The dilemma is characterized by an undeniable power difference between the client and the therapist

Nonverbal cues

The client’s communications that do not involve the use of formal language, such as facial expressions or body posturing

Crisis points

An unanticipated, stressful event that causes a client to become distracted and/or that temporarily interferes with the client’s capacity for occupational engagement

Resistance and reluctance

A client’s passive or active refusal to participate in some or all of the aspects of therapy for reasons linked to the therapeutic relationship. Reluctance is disclination towards some aspect of therapy for reasons outside the therapeutic relationship

Boundary testing

Boundaries provide limitations and help the client to understand what to expect during therapy sessions; boundary testing is when a client behavior violates those limitations or asks the therapist to act in ways that are not part of the therapeutic relationship.

Empathetic breaks

When a therapist fails to notice or understand a communication from a client or initiates a communication or behavior that is perceived by the client as hurtful or insensitive

Emotionally charged therapy task or situations

Activities or circumstances that can lead clients to become overwhelmed or experience uncomfortable emotional reactions such as embarrassment, humiliation, or shame

Limitations of therapy

The client’s restrictions on the available or possible services, time, resources, or therapist actions

Contextual inconsistencies

Any aspect of a client’s interpersonal or physical environment that changes during the course of therapy.

Advocating

Understanding that disability is a result of an environmental barrier and responding to physical, social, and environmental barriers that a client encounters.

Collaborating

Making decisions jointly with the client, involving the client in reasoning and expectations, and having the client participate actively in these decisions.

Empathizing

Bearing witness to and fully understanding a client’s physical, psychological, interpersonal, and emotional experiences.

Encouraging

Providing the client with hope, courage, and the will to explore or perform a given activity.

Instructing

Educating the client in therapy and assuming a teaching style while interacting with the client.

Problem solving

Relying heavily on using reason and logic in their relationships with the client.

Payer Sources: Third-Party Payers

Payment for services by en entity other than the Pt or their family. There are two types of third-party payers- private insurance and government programs.

Payer Sources: Private Insurance

Typically funded by contribution to a plan through an employer or it can be purchased individually. Specific coding, billing and appeals issues may need to be considered while maintaining ethical practice

Payer Sources: Government Program - Medicare

Medicare Part A - All medicare beneficiaries are covered under Part A, which covers inpatient hospitalizations, critical access hospitals, SNF’s, home health care and hospice care

Medicare Part B - Voluntary program which beneficiaries can enroll in. This covers physician and outpatient services, home health care, blood tests, some preventative tests, and DME (on a limited basis)

Medicare Part C - AKA Medicare Advantage or privately administered Medicare coverage for Parts A and B and other benefits

Medicare Part D - A voluntary prescription drug plan

Payer Sources: Government Program - Medicaid

A jointly funded federal and state program that covers older adults, children and parents of dependent children, pregnant women, and people with disabilities who meet eligibility requirements

People can only qualify if their income and assets are below a level set by the program

States regulate the programs so coverage varies depending on where you live

OT is an optional benefit and may not be covered in all states

Payer Sources: Government Program - Worker’s Compensation

State programs that pay for care of workers who have injuries or illnesses from work related causes

Programs vary from state to state but generally pay for medical services to get the person back to work, which may include OT services, benefits for lost wages when appropriate, and disability compensation

Payment by Setting: Skilled Nursing Facilities

Patient Driven Payment Model (PDPM) is the current system for providing Medicare services in SNF’s

The goal of the model is to encourage quality over volume-based care

Pts are qualified for services through the use of a screening tool called the Minimum Data Set (MDS) which considers the Pt status and includes quality measures

Payment is based on Pt characteristics and diagnoses and not the amount of therapy services delivered

ADL’s are scored on performance using GG, which designates the amount of the task the Pt was able to perform and how much assist they needed

Payment by Setting: Home Health

The Outcome and Assessment Information Set (OASIS) is the screening tool in HH settings that evaluates Pt status and monitor outcomes for quality of Pt care

Pts must be home bound in order to receive HH services - requirements are fairly strict. Outside of Dr. appts and religious services the burden or risk in leaving the home must be substantial enough to prevent Pts from doing so on a regular basis

The Patient-Driven Groupings Model (PDGM) is the current system for providing Medicare services in HH. Similar to PDPM, this model focuses on achieving quality outcomes rather than payment for therapy services based on the amount of therapy provided

Payment by Setting: Inpatient Rehab

The Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) is used to screen patients to document status and monitor outcomes in inpatient facilities

IPR facilities also use section GG to capture client performance and required assistance on functional tasks

Pts must be able to tolerate 3 hours of therapy a day and require physical and or occupational therapy in order to qualify for a stay in IPR

Payment by Setting: Schools and Early Intervention

The Individuals with Disabilities Education Act (IDEA) is a federal and state program which regulates and finances services, including OT for children with special needs in public schools

Services among school districts and across states varies

Part B of IDEA requires schools to provide a free and appropriate education (FAPE) and covers children 3-21.

Part C of IDEA covers children birth-age 2 years 11 months and is a federal grant program that assists states in running early intervention programs

Payment by Setting: Outpatient Services

Through Medicare Part B OP services are managed through the Quality Payment Program (QPP) and Merit-Based Incentive Payment System (MIPS)

MIPS is a performance based payment system that is based on a clinicians score in 4 categories: quality, advancing care info, improvement activities and cost

Billing Codes: ICD-10

Consists of 2 parts of the ICD-10 CM (clinical modification) and ICD-10 PCS (procedure classification system)

ICD-10 CM - diagnosis codes that allow for high degree specificity, consists of 3-7 alpha-numeric digits that describe a diagnosis

ICD-10 PCS - used to bill inpatient services

Billing Codes: Common Procedural Terminology Codes (CPT)

Created by the American Medical Association

Most managed care and private insurance companies base their care on CPT codes along with Medicare

There are more common CPT codes used in practice, some codes are billed per occurrence and some are billed as timed codes

HCPCS Level 1 Codes - CPT codes for procedures provided to pts (eval, therapeutic activity, therapeutic exercise)

HCPCS Level 2 Codes - CPT codes for products and supplies (DME, orthotics and prosthetics)

Billing Codes: GG-Codes

Provides an alphanumeric representation of functional abilities and goals at start of care, resumption of care, follow-up and discharge

Codes are provided to relay info about a clients performance in functional areas such as self care, mobility, and cognition based on their PLOF

Performance ratings are based on the amount of a task the person can perform and amount of assistance needed

8-Minute Rule

1 unit = 8-22 mins

2 units = 23-38 mins

3 units = 39-53 mins

4 units = 54-68 mins

5 units = 69-82 mins

6 units = 83-98 mins

7 units = 99-113 mins

8 units = 114-128 mins

9 units = 128-143 mins

Goals and Objectives (Characteristics)

Occupation-based

Measurable

Observable

Action-oriented

Realistic and achievable

Formulated from problem list with client

Occupational performance or contributing factor based

Goals and Objectives (LTG and STG)

Goals are usually LTG’s

• Also called outcomes

• Usually set for d/c or re-eval

• Each problem requires a LTG (or more than one)

Objectives are usually STG’s

• Progress towards LTG

• One or more STG’s to get to a LTG

Goals are changeable based on the clients needs and progress

COAST Method

A way of writing goals:

• C- Client

• O - Occupation

• A - Assist Level

• S - Specific condition

• T - Timeline

EX: Client will perform UE dressing with Min A for buttoning while seated at EOB within 1 week

Reprimand

A reprimand is a formal expression of the Ethics Commission’s disapproval of the conduct of an AOTA member who has violated an ethical standard.

This is a private letter that cannot be disclosed to other regulatory bodies or stakeholders

Censure

Formal letter that publicly expresses disapproval of a member’s ethical actions.

Probation of Membership Subject to Terms

This type of sanction puts restrictions on the OT’s continued membership in AOTA. There are specific outlined terms that must be met in order for the member to maintain their standing within the organization.

These terms can include remedial activities or ongoing corrected behavior. Probation of membership subject to terms is publicly reported.

Suspension

Removes the person from AOTA membership for a particular period of time. It is also publicly reported.

Revocation

Permanent removal of a person from the association, which cannot be reinstated. This is a publicly reported sanction.

Educative Letters

Not necessarily a sanction for an ethical violation but are private correspondence with a member whose actions may warrant additional education about standards of practice.

The person’s behavior may have violated those standards but does not warrant a sanction for a true violation of the ethical code.

Advisory Opinions

Published on ethical issues to help educate association members on potential ethical issues and how to address them.