Marlowe Study Guide

Definition of Interdisciplinary Treatment Team

• is a team of healthcare professionals from different professional disciplines who work together to manage the physical, psychological, and spiritual needs of the patient

1. who potentially may be part of the team:

• Members of the Interdisciplinary Care Team may include:

- physicians

- recreational therapists

- dietician

- nurses

- physical therapist

- case manager 

- social worker

- occupational therapist

Advantages of an Interdisciplinary Treatments Team

• improved care and outcomes

• fewer errors

• faster treatment

• improved efficiency (streamlines operations)

• Improved morale

Elements of a successful Interdisciplinary Treatment Teams:

• Patient focused practice

• A clear end goal

• Effective communication

Co-Treatment

• when two or more medical professionals work together to treat a patient during the same session

Consultation

a meeting with a medical professional seeking advice

Referral

directing of a patient to a medical specialist by your primary physician

Principle 1 (Beneficence)

• RT should treat Person served an ethical manner by actively making efforts to provide for their well-being by maximizing possible benefits and relieving lessening or minimizing possible harm

Principle 2 (Non-Maleficence)

• RT Personnel have an obligation to use their knowledge skills abilities and judgment to help persons while respecting their decisions and protecting them from harm

Principle 3 (Autonomy)

• RT Personnel have a duty to preserve and protect the right of each individual to make their own choices

Principle 4 (Justice)

• RT Personnel are responsible for ensuring that individuals are served fairly and that there is equity in the distribution of services without regard to race color creed gender sexuality age disability Social and financial status

Principle 5 (Fidelity)

• RT Personnel have an obligation to be loyal faithful and meet commitments made to persons receiving services and have a secondary obligation to colleagues agencies and the profession

Principle 6 (Veracity)

• RT Personnel shall be truthful and honest including not using deception by being honest or omitting what is true

Principle 7 (Informed Consent)

• RT Personnel should provide services characterized by mutual respect and shared decision making to the client giving them all information and warnings needed to decide for themselves

Principle 8 (Confidentiality and Privacy)

•  RT Personnel have a duty to disclose all relevant information to persons seeking services,  they also have a corresponding Duty not to disclose private information to third parties

Principle 9 (Competence)

• RT Personnel have the responsibility to maintain and improve their knowledge relating to the profession and demonstrate current competent practice to persons served in an obligation to maintain their credentials

Principle 10 (Compliance with Law and Regulations)

•  RT Personnel are responsible for complying with local state and federal laws regulations and ATRA  policies governing the profession of RT 

1. Professional Boundaries:

• Treat all patients at all times with dignity and respect

• Inspire confidence in all patients by speaking acting and dressing professionally

• through your example motivate those you work with to talk about and treat patients and their families respectfully

• be fair and consistent with each patient to inspire trust amplify your professionalism and enhance your credibility

What shapes our ethics?

• Family Values

•  Education

•  government and Judicial Systems

•  religious beliefs

•  cultural heritage

•  personal and professional peers

•  business values and corporate culture

•  personal experiences 

1. Factors of VA National Ethics Model:

• This model consists of internal and external factors

• Internal includes: leadership, mission statements, policy and procedures, quality management, compliance offices, legal council

• External includes: professional ethics, business ethics, accreditation standards, federal and state law, political pressures, societal values

What is HIPAA?

• Health Insurance Portability and Accountability Act

• 1996

• A federal law that protects patients health information and health insurance coverage

• One aspect is fraud and abuse -> federal, state and local law enforcement programs work together

1. When do ethical dilemmas occur?

• They occur When a decision or action must be made or taken that has two or more competing courses of action based on different value sets moral Frameworks or varying or inconsistent organizational philosophy 

1. Law is a minimal standard of morality established by society (4 standards):

• Ethical and legal

• Unethical and legal

• Unethical and illegal

• Ethical and illegal 

Standard 1 (assessment):

1. Assessment is crucial in recreational therapy in order for it to be recreational therapy assessment is needed

Standard 2 (treatment planning):

1. the recreational therapist plans and develops an individualized treatment plan that identifies goals and evidence-based treatment intervention strategies.  treatment plans are measurable

Standard 3 (plan implementation):

1. working amongst other professionals to improve the client's health and quality of life

Standard 4 (re-assessment and evaluation):

1. occurs when you have someone long enough in the facility /  after a reassessment a RT will do another evaluation to determine if the treatment plan is working

Standard 5 (discharge/transition planning):

1. develop a discharge plan with family professionals and the patient in order to release the patient or continue care / treatment

Standard 6 (prevention, safety planning and risk management):

1. the RT  systematically plans to improve patient/client and staff safety by planning for prevention and reduction of risks in order to prevent injury and reduce potential or actual harm 

Standard 7 (ethical conduct):

RT and others will adhere to ATRA code of ethics

Standard 8 (written plan of operation):

1. All RT treatment must follow a written plan of operation that is based upon the atra standards for the practice of recreational therapy state and federal laws and regulations requirements of regulatory ad accrediting  agencies payers and employer policies and procedures as appropriate

Standard 9 (staff qualifications and competency assessment):

1. RT staff meet the defined qualifications demonstrate competency maintain appropriate credentials and have opportunities for competency development

Standard 10 (quality improvement):

1. there exist objective and systematic processes for continuously improving patient/client safety and for identifying opportunities to improve recreational therapy treatment and care and patient/client outcomes

Standard 11 (resource management):

1. RT treatment and Care are provided in an effective and efficient manner that reflects the reasonable and appropriate use of resources

Standard 12 (program evaluation and research):

1. RT staff engages in routine systematic program evaluation and research for the purpose of determining the appropriateness and effectiveness of recreational therapy treatment and care provided

1. What are some potential people that we would need to market to?

• It is important that the individuals receiving our services understand what recreational therapy can provide. Additionally, administrators, inter professional team members, funding sources and the public must also become aware of the benefits of our services. 

1. The marketing Process alliance with the “ TR process”  assessment planning implementation and evaluation APIE

• The marketing process shares similar activities with the therapeutic recreation process. Management of the marketing force requires four function; analysis, planning, implementation and control (cutler and Armstrong 2014), aligning with the "TR Process" of assessment, panning, implementations and evaluation with documentation. 

1. What are Target and social marketing?

• Target marketing is designing services to meet needs of a distinct population having common needs like clients, caregivers, and health professionals.

• Social marketing considers impact of individual benefits on the community, for example, improving health of clients to help reduce lost work time due to illness. 

1. Marketing mix used to influence the target Market's demand for services: 

• Product

• Price

• Place

• Promotion 

 what is a SWOT analysis?

• Strengths, weaknesses, opportunities and threats analysis

1.  what is a long-standing concern voiced by RT professionals

A long standing concerned voiced by RT  is the lack of awareness of the profession by the general public and within healthcare industry

1. what three awareness campaigns were created and by who

• Professional organizations banded together to generate awareness campaigns such as:

NTRS (dissolved)

therapuetic recreation, the benefits are endless

ATRA and CTRA

international recreaional therapy month, February

NCTRC

uses the tagline ctrs the qualified provider of RT and has identified healthcare employers as a target audience and developed a campaign to promote the hireing of ctrs

HIRE A CTRS

1. what are some goals of a marketing and PR campaign

• Building the identity of the organization or product

•  increasing the visibility of an established organization or product

•  establishing an organization or individual as an expert in a given field

•  educating stakeholders on issues critical to the organization

•  shaping public opinion about an organization, idea or individual

•  maintaining the image of an organization or product, over time or during a crisis

•  stimulating the repeat usage of a product 

Manager: Advocacy

• advocacy is defined as the act or process of supporting cause or proposal.. an advocate is someone who speaks on behalf others, or who speaks on behalf of a cause.

• manager is primary link to others in the agency (Internal audiences) and the community (external audiences)

• advocacy may occur in the context of individual effort, such as a letter written to a legislator, or it can involve coalitions and systems

• systems advocacy is necessary when the advocacy goal is to chance policies, laws or state or federal regulations that impact larger numbers of people

Advocacy

• we advocate for the individuals we serve, and we must advocate for the press ion, to assure our services are accessible to those who need them

• advocacy is an ethical mandate for all professionals and reflects the maturing of our profession and our professional organizations

• advocacy efforts are only successful when individual professionals participate in the process, as grassroots activities are necessary to bring issues to the attention of members of Congress and other policy makers at the state and local levels

Payment systems

• Public funds are generated through taxation with payments made to Health Care Providers through various systems operated at the national, state / territory, and local levels.  these public Insurance programs tend to cover specific population segments or specific services.

•  private payment includes out of pocket spending by individuals, third-party payments through privately purchased health insurance plans, and  coverage through employer-supported plans also purchased from private for profit and non-profit insurance agencies

Third party reimbursement

• The client is the first party, the healthcare organization or doctor is the second party, and the agency acting on behalf of the client is the third party

•  third party payers include government through an example, Medicare and medicaid, private organizations like Brew Cross Blue Shield Association and managed care companies like hmos

•  third-party reimbursement involves Health Care Providers delivering services to clients  who rely on the third party or intermediary to cover the bill

MCO:

• Variety of healthcare plans designed to contain costs using gatekeepers, capitation, and utilization review

HMO:

• Health maintenance organization - corporate body funded by Insurance premiums, professionals practice within Geographic and financial limits serving enrollees or members

EPO:

• Exclusive provider organization only cover in network care, client pays all of the out  of pocket expenses outside hmo, large network of providers

PPO:

• preferred provider organization - contract to pay at discount paying fee for service when provider used.  can see out of network.  has higher premiums.

Reimbursement for active treatment

• Provider under an individualized ( goal directed) treatment or diagnostic plan( diagnosis related)

•  reasonably expected and necessary to improve patient's condition

•  order, supervised and evaluated by physician

Recreation therpay coverage

• In active treatment, RT must: 

- Restore

-  rehabilitate

-  remediate

-  reduce

-  eliminate signs and symptoms of the admitting diagnosis 

Estimating service costs for coverage - common methods

Common methods used include cost per client or cost per program/intervention. in both methods, cost may be based on rate per hour.

AMA codes and service unit rates

• Unity of service: Hourly rate broken down into 15 minute intervals

• CPT codes:  current procedural terminology annual rate setting by interventions by American Medical Association ( RT related codes:  Aqua therapy and therapeutic  activities)

• Productiveity:  number of units produced per day per RT 

Qualified health care provider

• Us Healthcare policy is delegated to State legislatures as a result each state defines who is a qualified healthcare provider

•  dates tend to rely on licensure and certification to identify qualified professionals

•  if the CTR credential is recognized for the purposes of identifying qualified Healthcare professionals, allows clients to access to services that both the government and Commercial health insurance plans Define as eligible for coverage

Incremental Budgeting:

• Most budgets are developed through incremental changes of the previous year's budget incremental budgeting increases or decreases items of expenditure by some percentage comma usually the percent change in allocated or expected Revenue

(edits to the year before whether it be adding or subtracting)

Itemized Budgeting:

• Budgets are developed from a zero base each year. budget managers begin with an empty budget each year and have to develop rationales for every item in the budget for income and expenses

(starting at zero and adds expense one by one)

Fixed Allocation Budgeting:

• A budget which is made without regard to potential variations in business activity. budget managers of these types are encouraged to spend all of their budgets each year, if not, the department may end up with less money the next year 

(set budget, use all of it or you might not get the same amount the next year since you didn’t use it all)

Variable Expense Budgeting:

• Set the target income budget comment then allocates expenses based on a Target percentage of actual revenue. if revenue is higher than anticipated, then expenses are also expected to climb. if revenue is lower than anticipated than expenses are expected to decrease. 

(set a budget and if needed subtract or add as expenses come in)

What is a capital budget, separated from a operating budget

• Refers to a one-time expenditures on major purchases that generally have a life expectancy of at least 10 years 

Line Item Budgeting:

• Most commonly used, easy to understand, categories established an items fit under the category, does not support evaluation of programs, only looks at inputs does not relate outcomes to inputs

• Program Budgeting: 

- Budgeting for the delivery of a particular plan, If his last attention to the specific spending items of the program and more on its expected outpu

 Private for Profit Hospitals:

• Generate revenue from third-party embursement and private pay and they take limited forms of insurance/ they are required to pay taxes

Public Non Profit Hospitals:

• Funding comes from the government, third-party reimbursement, medicare, Medicaid and private pay/  do not have to pay taxes 

Medicare A (hospital insurance):

• This part covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care

Medicare B (medical insurance):

•  this part covers certain doctor services, outpatient care, medical supplies and preventative Services

Medicare C (Medicare Advantage Plans):

• This part covers all aspects of Medicare in one provided by private insurance companies isntead of the government

Medicare D (prescription drug coverage):

This part covers prescription drugs

1. Health care is paid by

• Healthcare is paid for by government programs such as Medicare and medicaid, Private health insurance plans usually through employers, and the person's own funds out of pocket 

Medicaid

• Medicaid is a joint federal and state program that helps with medical Cost for some people with limited income and resources

•  Medicaid offers benefits not normally covered by Medicare

•  each state currently has broadly way to determine who is eligible for its program and states are not required to participate in the program

• Medicaid  recipients must be a US citizen or legal permanent residence, and may include low-income adults, their children, and people with certain disabilities. poverty alone does not necessarily qualify someone for Medicaid.

Affordable care act and its key policies

• This act significantly expanded both eligibility for and federal funding of medicaid. however, the United States Supreme Court ruled in National Federation of Independent Business b.sibelius that states do not have to agree to the expansion in order to continue to receive previously established levels of Medicaid funding, and many states have chosen to continue with pre ACA funding levels and eligibility standards. 

CMS

• Centers for Medicare and Medicaid services:  is a federal agency within the United States Department of Health and Human  services that administers the Medicare program and works in partnership with state governments to administer medicaid, the state's children's health insurance program and health insurance portability standards