Arley.
Good points. Thanks for bringing me back to reality.
-----Original Message-----
From: Johnson, Arley <arley.john...@uphs.upenn.edu>
To: OTlist@OTnow.com
Sent: Fri, 24 Apr 2009 8:17 pm
Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
even
Having some experience with a RAC review a few years ago, they will go
after anything to deny payment. I don't know if CMS fixed their
incentive loophole, but they would get a percent of whatever amount
they denied. If the facility appealed the denials(80% turnover rate)
and won, the RAC would still get paid their cut. At the time, my OTs
did plenty of UE ther ex (which I disliked, but that's another convo)
with the joint replacement patients, but the RAC never mentioned that
in our reason for denials. That leads me back to my initial statement
that they will hunt for anything in the chart to get a denial. To
expand, they were inconsistent with their reviews. One patient had
unstable hgb levels, UTI and newly diagnosed diabetes. They said she
did not demonstrate a need for 24 hr medical supervision,but yet they
approved a straight forward unilateral TKR with no acute illnesses. Go
figure.
To conclude, we shouldn't get so bent on that one experience as the
fall of OT. :-) These reviewers aren't always the sharpest pencils in
the bunch.
Arley Johnson, MS, OTR/L
Site Manager, Pennsylvania Hospital
Rehabilitation Services
________________________________
From: otlist-boun...@otnow.com on behalf of cmnahrw...@aol.com
Sent: Fri 4/24/2009 5:04 PM
To: OTlist@OTnow.com
Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
even
PatJoan,
I do not think you understand. Medicare (our government payor source
for the elderly)is now not allowing general debility patients into
acute rehab period. We used to have this 75% rule in which 75% of our
cases had to match a certain diagnois (stroke, spinal cord, etc), and
the other 25% could be whatever diagnosis. Now Medicare CMS is
auditing charts and making rehab facilities pay back millions of
dollars finding that the patients were not appropriate to be there.
Several cases she explained was that the OT did not have enough
documentation to support that they truly needed OT. Her claim was that
a general debility patient would not need OT for arm exercises. When a
person has 5/5 strength and the therapists complete UE exerise and
group therapy all day long that is totally inapproriate. We need to
complete ADLs during the first three days of their stay to document the
need for skilled OT and then actually work on those issues during their
stay to demonstrate improvement on the FIM. The funny thing is the
patients improve much faster when we take an occupational approach. It
is not rocket science. Bottom line is that patients need to get up of
the the wheelchair and get moving by engaging in their daily
occuapations in the way they plan on completing them at home. We OTs
need to speak up to the OTs who are screwing our profession up. I am
sure AOTA is aware of these issues because these Medicare RACK audits
is a hot topic in rehab right now.
-----Original Message-----
From: Joan Riches <jric...@telusplanet.net>
To: OTlist@OTnow.com
Sent: Fri, 24 Apr 2009 2:32 pm
Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
even
Have you reported this with names and details to AOTA for follow-up?
What was the result of the debate? Will this person continue the blanket
refusal of all OT? Targeted refusals of UE exercise without specific
rationale and a UE diagnosis might go a long way to changing practice.
I wonder how widespread this is in Canada. I did see it 25 years ago as
a student. It definitely does not happen in this area. All the OTs are
far too busy too waste time that way.
Joan Riches B.Sc.O.T., OT(C)
Specialist in Cognitive Disability
Riches Consulting
High River, Alberta, Canada
403 652 7928
-----Original Message-----
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On
Behalf Of cmnahrw...@aol.com
Sent: April 23, 2009 8:12 PM
To: OTlist@OTnow.com
Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
even
Listened to a medicare teleconference describing why CMS is denying
debility patients from acute rehab stays. When asked why this is so,
the medicare communicater stated that they did not have medical
necessity for occupational therapy. When debating this issue and how
occupational therapy works on a debility patient's occupations, the
communicator stated that she thought that all we did was UE exercise.
I guess from all of her chart audits she has concluded this over the
years. I am starting to slowly see Ron's point of view even clearer
now. I now am recognizing that this is more of a standard practice than
I thought. I think we really need to focus on occupations when the goal
is to get the patient home or to improve their quality of life. I
think it is ok to work on UE strength, fine motor control to an extent
especiallly when the imparment is effecting the individual on a
disability level, but the focus needs to be on the skills that will
allow the patient to go home safelyl. I believe that this move by
medicare CMS will slowly trickle down into other areas of our care. We
need to start now to force our other therapists to treat as
occupational therapists not cone and peg pushers. Managers need to
initiate policies that address these issues now,
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