Re: [OTlist] A New One
Mary, That has been my experience with school system therapy as well. Goals have to be based on the educational goals for the school year. In fact, in one district near me, the OT no longer makes separate goals. Instead they look at the educational goals for the semester or 6 weeks and sign on to the ones that OT can help with. Sometimes ADLs can be addressed, but it usually has to be a Life Skills type classroom and not a mainstream classroom for these goals. Visual perception, eye/ hand coordination as well as fine motor are often addressed. Since education is the primary focus, therapy (all three) tends to take a backseat role to the academic objectives. It is definitely a different world than medical model. Does anyone remember the old fable of the blind men being asked to feel and then describe the elephant they are feeling? Each man is only given one area of the elephant to feel (i.e. the trunk, ears, tail), so each has a very different idea of what an elephant is. Seems to me that OT is similar. Depending on the piece you have been exposed to, you have a different interpretation of what OT is. None are necessarily wrong, but none actually get the whole picture either. How is that for different? Anyone ever compared our profession to an elephant before? smile Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Aug 23, 2009, at 7:49 PM, Mary Giarratano wrote: In a lot of school systems, most of what OTs do is fine motor and handwriting. The OT goals have to be educationally based, not overlap other services and the parents want their children to have legible handwriting. I'm sure it doesn't fit your definitions but it is the way most school systems work when the majority of pts do not have significant motor issues. Mary - Original Message - From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Sunday, August 23, 2009 8:39 PM Subject: [OTlist] A New One You know, I like fillin' everyone in when I come across OT definitions/experiences that are off the scale. Well, this Saturday was a new one. I was evaluating a woman whose daughter is a SLP working in school systems. What do you think the SLP told me was her understanding of the role of OT? 1. ADL's 2. Fine Motor 3. Occupation 4. Upper Extremity The answer is #2. In her experience, OT's worked only on fine motor control. PT does gross/large muscle and SLP does cognition. The SLP was actually surprised that I gave her mom a cognitive screen. It just seems that OT is so pigeon-holed into either FMC or UE. Will we ever break these shackles? Ron ~~~ Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] W/C evals
I don't have the actual reference close at hand. This was something I learned at a course when I first started billing on my own. The course was done by either Permobil or Pride. If you look at the list of CPT codes that are applicable to OT, it shows the code, the definition, and what it can be billed with, can't be billed with, and is suspect if it is billed with. I will do my best to find it later. I do know that it works to bill both on the same day as that is how I am getting reimbursed. That is Medicare. Private insurance and Medicaid are a totally different ballgame and vary wildly. Juan-- If I saw a patient for only an hour (never happens), I would bill the eval code and then 2 or 3 units of 97542, depending on how much time I felt was dedicated to chair discussion/decisions only. Just FYI, the Medicare evaluation I use is 12 pages long and includes a place to justify everything that is not an included item in the base price of the chair. Most Medicare evals take a minimum of 1 1/2 hours and as long as 3, depending on the complexity and circumstances. I also use my eval only and don't do an additional LMN. Good day, all. Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Jun 11, 2009, at 7:53 PM, Ron Carson wrote: Good conversation. Mary, will you provide a reference for this statement: It is also true that the 97542 wheelchair management and training code is the only code that can be billed for treatment on the same day the MAC evaluation code is used. - Original Message - From: Mary Alice Cafiero m...@mac.com Sent: Thursday, June 11, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] W/C evals MAC It is also true that the 97542 wheelchair management and training code MAC is the only code that can be billed for treatment on the same day the MAC evaluation code is used. This makes it possible to do the OT eval/ MAC Whelchair assessment on the same day. I procure the doctor's order for MAC eval and tx ahead of time. MAC It's all a work in progress on my part because it is a very new field MAC to be doing only w/c evals in patients' homes but not as part of a MAC home health agency. Believe me, it confounds all of the funding MAC sources when I call with ?S. MAC Sure is fun, though! MAC Your explanation of the 7 minute rule is what I understood. but it MAC needs to be clear that an hour long treatment is 4 units, not 8 units MAC (as it would be if it were a true per 7 minute unit). MAC Mary Alice MAC Mary Alice Cafiero, MSOT/L, ATP MAC m...@mac.com MAC 972-757-3733 MAC Fax 888-708-8683 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] W/C evals
Ron, I am curious to know where you got the per 7 minutes for unit time on the CPT codes. The manuals I have seen all say that it is per 15 minutes. That would make a huge difference in reimbursement as I am doing almost all complex evaluations. Also, I do charge for an OT evaluation and consider the first 20 to 30 minutes of my time with the patient the OT eval where we determine overall status and goals. If the goal is to pursue a mobility device, then the w/c eval starts and is actually the completion of the plan of care unless future sessions are needed for seating or training needs. Since I don't see patients for ongoing care, this seems to make the most sense. I would do it differently if I were a home health therapist and this was just one or two of my sessions. There is also an Assistive Technology code that you can use for things like power training, teaching at delivery, etc. I forgot the CPT number, but it is an OT/PT code that is billed per unit. Just as a word of caution from someone who does this all day every day, please be aware of all the Medicare changes and rules if you are recommending mobility equipment for your patients. The documentation requirements are extensive. It is almost impossible to get Medicare to pay for anything new for five years, so be sure that you know the equipment you are recommending is the most appropriate match for the patient now and for the predictable future. Know that suppliers are now required to have an ATP on staff that needs to be involved with equipment selection on every client requiring a Group 2 chair with multiple power options or any Group 3 chair and above. Have a good day, all! Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Jun 11, 2009, at 7:27 AM, Juan Turcios wrote: Ron thanks for all the good information you have given me. This helps a lot. Juan Turcios On 6/10/09, Ron Carson rdcar...@otnow.com wrote: Lots of good questions. I'll answer to the best of my ability: JT I read somewhere that we needed some type of credentials At one time, Medicare was going to require that all w/c evals be done only by people holding an ATP credential. This never came to fruition, so no special credential is currently required. JT NMy second question is how do you bill medicare for this? I bill Medicare under the CPT code 97542 W/C Management. This is a timed codes so billing in accordance with all time code requirements, e.g. 7-minute rule, face to face, etc. There is no specific time allowed for the eval. Each eval is different and requires a different time. Usually, 30 minutes to an hour is what is required. Higher level evals take longer! Do not bill under OT eval, as this is NOT appropriate. An OT eval is used to generate a plan of care and you will not be doing that. JT Do we need a doctors order to do this evaluation? Medicare does NOT require doctor's orders for any therapy. The requirement is that the patient be under the care of a doctor. This requirement is met when a doctor signs your w/c evaluation. You may obtain an order if desired and/or required by your state, but it's NOT required by Medicare. But, the patient MUST be under a doctor's care. You will need the MD's information for billing purposes. For the record, I do NOT write a separate letter of justification. That information is contained in my evaluation. Hope this helps. Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Juan Turcios jcd...@gmail.com Sent: Wednesday, June 10, 2009 To: OTlist@otnow.com OTlist@otnow.com Subj: [OTlist] W/C evals JT Hello all, I have more medicare questions for you. Are there any JT requirements that we (OT's) must have to perform w/c evaluations? I read JT somewhere that we needed some type of credentials. When I use to do the JT evals (more than 8yrs ago) I remember that I spent about 45-60 minutes doing JT the measurements and about an hour writing the letter of justification. My JT second question is how do you bill medicare for this? and what is the JT billable time allotted for these type of evaluations? Do we get the hour JT only and bill under OT evaluation. Do we need a doctors order to do this JT evaluation? or we can do the evaluation without the other, but we need JT it for w/c training? Thanks again Juan Turcios JT -- JT
Re: [OTlist] W/C evals
It is also true that the 97542 wheelchair management and training code is the only code that can be billed for treatment on the same day the evaluation code is used. This makes it possible to do the OT eval/ Whelchair assessment on the same day. I procure the doctor's order for eval and tx ahead of time. It's all a work in progress on my part because it is a very new field to be doing only w/c evals in patients' homes but not as part of a home health agency. Believe me, it confounds all of the funding sources when I call with ?S. Sure is fun, though! Your explanation of the 7 minute rule is what I understood. but it needs to be clear that an hour long treatment is 4 units, not 8 units (as it would be if it were a true per 7 minute unit). Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Jun 11, 2009, at 7:00 PM, Ron Carson wrote: Hello Mary: The 7 minute rule is this: 1 unit= greater than 8 minutes bus less than 23 minutes 2 units = greater than 23 minutes but less than 38 minutes 3 units = greater than 38 minutes but less than 53 minutes 4 units = greater than 53 minutes but less than 68 minutes etc In general, there are two different types of w/c evals: 1. One time evals to determine medical necessity 2. Eval and ongoing treatment for high-level needs For one-time evals, I recommend the w/c assessment code. For the ongoing needs of high-tech seating, I can see that an OT eval generating a plan of treatment that is signed by an MD is indicated. However, the plan of treatment should be generated prior to beginning treatment. In general Medicare will only purchase new equipment if there is a significant change in the patient's status. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Mary Alice Cafiero m...@mac.com Sent: Thursday, June 11, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] W/C evals MAC Ron, MAC I am curious to know where you got the per 7 minutes for unit time MAC on the CPT codes. The manuals I have seen all say that it is per 15 MAC minutes. That would make a huge difference in reimbursement as I am MAC doing almost all complex evaluations. MAC Also, I do charge for an OT evaluation and consider the first 20 to 30 MAC minutes of my time with the patient the OT eval where we determine MAC overall status and goals. If the goal is to pursue a mobility device, MAC then the w/c eval starts and is actually the completion of the plan of MAC care unless future sessions are needed for seating or training needs. MAC Since I don't see patients for ongoing care, this seems to make the MAC most sense. I would do it differently if I were a home health MAC therapist and this was just one or two of my sessions. MAC There is also an Assistive Technology code that you can use for MAC things like power training, teaching at delivery, etc. I forgot the MAC CPT number, but it is an OT/PT code that is billed per unit. MAC Just as a word of caution from someone who does this all day every MAC day, please be aware of all the Medicare changes and rules if you are MAC recommending mobility equipment for your patients. The documentation MAC requirements are extensive. It is almost impossible to get Medicare to MAC pay for anything new for five years, so be sure that you know the MAC equipment you are recommending is the most appropriate match for the MAC patient now and for the predictable future. Know that suppliers are MAC now required to have an ATP on staff that needs to be involved with MAC equipment selection on every client requiring a Group 2 chair with MAC multiple power options or any Group 3 chair and above. MAC Have a good day, all! MAC Mary Alice MAC Mary Alice Cafiero, MSOT/L, ATP MAC m...@mac.com MAC 972-757-3733 MAC Fax 888-708-8683 MAC This message, including any attachments, may include confidential, MAC privileged and/or inside information. Any distribution or use of this MAC communication by anyone other than the intended recipient(s) is MAC strictly prohibited and may be unlawful. If you are not the recipient MAC of this message, please notify the sender and permanently delete the MAC message from your system. MAC On Jun 11, 2009, at 7:27 AM, Juan Turcios wrote: Ron thanks for all the good information you have given me. This helps a lot. Juan Turcios On 6/10/09, Ron Carson rdcar...@otnow.com wrote: Lots of good questions. I'll answer to the best of my ability: JT I read somewhere that we needed some
Re: [OTlist] We Better Wake Up...
Susanne, I have to agree with you. I don't think OTs have a lock on the market of making an activity functional. Certainly I find plenty of OTs that are threatened by PTs use of functional activity and functional goals. Interestingly, the first time I heard that PT was trying to take over OT because they dared to say they were doing functional tasks was about 15 years ago. So far, it seems that there is plenty of room for all of us to help our patients in a variety of ways with varying approaches/frames of reference. It is hard to avoid feeling that many OTs who are upset by this are talking out of both sides of their mouth. How can we be upset that PT is frustrated when we address gait, balance, functional mobility, transfers, and even progression to different assistive devices for ambulation when, at the same time, we are frustrated that they are using functional language? Personally, I feel that it is splitting hairs. If we focus instead on helping clinicians (PT and OT) be creative with treatment approaches and individual specific goals within the allowances of the health care system, we will be busy for years. Instead of just sitting around moaning and groaning that there is another therapist out there doing upper body bike exercises or pegs in putty, start where you are with education on ways to change it up a bit. Trust me, I was in a skilled nursing rehab unit today, and saw the usual line-up of suspects doing their upper extremity exercise time was very frustrating to observe. I talked with the therapy director and set up an inservice with the staff to talk about how to come up with treatment ideas and individual goals in their practice setting. We shall see how it goes. Always interested to hear everyone's opinions. Thanks for sharing! Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Apr 8, 2009, at 6:05 AM, susanne wrote: Hi Ron! Me, I'm usually happy when a PT is also observant of occupational stuff - IMO makes their treatment more meaningful for the patient, and helps the cooperation when both PT and OT services are involved/available. But from there, and to advertising their services as such - that's a stretch, I agree! A recent example of the dangers of PT not being observant of occupational stuff: New PT has first treatment with a patient (quadriplegic) seen by other PTs for years, mostly for PROM. She asks the patient about previous treatment and preferences, but seems very much wanting to change it regarding the paralyzed hands, which she also wants to do PROM to - finding them much curly - she even starts stretching one hand while he's looking away. At that point I could not hold myself back anymore:-) - and explained to her how the curliness of the hands was what made it possible for him to hold and use things like eating utensils, cups, typing sticks, and that the hands even had been taped in rehab to get just the right curl/tightness. Or, maybe it's just an example that if you have a hammer, everything looks like a nail - anyway, we all ended up agreeing that she'd stick to treating LE:-) Warmly susanne, denmark Original Message From: Ron Carson rdcar...@otnow.com (snip) Shouldn't PT's scope of practice be limited to remediation of physical dysfunction and OT's scope of practice be limited to occupational dysfunction? Doesn't this make sense and sound right? It does to me! Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best practice
Does the patient have any issues with tone? Typically drop-down shower seats have no arms or positioning belts. If a patient has increased tone, it may kick in and cause them to slide off the seat or to hit the walls of the shower causing injury. If they have decreased tone, do they have any trouble maintaining a sitting position? If so, how many hands does a caregiver require to keep them on the seat? It is almost impossible to support someone to maintain sitting while also manipulating soap, washcloth, and other needed items safely and/or successfully. If the patient is able to do any of the bathing themselves, I would also observe and see if any of the movements needed (i.e. bending to wash feet, reaching with two hands to shampoo, etc.) trigger tone or decrease sitting balance. Also, it is important to know if the patient has seizures. If so, are they well controlled or do they happen often? If a seizure happens while in the shower, what will the result be? That's just the beginning of the list of questions I would want to find out. Anything that might cause fall risk or decrease safety with that type of seat that could be altered by a different type. Good luck. Hope this is helpful. Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Mar 26, 2009, at 5:32 AM, Veronica wrote: Hi, does anyone have any (research) information that would help substantiate why it would be a BAD idea for a teenager (or adult) with a neurological condition to use a drop-down shower seat? One of my collegues has a child that she is currently working with and the mother is applying A LOT of pressure to try and get this done. We're trying to give her best practice information and it would be helpful if there is any documentation/research into the use of drop- down shower seats and safe handling. Many thanks Veronica Children's Occupational Therapist -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Good Room for Debate/Problem Egocentric Thiniking
Brent, I just had to make a comment on your reference here because I think it is wonderful. My husband teaches a class in the high school IB program called Theory of Knowledge, and I forwarded him your citation. The class is all about what we know, how do we know what we know, and what do we do when presented with new information. Reject it? Assimilate it into our current belief system? Modify it to meet our needs? I just thought it was great that what you posted fit so well. Thanks, Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Mar 21, 2009, at 9:15 AM, Brent Cheyne wrote: To the list, I agree Ron, it's probably healthy for the profession to get critical appraisal in the format here on the listserv. I have a tendency to avoid conflict where possible and that means sometimes I am flawed in thinking that nothing critical should ever be spoken or written, but in reality the true Science Based Professions and Disciplines have ongoing debates all the time, and it's healthy, hence the popular phrase DEFEND YOUR THESIS...when completing a doctorate. I tend to play devil's advocate with any stauchly held set of principle or theories, sometimes with a meager attempt at satire or lame humor.. While I enjoy the meat and potatoes clinical discussion, I find the philosphical debate an irresistibly frivolous and guilty pleasure. As OT LIST members spell out their widely held truisms, I suggest they revisit their doubts and examine their own certainties with a little self-critical thinking. In order to truly improve ones own development consider these Problems with Egocentric Thinking: ( Reference:Critical Thinking: Concepts and Tools-Dr. Richard Paul and Dr. Linda Elder www.criticalthinking.org ) IT'S TRUE BECAUSE I BELIEVE IT I have never questioned the basis for my beliefs IT'S TRUE BECAUSE WE BELIEVE IT I assume the dominant beliefts of the group are true, without question, how could we be wrong? IT'S TRUE BECAUSE I WANT TO BELIEVE IT what i believe puts me in a positive light compared to others yet I have not considered the evidence to the contrary of my belief, and it feels good to be right and not have to admit I am wrong. IT'S TRUE BECAUSE I HAVE ALWAYS BELIEVED IT Why would I change what I believe now even with new evidence to be considered? IT'S TRUE BECAUSE IT'S IN MY SELFISH BEST INTEREST TO BELIEVE IT I hold fast to my beliefs that justify my getting more power, respect, influence, money, personal advantage even though my beliefs are not grounded in sound reasoning or evidence. Just a little food for thought, Quote of the day The unexamined life is not worth living--Socrates of Ancient Greece, stated in defense at his trial for encouraging his students to challenge the accepted beliefs of the time. Brent C -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Wii therapy
I have used both the Sports and the Fit games mostly with patients who are adults. (Unless they were gamers before injury and have favorite games). Golf and baseball on Sports can both be done in either sitting or standing depending on how much balance challenge you want. Actually they all can, but those two seem to be the most intuitive. You can also teach the person to use their wrist or full arm to do the movements, again based on what you are looking to challenge. The Fit balance games are very challenging! The step (in aerobic section) is more advanced because you are truly stepping on and off the balance board. The walking/jogging (also aerobic) you do on the floor instead of the balance board, so balance isn't challenged as much as the ones on the balance board. It is really fun and easy to keep going longer than you should. Watch out for repetitive motion injuries in people that don't do a lot of activity. Let us know what you try! Oh, we also do tournaments between patients who show interest. The competition is a good thing sometimes. Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Mar 20, 2009, at 6:56 PM, cmnahrw...@aol.com wrote: I am so excited. Our acute inpatient unit just purchased a Nintendo Wii and a big screen TV. So far we have the sports games and the Wii Fit. Does anyone have any experience with this and its application to OT? Do you know of any other games that would benefit the patient in OT? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] How NOT to be an OT
That's a bit elitist, Ron. If someone wants to be able to fold clothes and has impairments preventing them from doing so, then that is an excellent role for OT. Taken as a single incident or out of context, much of what we do sounds childish. Walking to the bathroom, counting money, using a screwdriver, etc, etc. BUT, if someone thinks it is childish, they most likely have never been in the position of not being able to do one of the things that matters to them. Maybe we should worry less about leaving a grand mark and important name for ourselves in the future world and more about changing patient's lives, one at a time. If enough of those lives are changed, the people that matter know what OT is. I'm not saying we shouldn't publicize what we do. I'm not saying we don't need a better job of explaining our role and our profession. I AM saying that there seems to be an awful lot of complaining about PT and other professionals being competitive and taking over our territory when many of the OTs (on this board and elsewhere) perpetuate the competition by repetitively talking about it. Work where you are. Build a team with other professionals where you are. If you are successful, the people you work with will take that with them in future jobs and continue to try to do the same thing. Yes, I'm a little fed up. I need to post more good stories of things I experience. I hear them every week. Not putting down other disciplines but simply expressing appreciation for OT on the part of patients. This week, I saw a lady for a power wheelchair evaluation. She has a progressive neurological condition and was very resistant to talking to me. She finally asked who I worked for. When I told her that I had my own company, was an OT, and specialized in complex wheelchair evaluations, she visibly relaxed and smiled. She said, Thank goodness you are an OT. Other people I have worked with in rehab places in the past have not done a good job of listening to what I have to say about what I want and need. The OTs are always my saving grace because they start out by asking what I want to work on. Someone along the way, and it sounds like more than one someone, has done an excellent job! We had an excellent evaluation, and she was willing to listen to some of my suggestions for her future needs because she trusted our profession. Enough for now, Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Mar 19, 2009, at 8:26 PM, Ron Carson wrote: Isn't it a bit childish that OT is remembered for folding clothes? Should we be remembered for something a little more substantial? - Original Message - From: R. Eren Can re_...@hotmail.com Sent: Thursday, March 19, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] How NOT to be an OT REC gotta agree on the first example Ron, you may be off base ont he REC second- folding clothes attacks, balance, endurance, REC sequencing.need I go on- and I imagine she NOW CAN DO IT REC because she practiced and likely told an OT she needed to do it at home so not=stupid on that- Ryan Date: Thu, 19 Mar 2009 18:46:40 -0400 From: rdcar...@otnow.com To: OTlist@OTnow.com Subject: Re: [OTlist] How NOT to be an OT And as if to add insult to injury, my clinical director told me that we have a mandatory inservice next week. The topic is orthopedic referrals and OT is to be involved especially for the UE. :-( I do NOT focus OT treatment on any body part, so I think my director is not going to be happy when I don't take ortho referrals. Well, at least not to focus my treatment on the UE. Ron - Original Message - From: virginiask...@comcast.net virginiask...@comcast.net Sent: Thursday, March 19, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] How NOT to be an OT vcn Wow...as a graduate student in the OT profession I find myself vcn appauled at the below comments. Too many times we are not vcn identifying with the patient on their needs, this is found through vcn an easy interview or needs assessment. I have recently done a vcn project with the ALC here in stillwater, and the site is planning vcn on implementing the program based on our practice of addressing the vcn needs of the site, the needs of the community as well as the needs vcn and desires of the students. I do not want to graduate with this vcn degree with an image such as the one below. and i will fight to vcn change that. I am fortunate to have worked and study under some vcn
Re: [OTlist] OT's for swallow evals?
I have been on the feeding team in three different hospitals as an OT. Sometimes there was speech too, and sometimes there was not. Either way I participated in the swallow study and oral motor/feeding assessment. I also helped with education regarding the results of the study and the implementation of recommendations. Not all OTs were comfortable in this role, but the ones who had experience and/or were interested were welcomed on the team. Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Feb 23, 2009, at 6:42 PM, Miranda Hayek wrote: Hi, I work in a small community hospital where we have 4 OT's and 1 Speech Therapist. We are trying to inquire with various OT's as to their experience/hospital policy with performing swallow evaluations. We have occasions where our Speech Therapist is gone, and a swallow evaluation is put through. We are questioning if other hospitals have their occupational therapist perform the swallow eval or do they find a PRN/contract speech therapist to complete this. Thanks, Miranda -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] The Timing of OT...
I think that patients often equate PT not only with walking, but also with strengthening. It seems they often feel that the majority of their problems doing things are because of weakness. If they can just get stronger, all else will fix itself. I can see this especially being true with a diagnosis like MS or other progressive neuromuscular disease. We, as OTs, can clearly see that learning to do the things you need to do for yourself has inherent value. It also ends up addressing strengthening without doing a straight exercise program. I tend to think that patients often prescribe to the no pain, no gain theory and feel that they have to do multiple reps of an exercise in order to address weak muscles. My two cents. I'll be curious to see if anyone responds. The majority of times that I post a response on this board, no one directly responds, and my answers just get shuffled over. Not sure of the reason for that, but it is certainly frustrating. Makes me reluctant to post because it doesn't seem to add to or lead to further discussion. Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Feb 21, 2009, at 1:21 AM, Ron Carson wrote: I had an interesting experience that I want to share. Last week, I evaluated a middle-aged man with muscular dystrophy. He had recently moved back home with his parent and was started on home health. The man essentially told me that there was nothing I could do for him. He said that PT was all he needed. I explained that as an OT, my job was to teach him to take care of himself as much as possible and desired. But, he still felt that PT is what he needed. I am really perplexed as to why someone might value PT instead of OT? I have some ideas, which I'll share, but I hope readers are willing to discuss this situation. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Puposeful activity
Joan, No worries at all on the name thing. When you have a double name that starts with Mary, you learn early on to answer to Mary Ann, Mary Beth, etc., etc. If someone calls me the wrong name, I just always say that if that is the worst than anyone calls me then I'm doing pretty good! 8-) I very much appreciated your comments in your earlier post. It's nice to know that people are listening and reading. I am pretty bad about not posting to say that I agree with something as well, so I will try to be more aware of that in the future. I have enjoyed all the discussions lately although we need more people to join in. Please don't be afraid to post! Everyone I've encountered here is very friendly--- although occasionally a bit passionate about their own view! Happy Weekend All! Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Feb 21, 2009, at 5:42 PM, Joan Riches wrote: Back again. I didn't catch all the edits I needed to make in my dictation so I have done that below. I hope you were able to read over them but if not this may help. Also I apologise to Mary Alice for getting your name wrong. Obviously I have a Mary Catherine in my life. Joan Hi Ilene The book Ron Mentioned, Enabling Occupation: An Occupational Therapy Perspective, as well as Enabling Occupation II: Advancing an Occupational Therapy Vision for Health Well-being and Justice and Through Occupation are the official guiding documents for OT in Canada. They are both published and available from www.caot.ca. They are good but do not address the payment and productivity demands of your SNF practice in the US. You wrote Hi Joan and thanks for your insight! May I ask what you would want an OT to work on with you though before you had sufficient range to fasten your bra behind your back, if increasing the range of motion or adapting the task (i.e fastening in the front) were not options you would want? Increasing range, strength and stability as well as adapting the task were all necessary and, of course, increasing range strength and stability improved occupational performance in many other ADL and IADL tasks. What I would have wanted from another OT, if I had not been doing it for myself was good task analysis and grading. Analyzing how I pulled up my pants and to what extent that was facilitating internal rotation is an example of grading toward the ultimate goal of fastening my bra at the back. Pulling up the pants can be graded from starting at the front and wiggling into them to gradually moving both hands further back. It was several months before I could pull up my pants with both hands behind my back. It was also a good way to see progress with my Peete exercises (I can't resist leaving this in. I have just begun to be able to dictate to my computer. It has not yet learned what I'm talking about). I guess in my own case I did have multiple goals because I was analyzing all the things that I had to do differently, how I was doing them, how I wanted to do them and how I could grade the movements I was making to lead toward how I wanted to do things rather than falling into bad habits of accommodation, especially the habit of limiting myself in terms of what I was willing to do. Because I had a hip fracture as well I was particularly concerned about not developing an accommodated gait. However my measurable goal for my hip was to be able to cut my toenails on that foot. I can do it now but it is a real struggle and when I can do it easily I think that the stride of both legs will be equal and my gait will be balanced. This example is only applicable to a client with intact cognition who can look forward and see the implications of the difficulties they are having. In other words they will be able to follow the logic of your reasoning. It is a very different matter when you are working with people who have a cognitive deficit. They are unlikely to understand working toward a measurable goal. The goal in that case may be implicit in terms of comfort so your analysis and grading may lead you toward some motions that can be elicited by an activity, such as balloon ball to encourage reaching up. The Canadian Occupational Performance Measure includes those things that a client wants or needs to do as well as those things that someone else needs or wants wants you to do. In the SNF setting treating a shoulder injury may have the goal of improving comfort during mechanical transfers so the want or need will be expressed by the caregivers not the client. As you
Re: [OTlist] Game using reacher
I completely agree about the benefits and importance of social interaction. I definitely don't think it has to be a specific goal to be effective. I also think that you can uncover a world of problems or issues by observing a patient interacting with staff, peers, family, etc. Might end up finding new areas that need to be addressed. Therapeutic use of self and using real world activities are completely OT! Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Feb 4, 2009, at 5:16 PM, bbh1...@comcast.net wrote: If someone is going to be using a reacher for the foreseeable future after D/C because of medically established precautions against trunk flexion, etc. then this kind of practice with a reacher is medically beneficial. Call it whatever perjorative name you like, patients enjoy activities that are entertaining as well as medically necessary/useful/goal-directed. I am certainly not going to sit with a patient and make him/her take her pants on and off interminably just because that is how the goal is worded - LB ADL Indep using AE... Come on, people. Lighten up! And as far as social interaction is concerned, there is NOTHING that is more conducive to helping patients progress, especially those in SNFs, than interaction with the therapist or with other patients. You don't need a goal. It is ALWAYS a factor, hence it is therapeutic to the goals you are working on. Just today, I had a patient who more easily lost his balance because of laughter. He is a funny guy and likes to joke around. Because I engaged with him, I was able to observe this phenonmenon directly. I then suggested that we should have him watch funny videos standing so that he can practice his dynamic balance. This was a direct result of social interaction. Social interaction is an integral part of any occupation, and I mean that in the broad OT sense of the word. Well, I guess not for hermits, or possibly accountants and others whose goals are impeded by interaction. But you get the drift. Thanks for your suggestion, Barbara. I may try this with appropriate patients. I have a few on my caseload with precautions like these. I find that competitive games are very helpful in supporting patients by giving them tangible evidence that they are not the only person in the world struggling to recover/ adapt to a new medical condition. Barb Howard - Original Message - From: Neal Luther neal.lut...@advhomecare.org To: OTlist@OTnow.com Sent: Wednesday, February 4, 2009 8:33:02 AM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Game using reacher Could not agree more. In addition, this just simply sounds juvenile...pediatric. Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Tuesday, February 03, 2009 5:50 AM To: Barbara H. Hale Subject: Re: [OTlist] Game using reacher I don't want to sound negative, but I can't help wondering what patient's think about using what should be medically necessary equipment to play games. What message might this send to patients, other professionals and payers? Finally, should social interaction only be considered as therapeutic if it's an actual goal? Just some random questions. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Barbara H. Hale Sent: Monday, February 02, 2009 To: OTlist@OTnow.com Subj: [OTlist] Game using reacher BHH I have a bean bag tic tac toe game that I use for a reacher training BHH activity. The grid for the game is painted on a fabric square that I place BHH within reach on the floor. Each bean bag has an X or an O painted on it. All BHH the items fit into a tote bag and I usually hold the bag for the patient to BHH clean up our game
Re: [OTlist] From Standing to Toilet Transfers
I think absolutely yes. I do find it interesting that this post is from you though, Ron. And here's why A lot of your comments and thought-provoking questions relate to working on the specific activity that is the ultimate goal the entire time rather than breaking down an activity into different components and working on the component parts separately. Isn't this case a similar thing? I realize that there are differences since clearly standing is part of walking and you were following the natural progression of her recovery. Still, in a whole picture way, you were working first on a small piece of the activity that was the ultimate goal. I haven't replied to a lot of these types of cases just cause I like seeing what everyone else says. I do think that there is a reason we learn activity analysis and how to pick activities that work on the different skills required to reach an ultimate goal. I don't agree that making up an activity to work toward a goal is not OT or is bad OT. Certainly, it can be bad OT if it isn't done with thought and planning. For example.. working with a male patient who has cognitive issues post whatever neuro incident happened. Typically in his life, he does not do a lot of cooking. He does, however, really like cupcakes. If you use a box mix or a recipe and have him make cupcakes, you are hitting many areas of cognition that are involved in every day activities that most people don't ever stop and think about. You've got sequencing, visual scanning, visual perception, judgement, safety awareness, etc, etc. His goal may not be ultimately to make cupcakes. You do need to know if he uses reasoning and safety awareness while doing an activity that could be dangerous. Maybe he has poor endurance from a long hospitalization. You have him stand for some of this activity and are working on endurance while doing an activity. The component pieces of the activity are addressing his current deficits and providing a vehicle for real-world evaluation. I still think that is OT and is occupation. What do other people think? I am not trying to be ornery just truly curious about how different people view these different scenarios. Also apologize that it is somewhat rambling. I'm very tired and up too late again. Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Feb 3, 2009, at 9:40 PM, Ron Carson wrote: A while back on an AOTA forum, I was criticized for working on mobility when there were not obvious occupational forms present (i.e. toilet, shower, chairs, etc). At least one person's contention was that working on mobility in the absence of an occupational form is not OT. I want to share a quick case study which highlights why I take exception with the person's comments. For the sake of brevity, I'll keep Jane's case study as simple as possible. Jane has a spinal condition leaving her with partial lower extremity paralysis. The patient's initial goals are of course to walk but also to transfer to her toilet, shower, etc. Again for brevity, she wants to learn skills for the job of living. Initially, the patient was unable to stand, so we began working on standing. This required maximum, and I mean max, assistance x1. At this early stage, the patient was unable to use a walker. After a week or so, I progressed the patient to a walker, but she still required knee blocking to stand. Eventually, the patient was able to stand without knee blocking and finally began taking steps. After she was able to walk 10-15 feet with a rolling walker, we tried transfers from wheelchair to wheelchair. This was very difficult and required continuing practice. After approximately 6 weeks of almost daily OT, TODAY, the patient transferred from her w/c to her toilet using a walker. She required assistance with sit to stand and cuing with the transfer but it was essentially her doing the transfer. This is a huge milestone for this patient and made her VERY happy and optimistic that her life was going to again have some semblance of normal. ## Now, in my opinion, I have been working on occupation from day ONE! The patient had occupation-related deficits, her barriers were identified I was competent to address those barriers and the patient had good
Re: [OTlist] An Occupation Approach to a hand patient
I would also teach retrograde massage techniques and educate regarding parrafin bath and maybe a few other ideas to facilitate decreased edema and gentle movement. Edema can definitely impair your fine motor coordination, and it will not always go away just by using your hands. There are times when you have so much edema that you can't actively use your hands enough to decrease the edema and then increase the movement. Vicious cycle, but see what I mean? I've also had guys that have shops and like handwork and building/ remodeling to just work on tightening/loosening varying size nuts and bolts both with their hands and with tools. I know that is not the ultimate goal but it is a piece of the goal. Sometimes I find that patients feel like they are doing themselves more good if it feels like an exercise program. You can also use that as a way to get in multiple reps of a needed activity that might only need to be done a few times in the course of one real project. There's no harm, and if it helps, everybody wins. I will tell you that I learned a lot about edema and decreased sensation in hands and arms over the past 1 1/2 years from personal experience. I had to have major surgery and ended up having some sensation return that I didn't know was lost. It really surprised me because I thought, as an OT, that I would know if I had an obvious impairment like that. Nope! Not a clue! I was so shocked when I had to have an infusion for the first time post-op, and it was like someone had sharpened all the needles! I used to never mind if it took a while for them to find a good vein. Didn't hurt, didn't bother me. Well, that's not cause I'm tough. It's cause I couldn't feel a damn thing! Very strange. I still have neuropathy to varying degrees throughout each day and day to day and find myself compensating all the time. It's very interesting to switch the roles now and then. Enlightening experience. I am now using my new Wii Fit to see if I can help improve my static and dynamic balance. I'll tell you the results if anyone is interested. Ciao for now! Mary Alice in Texas Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Jan 19, 2009, at 8:45 PM, Ron Carson wrote: Evaluated a man last week who is s/p hospitalization for multi-organ failure. Basically, the man died but recovered. During the eval, the patient's primary c/o was bi-lateral hand swelling, decreased sensation, decreased gross and find motor strength/coordination. He reported that about the only thing he couldn't do was buttoning. But, he also said that things are getting much better. I instructed him to keep doing what he was doing, use his hands as much as possible to get back to work. I told him I would be back in one week. Today, the man's hand were minimally improved. He stated that yesterday he couldn't open a set of jumper cables and had to call his wife. She said that he was literally crying. The patient seemed frustrated at his situation, but still said things were getting better. I asked him to show me the cables that he couldn't open. So, we walked outside and he showed me the difficulty he had. Once again, I suggested that he get in his shop (he's building an ultra-light aircraft) and that he get busy using his hands. I again, said I'd be back in one week. I don't know what is wrong with this man's hands. I'm sort of torn because he is able to do so much, but is then somewhat limited. I strongly believe that if he will increase the use of his hands, they will improve. But, it seems that my suggestions were met with some skepticism. The patient's wife wanted to buy an exercise ball, the social worker, who just happened to be there, suggested hand exercises. I just sort of shook my head and reiterated that the best exercise was using his hands. Am I wrong in my approach? Not to bring up the PT ~vs~ OT thing, but the PT wrote OT can address all the patient's needs. I always feel a double-edged sword when PT dismisses UE patients. Ron -- Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Client without goals
I recently had this discussion with a good friend here who does home health. She had a patient that was very similar as far as not being able to identify goals. Her pt had a very flat affect and didn't do anything other than move from her bed to her couch during the day and occasionally get up to go to the kitchen for some snack food or similar that she just had to grab and eat. The referral actually got to home health because the lady had a shoulder arthroplasty done. However, when my friend did the evaluation, this lady was able to do all of her basic ADLs and even some IADLS in her home. PT was also on the case and was addressing the specifics of range and exercise for the shoulder. The first thought was that there were not really OT goals. My friend wasn't totally comfortable with this, and I'm sure that was, at least in part, because my friend does have some background working in mental health. She talked with the pt who agreed to have her come back to check on her. On the next visit, they talked about depression and how having a schedule of doing things during the day can help alleviate symptoms. They made a very simple plan/schedule for the pt to begin following each day with just 3-5 activities scheduled throughout the day. Simple things like getting dressed instead of staying in pajamas, brushing her hair and teeth, making a sandwich or microwave meal for lunch, stepping out into the front or backyard once or twice a day, etc. On just 1-2 follow-up visits, the pt was actually doing the things they scheduled and said she was feeling better and even smiled. The smile was huge because during the evaluation, the pt had an absolutely flat affect and showed no emotion the whole time. She was able to verbalize that she could understand why getting up for activities during the day made a difference in how she feels. Now, of course, we don't know if she will continue to do those things when no one is checking, but I think the OT intervention was valid and meaningful even though the pt could not initially verbalize goals. Certainly, a recommendation was given to the HH agency and physician that a pscyh referral would be a good idea. My friend did a lot of education regarding depression and basic things that the pt can do around her home to combat the depression. What do y'all think? Was this appropriate US medical model home health OT intervention? Sorry for being long-winded, Mary Alice Mary Alice Cafiero, MSOT/L, ATP [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Oct 31, 2008, at 12:59 AM, FAY, Felicity wrote: Hi there, I'm a Mental Health OT from Australia and work with clients who find it difficult to engage and identify their goals daily. Sometimes just engaging with the person and building rapport for a couple of sessions is enough for them to feel safe to work with you on re-engaging and devising personal goals that require some level of functional ability: thereby making physical therapy more meaningful (?). Occupational dysfunction often occurs previous ability, stability) across many domains due to depression, poor motivation, grief (loss of pet) and other mental health issues, in addition to aging and loss of general function. A good general screen is the DASS (Depression, Anxiety and Stress Scale) to inform treatment, or maybe a cognitive screen to ascertain whether she is able to formulate appropriate goals due to low mood and requires more support to identify them? Perhaps there are some personality vulnerabilities present that compound her current presentation of rejecting (or testing) you, then wanting more input. If her goal of being normal is strongly held then assistance to manage depression symptoms and education re same may assist her to return to a state that is more comfortable for her? I'm not sure how your system works or whether there is provision for OT's to work in this way? Felicity Fay Mental Health Occupational Therapist -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Friday, 31 October 2008 11:31 AM To: otlist@otnow.com Subject: OTlist Digest, Vol 43, Issue 44 Send OTlist mailing list submissions to otlist@otnow.com To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your
Re: [OTlist] Client without goals
I have two comments/questions. Ron, I think the other thing that I thought of with your patient is about when she said she wanted to be normal. Could she tell you in any way what normal was to her? I think I would have tried to use that as a starting point to find out what she thought she was lacking. Neal and Ron, I think hope/faith/whatever term you want to use like this is very important. I am always careful not to share my specific beliefs, especially when I don't know the patient's background or belief system. I think talking about hope, personal satisfaction/ stability (can't actually think of the word I'm looking for here) is fine but that recognizing the validity of other people's belief systems is also very important. I don't see my role as an OT including testifying to someone about my personal beliefs. It's just dangerous ground in my mind. Respectfully, Mary Alice Mary Alice Cafiero, MSOT/L, ATP [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] How Would YOU Treat This Patient?
I would ask both her and her daughter about their goals and start from there. Maybe it is just education with the daughter on the safest most effective way for her to offer help when she is alone with her mom. In any case, I wouldn't see it as a very long term thing! Mary Alice Mary Alice Cafiero, MSOTR, ATP [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Oct 17, 2008, at 6:58 PM, Ron Carson wrote: Did an eval today and wondering how other OT's might address the situation. 94 y/o female living with her 70 y/o daughter. Recent fall resulting in femur fracture. Ambulates with a rolling walker and supervision. Independent with toileting. Requires assistance with upper body dressing, independent with LE dressing. Requires assistance with bathing. Patient previously received assistance with bathing and dressing. Patient has pain 8/10 in right femur with weight bearing. She is unable to raise her bi-lateral shoulders past approximately 90 degree flexion/abduction. How would you treat this patient and WHY??? Thanks, Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Would You Treat For Refer to PT?
I think there are too many specialty areas within our vast field to make a blanket statement about what we do. No one graduates from OT school with knowledge in every area of the field. It is rare that anyone can actually be competent in every area of the field (in my opinion). Think about work hardening/vocational training. Often that is very biomechanically oriented. Does that mean that OT shouldn't do it? I think what is becoming more and more clear is that AOTA needs to state that OTs who have just graduated from school have a foundation in the many areas of the profession. The areas should then be listed and explained. For areas that require in-depth knowledge to do well, we need to explore advanced certification or something along those lines. I think if we can come up with a way to define all the areas that OT can and does cover, we will gain more respect professionally and in the general population. MA Mary Alice Cafiero [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Aug 27, 2008, at 9:39 AM, Ron Carson wrote: I think the earlier message presents good arguments for seeing the patient in question. However, it seems that this person is suggesting that advanced training qualifies her for doing the treatment. But what about the rest of us OT's who do NOT have ortho expertise? And, what about referral sources? In my experience, most referral sources see OT's as UE ortho people, but that is NOT my expertise. So, once. What I'm trying to do is find common ground for phys dys OT so that AOTA promotes what we do and that we do what AOTA promotes. Thanks, Ron -- Ron Carson MHS, OT - Original Message - From: [EMAIL PROTECTED] [EMAIL PROTECTED] Sent: Tuesday, August 26, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Would You Treat For Refer to PT? cac Does she?not lift?with her right shoulder because of the high cac pain level?? If she lives alone how will she take her trash out?? cac How will she load and unload her groceries from her car?? How cac will she carry her laundry basket to her room to put her clothes cac away?? Unless this lady has a fulltime maid, her life is a little cac difficult right now.? Perhaps prompting the lady's memory isn't cac such a bad idea, considering that her mind is probably focused on cac her high pain level, and she is probably thinking to herself Why cac does this guy have to know that information, I just want him to cac work on my arm, and she is giving you short answers, probably cac unaware that you were going to DC her. ?I would start on goal cac oriented compensation techniques to get her through her typical cac IADLs and a restorative program for her shoulder involving cac modalities, soft tissue mobilization around the coracoid process, cac relaxation facilitation techniques for?the shoulder,?and a graded cac therapeutic exercise program.? Based on AOTAs position papers cac over the years, this is certainly an appropriate?approach.? What cac is wrong with a bottom up approach starting with body functions cac and gradually improving to graded functional activities when the cac pain and the AROM improves significantly.? There is no way a cac patient like this would improve based on a top down approach.? cac She would learn to compensate, but from your evaluation it sounds cac like she wants her pain to improve, and for her shoulder to cac improve to her normal baseline.? Why in the world wouldn't a cac skilled OT with orthopedic shoulder?experience take this case? cac As OTs it is in our scope of practice to treat shoulders, knees, cac backs, hips, whatever, from a compensation and a restorative cac approach depending on the state in which you practice.? Now based cac on our level of education I would not suggest diving into cac restorative techniques for these areas unless you have cac had?extensive training, and if your PT partner on the other side cac of the clinic is working on the same thing.? Team work and cac communication is the key for those situations. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Would You Treat For Refer to PT?
Ron, I personally would not treat her because I don't feel that I have the experience with modalities and therapeutic exercise that would benefit her the most. I think there are OTs out there that do have this experience, so I don't think it is necessarily an inappropriate OT referral. I think it is a case of a therapist needing to refer when something is outside the scope of their expertise or comfort level. Mary Alice Mary Alice Cafiero [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Aug 26, 2008, at 3:15 PM, Ron Carson wrote: Received a new home health referral. Patient's diagnosis is right shoulder pain. Patient presents with bicep tendon pain during AROM, PROM and palpation. She lives alone and is independent with all her daily living tasks. I referred the patient to PT for the shoulder pain. Would you, as an OT, treat this patient? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Do You Agree with This Statement?
I certainly don't see myself as a hand therapist in any way, shape, or form. My 5 year-old son could probably make a better splint than me. The only application I see for myself with repetitive motion injuries is when they come to light with propelling a manual wheelchair independently. Even then, I don't see it as being an upper extremity specialist. Rather, I see it as evaluating the client's need for independent mobility throughout their day and how to make that possible now and in the future. Pigeon holing OTs as upper extremity/repetitive motion prevention therapists sounds too biomechanical for the way I view the profession. There is my 2 cents! Mary Alice Mary Alice Cafiero [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Aug 25, 2008, at 2:24 PM, Ron Carson wrote: Chuck, stop busting my bubble BIG smile As usual, Chuck is correct. The quote IS from AOTA's Grip and Grin brochure. And as Paul Harvey say's, Here's the rest of the story. I recently received an AOTA e-mail announcing that an OT was going to be on The Early Show, discussing preventing hand and wrist injuries on the campaign trail. The source of the message was Heather Huhman, AOTA Media Relations Manager. Because I am so against OT being affiliated with UE/hand issues, I promptly replied to Ms. Huhman's message with the following: Great, National exposure about OT's being hand/UE therapists. That's the LAST thing our profession needs. Let's get some media relations about OT helping people engage in occupations, especially those that don't focus on the hand/UE! Apparently, my message was forwarded to Chritine Metzler (who works for AOTA but I'm not sure in what capacity) and she replied to me. Part of her reply was directing me to AOTA's Grip and Grin brochure. The quote in the brochure, which I included in the original message of this thread, stood out. I posted it because I'm curious to know if any OT's on this list agree with statement. I'm still curious to know if any OT's see themselves as: expert in preventing and treating conditions such as repetitive-motion injuries. I know for a fact, that is NOT how I see OT. Thanks. Ron - Original Message - From: Chuck Willmarth [EMAIL PROTECTED] Sent: Monday, August 25, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Do You Agree with This Statement? CW Ron, CW Looks like that quote was pulled from AOTA's Grip and Grin brochure CW which is a promotional item rather than an official document. CW See: CW http://www.aota.org/Practitioners/Advocacy/Tools/PromotionalItems/39726 . CW aspx CW Grip and Grin: AOTPAC Chair Amy Lamb Appears on CBS to Talk About CW Preventing Injuries on the Campaign Trail CW On Wednesday, August 13, 2008, Cindy McCain, the wife of Senator John CW McCain, sustained a wrist injury after shaking hands with an CW enthusiastic supporter. AOTPAC Chair Amy Lamb, OTD, OTR/L, spoke with CW the CBS Early Show about AOTA's Grip and Grin campaign and how CW candidates across the country can prevent similar injuries. CW See the video online at: CW http://www.aota.org/News/Announcements/GripandGrin.aspx CW Chuck CW -Original Message- CW From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On CW Behalf Of Ron Carson CW Sent: Saturday, August 23, 2008 7:05 AM CW To: OTlist CW Subject: [OTlist] Do You Agree with This Statement? Occupational therapy practitioners are health, wellness, and rehabilitation professionals who are expert in preventing and treating conditions such as repetitive-motion injuries resulting from excessive handshaking. CW The above statement is from an official AOTA document. CW If you are an OT/COTA, do you see yourself as an expert in preventing CW and treating conditions such as repetitive-motion injuries resulting CW from hand shaking? CW Ron CW -- CW Ron Carson MHS, OT CW www.OTnow.com CW -- CW Options? CW www.otnow.com/mailman/options/otlist_otnow.com CW Archive? CW www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Do You Agree with This Statement?
Here I go jumping in again. Y'all may have to ban me after about 9 PM cause after then I'm just really straight-up honest. I do think that hand therapy can be occupational therapy. I just don't think it is all of occupational therapy. I think if a specialty area is going to be the focus of publicity display, it should make sure to include that it is a specialty in the much larger profession of OT where you can find information about many areas in the professionblah, blah, blah. DONT leave it at just the OTs prevent repetitive motion injuries. It needs to include some context within the larger picture of OT. Define its place in our world. MA Mary Alice Cafiero [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Aug 25, 2008, at 9:57 PM, Ron Carson wrote: IMHO, patients reaching into their pockets or buttoning their top are not the language of OT. To me, these are more like the language of PT. For example, heres a goal that a PT *might* write: Pt will improve finger flexion to allow him to button his shirt Contrast this with an occupational goal: Pt will independently button his shirt See the difference? And yes, the patient may improve finger flexion to button his shirt, but flexion is NOT the goal! Also, I do NOT believe that a therapist can earnestly and whole-heatedly focus on BOTH occupation and performance goals. In some ways, occupational goals and physical performance goals are diametrically opposed. The goals require different trains of thought, treatment approaches, expectations, treatment spaces/equipment, time, etc. I think that crossing from one line of thinking to the other is very, very challenging. Maybe, look at it this way. When a patient comes to you with a hand injury, what's your goal? What does the referring physician expect? What are the patient's goals? If the goal is for the patient to button their shirt, why measure hand strength, pinch etc? If the goal is improving hand strength, who cares about buttoning a shirt? Despite the admirable writings of Debbie Amini, (whom I respect) I do not think that hand therapy and OT should come together. Ron P.S. Even though my message is in reply to you, the comments, issues and questions that I raise are not directly specifically to you. I encourage other readers to respond as they feel led! - Original Message - From: [EMAIL PROTECTED] [EMAIL PROTECTED] Sent: Monday, August 25, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Do You Agree with This Statement? Rac Hello all, Rac I personally don't agree with the statement and I'm sitting for the CHT exam Rac in 2 years. I'm feeling some dissension in regards to hand therapy. I feel Rac that as an Occupational Therapist that has an interest in hands I can actively Rac promote the profession with my pts and doctors alike. I don't only measure their Rac grip, pinch strength and ROM but also ensure that they are able to partake in Rac daily activities that are meaningful and important for them. I also have the Rac opportunity to work hand in hand (no pun intended) w/doctors and advocate for Rac our profession. When I see a pt that is unable to button their tops or reach Rac into their pockets for change I make sure that they are able to perform these Rac activities throughout their therapy. I think that we as OT's should come Rac together and advocate for our profession and what we are really about! Rac ** Rac It's only a deal if it's where you want to go. Find your travel deal here. Rac Rac (http://information.travel.aol.com/deals?ncid=aoltrv000547 ) -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
[OTlist] OT/PT perspective
I first must start my comment by saying that many of my dear friends are Physical Therapists. I love them and learn from the constantly. I also continually learn the differences in our approaches to situations. The example coming to mind is when I am doing a wheelchair clinic at a teaching hospital with a PMR doctor, patient and patient family, and wheelchair supplier. My role was previously done by a PT who is now doing research full time. I have not met her directly but have heard wonderful things about her. I do know that her approach to a seating assessment and my approach to the same assessment are very different. For instance, she measured every joint angle upper and lower extremity with a goniometer. I want to know what is limited and what that limitation hinders. I also want to know the mechanism for why it is limited, and if it is fixed or flexible. I want a lot more information in question and answer format or in patient giving me a narrative format about how they use their chair, what they can and cannot do in their chair, and what needs to be different next time around. I think much of the most valuable information I get comes from that type of conversation. BUT I don't get a goniometer out of my briefcase. I'll tell the supplier that we need to have a specific type of footplate because their knees can't come to 90 degrees, but I'm not going to measure it. So, is that a huge difference? Not in and of itself. My focus is on getting the client the best equipment possible so that mobility is easy and they can go do what they want to do. I wish it was simple to do that. It's very complex and is what consumes my life these days. The above comments are not a knock on PT. I work with some amazing PTs who do wonderful seating and mobility evaluations. Conversely, I work with some OTs who totally miss the point and should not be doing a mobility evaluation. PTs and OTs alike need to be willing to admit that Seating and Mobility is another specialty area. Not every new graduate from every program has the skills to walk in and start doing evaluations for complex rehab equipment. Until our national organizations agree with this, we are fighting a seriously uphill battle! That was a little rantish. And a bit oddball and tangential because I am very tired. If it doesn't make sense, just ask me! Mary Alice Mary Alice Cafiero [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Blurring the lines
I was told almost ten years ago now that PT as a profession was beginning to see the writing on the wall for the future emphasis of functional outcomes. PT programs became more tailored to teach functional skills and functional goals to better match funding source's expectations. I don't know that it is bad that we are all focused on function. I certainly don't think it is bad that the old division of upper body vs lower body is gone. I DO worry though that PT will continue to try to take more and more things that truly should be OT realm because of our philosophical and frame of reference differences. I hate territory wars. More than that, however, I hate to see someone doing something with a patient without understanding why they are doing it. Am I making any sense? Mary Alice Mary Alice Cafiero, MSOTR, ATP [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Aug 20, 2008, at 4:00 PM, Ron Carson wrote: Just received a flyer offering two education workshops: 1. Using kinesotaping and splinting to improve UE function in children w/ neuromuscular conditions 2. Functional anatomy of the upper limb and prehensile system #1 is offered by an OT #2 is offered by a PT It sure seems the the lines between PT and OT are becoming more and more obscured. At least, in the realm of physical dysfunction. Ron -- Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
[OTlist] Story on Wii
I had the Today show on this morning while I was getting ready and heard them mention therapy and Wii. It was a great little story about a rehab place in Raleigh, NC that is using the Wii with all ages and levels of patients and seeing great results. They said the physical benefits are great, but the social and emotional benefits are just as great. It showed them using the boxing game and a cooking game. I think there was also tetherball that a younger boy was playing. Seems like a great idea! I want one now for home for the easy, fun workout! Mary Alice Mary Alice Cafiero [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] falls in the home
Bill, I have worked with many patients who have fallen walking to the bathroom or transferring to the toilet or bedside commode. Also falls in and out of tub or shower. Not sure if I just hear about it more because I ask those questions probingly during wheelchair and equipment evaluations. As far as numbers, I would say that of the 20 patients I've seen this month, 8 of them have had this type fall. Hope that's helpful. Mary Alice Cafiero, MSOTR, ATP On Jan 24, 2008, at 9:05 AM, Bill Maloney wrote: How many of you have personally worked with, or know of (perhaps from colleagues or other disciplines within your practice settings) patients who have fallen, with or without resulting injuries while, specifically: 1. ambulating to/from the bathroom for toileting; 2. transferring on/off the toilet; 3. while cleaning/wiping immediately after toileting? There are, of course, statistical data for these issues but I wanted to hear directly from those of you who read this list. I very much appreciate anyone who takes the time to respond. Be well. Bill Maloney, OTR www.embracelifewell.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** Mary Alice Cafiero [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] In Home Rehab Business
I am meeting with a business advising group on Tuesday to get advice on LLC, accounting, branding, etc. The business part of it is time consuming and gives me a headache! By the same token, the referrals have doubled in the last two weeks, so I'm getting to see patients which is the part I love. Now, I'm trying to think of a name for the company when I do the LLC paperwork. I'm having trouble thinking of something that in some way captures what I do and why it is different than any other therapy company. How is yours going? Mary Alice On Nov 30, 2007, at 7:27 AM, Gregory Stelmach wrote: Mary: How is everything going with your business? Greg - Original Message From: Mary Alice Cafiero [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Monday, August 20, 2007 1:20:51 PM Subject: Re: [OTlist] In Home Rehab Business Greg, I am in the beginning stages of doing this under a different treatment model (wheelchair and high end equipment evaluations for both adults and peds). It is fun and exciting. Will you doing the billing yourself or outsourcing that? What I am finding is that billing is the hardest thing for me. I am not a business person and have never claimed to be! Just curious on how you are planning on setting it up, Mary Alice On Aug 20, 2007, at 9:30 AM, Gregory Stelmach wrote: I am going to offer both Physical and Occupational Therapy. Working with geriatric population. I have referral contacts including assistive livings and senior housing. Ron Carson [EMAIL PROTECTED] wrote: Greg, I am in private practice doing in-home rehab. I've been doing it for almost 4 years. It's a great model of care but does have some distinct drawback/disadvantages. Are you going to offer OT only or OT/PT? Adults, peds or both? Do you already have referral contacts? Give me some more information about what you are thinking? Ron -- Ron Carson MHS, OTR/L Hope Therapy Services, LLC www.HopeTherapyServices.com www.OTnow.com - Original Message - From: Gregory Stelmach Sent: Sunday, August 19, 2007 To: otlist@otnow.com Subj: [OTlist] In Home Rehab Business GS To All: GS Is anyone currently or seeking to develop a in-home business model where you bill Med B in GS the home setting? I am aggressively seeking to do this. I have not determined a significant GS con to this business model. Please let me know your thoughts and experiences. GS GS Greg -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * * Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * * -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * * Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * * -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] ROHO Cushions and Transfer Boards?
I have used this technique with patients as well. The idea is that since the ROHO is Squishy, you put the board underneath the cushion in the wheelchair so that the surface the patient is pushing against is firm. Also if it is a ROHO Quadtro cushion, make sure the cells are locked so that air is not moving around in the cushion while the person is transferring. Mary Alice On Nov 19, 2007, at 9:52 PM, susanne wrote: Original Message From: Chris Smith [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Tuesday, November 20, 2007 2:01 AM Subject: Re: [OTlist] ROHO Cushions and Transfer Boards? So does the patient sit on the cushion while sliding? Sounds rather difficult since Rohos are squishy. Why do this? No - the Roho stays in place. I imagine this technique is mostly used by someone who can mostly transfer without the board, but uses it for safety, difficult transfers etc. Saw it mentioned, by more than one poster, on the CareCure forums http://sci.rutgers.edu/forum/index.php? Susanne -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] home health question
Bill, I am in the same area that you are and am not currently reimbursed for mileage. I am an independent contractor and do evaluations for clients in their homes. I used to get paid by the wheelchair vendor for the evaluation and mileage (.36/mile). With all the Medicare changes, I no longer invoice the w/c vendors but bill the patient's insurance (Medicare, Medicaid, or private) myself. Mileage is not reimbursed per patient or per week. The difference now is that I can use mileage as a tax deduction at the end of the year. It doesn't help as much when I get my checks or put gas in my car, but it will help out in the end. I also drive about as many miles as you do, but that is by choice since I could turn down the referrals if I wanted to. I know that my situation is not exactly like yours but thought I'd weigh in anyhow. Mary Alice On Nov 20, 2007, at 8:57 AM, Bill Maloney wrote: If there are any readers out there who practice home health, I'd truly appreciate it if you could spend a moment responding to this message. I am working for a for-profit agency. As such, the owner will not turn down any referrals (esp. medicareethics questions, but not in this message), irrespective of the distance that clinicians have to commute to cover them. I am reimbursed .36/mile (used to work for an agency that reimbursed current IRS allowable (.48.5/mile so got spoiled) and on average travel 350 to 600 miles a week. My biweekly quota or productivity expectation is 64 units/points (an evaluation visit counts as 1.5, a regular revisit counts as 1, and a discharge OASIS counts as 1.5; meetings are counted as points/units for time). Questions: Are there any of you who travel more? Are any of you either not reimbursed for mileage at all, or reimbursed at a lower rate? Are there any of you who have higher quotas? Again, thanks for your time. If you'd prefer to respond directly to my e-mail (although others would miss the benefit or your responses) feel free to do that as well: [EMAIL PROTECTED] Bill Maloney, OTR Dallas, TX -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] home health question
I just hired a billing company because the detail of billing was driving me nuts. They haven't put through the first batch yet, so I'm not sure how much better I will like it. I can tell you that I already like not staying up late worrying about billing when I am already tired from the day. I am my own LLC, and everything is billed through my Medicare provider number. (or Medicaid or often SS# for private insurance). Since I am doing only wheelchairs and seating and not billing for ongoing therapy, it is a different ball game than pure home health. The biggest thing for me is making sure that the patient is not receiving home health services paid for by Medicare because, if they are, I cannot bill separately for my services. Hope that makes sense, Mary Alice On Nov 20, 2007, at 10:16 AM, Gregory Stelmach wrote: Is it easy to bill Medicare part B for therapy services? Do you have your own LLC or bill it through your own Medicare provider number? Is it worth getting into? Mary Alice Cafiero [EMAIL PROTECTED] wrote: Bill, I am in the same area that you are and am not currently reimbursed for mileage. I am an independent contractor and do evaluations for clients in their homes. I used to get paid by the wheelchair vendor for the evaluation and mileage (.36/mile). With all the Medicare changes, I no longer invoice the w/c vendors but bill the patient's insurance (Medicare, Medicaid, or private) myself. Mileage is not reimbursed per patient or per week. The difference now is that I can use mileage as a tax deduction at the end of the year. It doesn't help as much when I get my checks or put gas in my car, but it will help out in the end. I also drive about as many miles as you do, but that is by choice since I could turn down the referrals if I wanted to. I know that my situation is not exactly like yours but thought I'd weigh in anyhow. Mary Alice On Nov 20, 2007, at 8:57 AM, Bill Maloney wrote: If there are any readers out there who practice home health, I'd truly appreciate it if you could spend a moment responding to this message. I am working for a for-profit agency. As such, the owner will not turn down any referrals (esp. medicareethics questions, but not in this message), irrespective of the distance that clinicians have to commute to cover them. I am reimbursed .36/mile (used to work for an agency that reimbursed current IRS allowable (.48.5/mile so got spoiled) and on average travel 350 to 600 miles a week. My biweekly quota or productivity expectation is 64 units/points (an evaluation visit counts as 1.5, a regular revisit counts as 1, and a discharge OASIS counts as 1.5; meetings are counted as points/units for time). Questions: Are there any of you who travel more? Are any of you either not reimbursed for mileage at all, or reimbursed at a lower rate? Are there any of you who have higher quotas? Again, thanks for your time. If you'd prefer to respond directly to my e-mail (although others would miss the benefit or your responses) feel free to do that as well: [EMAIL PROTECTED] Bill Maloney, OTR Dallas, TX -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * * Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * * -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] home health question
You can bill through just your name and Medicare number without a problem. I haven't yet changed my Medicare provider info to indicate the company name instead of my name but am told that it is a fairly painless process. Licensure through the state worked fine for me when applying for both Medicare and Medicaid numbers. No one even brought up the national registry (which I am not currently paying for). I think that there are a lot of kinks and strange things with billing Part B. For instance, they only pay for certain services with certain diagnosis codes. I didn't find that information easy to access through my intermediary, but other intermediaries may have it more readily available. I certainly have plenty of business with doing only custom rehab evaluations and follow-up to make this a full time business. I am anxious to see how much easier payment is with a billing company doing that legwork. With providing home health, as in ongoing treatment, I think that you have to be careful. Either you need to contract with smaller home health companies that don't have OT, and then the company will bill and pay you contract. OR, you have to make sure that there is not a home health company providing services in the home or you will be caught under the home health episode of care rule from Medicare. The overview, to my understanding, is that if a home health company is providing services, Medicare feels that everything should be billed/covered through that one agency. If they get a separate bill from you while a home health company is billing, your services will be denied. It is kind of a lot of run-around and phone time. I don't know if you are going to have an office person or not. I don't, so everything is up to me. Good luck! Mary Alice On Nov 20, 2007, at 5:51 PM, Gregory Stelmach wrote: Mary: Thank you. How is the compliance, licensure, business aspect of providing therapy through part B. I am actively developing a LLC, I have applied for my personal Medicare number, then I am going to link it to the LLC. Do I have to wait to bill Medicare through my LLC until I link my Medicare number to the LLC or can I just use my Medicare number? I am meeting my attorney to figure out the legal aspect. How do you see this as a business? Thanks. Greg Mary Alice Cafiero [EMAIL PROTECTED] wrote: I just hired a billing company because the detail of billing was driving me nuts. They haven't put through the first batch yet, so I'm not sure how much better I will like it. I can tell you that I already like not staying up late worrying about billing when I am already tired from the day. I am my own LLC, and everything is billed through my Medicare provider number. (or Medicaid or often SS# for private insurance). Since I am doing only wheelchairs and seating and not billing for ongoing therapy, it is a different ball game than pure home health. The biggest thing for me is making sure that the patient is not receiving home health services paid for by Medicare because, if they are, I cannot bill separately for my services. Hope that makes sense, Mary Alice On Nov 20, 2007, at 10:16 AM, Gregory Stelmach wrote: Is it easy to bill Medicare part B for therapy services? Do you have your own LLC or bill it through your own Medicare provider number? Is it worth getting into? Mary Alice Cafiero wrote: Bill, I am in the same area that you are and am not currently reimbursed for mileage. I am an independent contractor and do evaluations for clients in their homes. I used to get paid by the wheelchair vendor for the evaluation and mileage (.36/mile). With all the Medicare changes, I no longer invoice the w/c vendors but bill the patient's insurance (Medicare, Medicaid, or private) myself. Mileage is not reimbursed per patient or per week. The difference now is that I can use mileage as a tax deduction at the end of the year. It doesn't help as much when I get my checks or put gas in my car, but it will help out in the end. I also drive about as many miles as you do, but that is by choice since I could turn down the referrals if I wanted to. I know that my situation is not exactly like yours but thought I'd weigh in anyhow. Mary Alice On Nov 20, 2007, at 8:57 AM, Bill Maloney wrote: If there are any readers out there who practice home health, I'd truly appreciate it if you could spend a moment responding to this message. I am working for a for-profit agency. As such, the owner will not turn down any referrals (esp. medicareethics questions, but not in this message), irrespective of the distance that clinicians have to commute to cover them. I am reimbursed .36/mile (used to work for an agency that reimbursed current IRS allowable (.48.5/mile so got spoiled) and on average travel 350 to 600 miles a week. My biweekly quota or productivity expectation is 64 units/points (an evaluation visit
Re: [OTlist] ATP
I think it is worthwhile to note that CMS decided on ATP being the required certification without RESNA knowing ahead of time. RESNA.org has some very interesting position papers and remarks regarding federal legislation on the website. When the ATP rule was first announced, RESNA put a disclaimer on their site stating that they did not seek this rule from CMS and, basically, were as surprised as everyone else. I checked to see if that statement was still available, and I did not see it on the site tonight. I know I've said it before, but I will say it again, I agree with Ron that certification is a great idea. I don't think an ATP's knowledge base as compared to a knowledgeable rehab OT or PT is necessary for straightforward scooters or power chairs. I do think an advanced certification should be required for complex rehab. I also am very much in agreement with the efforts being made to carve-out complex rehab from the competitive bidding process going on now for equipment vendors/dealers. If complex rehab remains part of the bidding process, the main losers are the clients who have significant seating needs, primarily those with lifelong diagnoses, both orthopedic and neurological in nature. It's a tough issue, and there may be some folks who suffer as it is all worked out. I hope that is not the case! Mary Alice On Nov 5, 2007, at 8:15 PM, Ron Carson wrote: AAh, now I understand. I can't help wonder if a seating certification wouldn't be the BEST solution for all parties. Seems like Medicare, beneficiaries, therapists, AOTA, etc would ALL benefit. Personal, I think certification is a great idea. If it was somehow tied to reimbursement it would be an OUTSTANDING idea. Ron - Original Message - From: Chuck Willmarth [EMAIL PROTECTED] Sent: Monday, November 05, 2007 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] ATP Ron, No, we have requested that the ATP certification requirement be repealed, and believe that no special certification should be required under Medicare for payment. Chuck -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Monday, November 05, 2007 8:44 PM To: Chuck Willmarth Subject: Re: [OTlist] ATP Chuck, do you know if AOTA has offered speciality certification in place of ATP certification? Thanks for clarifying your position. Ron - Original Message - From: Chuck Willmarth [EMAIL PROTECTED] Sent: Monday, November 05, 2007 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] ATP Ron, Just to clarify, AOTA does not have a seating and wheel mobility certification...the ad hoc group is examining the need for such a certification from what I understand. I was suggesting that a broader level, AOTA's Board and Specialty Certifications are not tied to reimbursement. We are stilling waiting to hear from the DME Medical Directors in response to our request that the withdraw the ATP certification requirement. Chuck -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Monday, November 05, 2007 7:04 PM To: [EMAIL PROTECTED] Subject: Re: [OTlist] ATP Hello Theresa: Thanks for the update. In an earlier message, I think Chuck Wilmarth indicated that AOTA's w/c seating certification is NOT tied to reimbursement. Is this accurate? Is AOTA not pursing acceptance of their certification with CMS instead of only the ATP certification. The ATP certification is such over- kill for many, many w/c evals. If the AOTA certification is NOT accepted by Medicare as a qualifying credential, why will OT's pursue it? Thanks, Ron - Original Message - From: [EMAIL PROTECTED] [EMAIL PROTECTED] Sent: Monday, November 05, 2007 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] ATP Laura: The seating and wheeled ad hoc committee is in the process of studying the issues around this topic and will be surveying membership soon (probably this week so look for the survey through AOTA One-Minute update). After that we will be putting together a report to the commission on practice of whether to pursue a certification process through AOTA or not. Theresa Gregorio-Torres -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * *** ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * *** ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] ATP
I have to say more on this subject. Sorry if I'm boring some of you! Unless things have changed dramatically in OT schools since I graduated, OTs do not come out of school with knowledge of seating and positioning or function-based wheelchair assessment. I have spoken with many students on their internships in the past 7-8 years, and they report that they still get the 1/2 to 1 day education on what a wheelchair is but nothing more in depth than that. Do I think OTs are the best profession ultimately to be doing this type of assessment? Absolutely! BUT, I don't think being an OT automatically makes you qualified to be recommending complex rehab equipment and advanced seating. RESNA respects and requires hours of direct experience in the field before you are even qualified to take the exam. Currently AOTA does not have a way to acknowledge or recognize OTs that are specialists in this field. How can AOTA expect CMS to turn to them for definitions and qualifications of who should be performing this type of evaluation? I'm not just trying to be stubborn and disagreeable, but this is an area that I feel passionate about. Recommending equipment that is inappropriate for a client can cause harm. Recommending equipment that will not accommodate a client's needs for the next 4-5 years can cause the patient to be stuck because funding will not cover another mobility device. Mary Alice On Oct 30, 2007, at 2:01 PM, Chuck Willmarth wrote: I'd like to address part of this discussion. There was no request from CMS to provide our qualifications to evaluate chairs prior to the LCD draft issuance. We LONG advocated for OTs to be specifically recognized as qualified to do this, starting with when CMS began the process of disseminating the National Coverage Decision, but CMS' response to us repeatedly (in writing and on calls) was that they were going to leave the decision of who would be qualified to another process. They didn't identify the DMERC Medical Directors as the group tasked with determining who would be qualified until very late in the game, a few months before the draft LCD was issued. We commented on the draft LCD and subsequently requested reconsideration of comments. We had a conference call with the DMERC Medical Directors last week to make our case. We should know something by mid-November. Here are some articles that discuss the issue in more detail. http://www.aota.org/Archive/NewsA/FedReimbA/39756.aspx http://www.aota.org/News/AdvocacyNews/fedreim/39739.aspx http://www.aota.org/Practitioners/Reimb/News/Letters/40713.aspx http://www.aota.org/Practitioners/Reimb/News/Announcements/40727.aspx Chuck Willmarth Director, State Affairs and Reimbursement Regulatory Affairs AOTA -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary Alice Cafiero Sent: Sunday, October 28, 2007 11:35 AM To: OTlist@OTnow.com Subject: Re: [OTlist] ATP Medicare first looked to AOTA and APTA to ask what the standardized education and monitoring was for therapists who performed high end wheelchair evaluations. Neither organization had an answer, so Medicare expanded it's search to RESNA (Rehab Engineering Society of North America), some of the top manufacturers (Sunrise-who makes Quickie chairs, Invacare, Permobil, and Pride) to ask the same questions. The only credential available to show that a therapist has specific knowledge of assistive technology is the ATP exam through RESNA. There is also an ATS exam/credential for suppliers. RESNA requires that you have a certain number of hours in the AT field before you can take the exam and also requires continuing education applicable to the area in which you practice to keep your credential current. Medicare isn't going to require an ATP for every power eval. It is only for Group 2 chairs with a power function such as tilt or recline and any Group 3 chair. Group 3 is for more complex rehab and, in my opinion, should always require a therapist's evaluation. It is a good checks and balances system as well as a good way for clinicians and suppliers to collaborate. I personally think the therapist should be involved in the delivery of higher end equipment every time. So, after all that, my answer to your question is that, yes, it is a good idea to require the ATP. Mary Alice Cafiero, MSOTR, ATP On Oct 27, 2007, at 7:19 PM, Ron Carson wrote: Hello All: Mary, your recent message and your credentials prompted to write this message. Starting in 2008, Medicare will require the ATP credential for certain types of wheelchair evals. How do list members feel about this? Is an ATP credential necessary to satisfactorily evaluate a patient for power mobility? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] ATP
Chuck, I definitely agree that access to care is going to be an issue. However, the rules also state that a PMR doctor can be responsible for the recommendation of equipment and, in that case, the ATP eval would not be needed. That's a whole other ball of wax if we then start delving into whether PMR docs have any more knowledge of PMDs than any other type of doctor. I do not think that the RESNA ATP certification is the be all/end all requirement to show competency. However, I do know that CMS was looking for some type of certification to show knowledge of this specialty area, and ATP was all they could find. As far as the original problem, I don't think anyone has said it was the OT or PT causing it. I think the main problem was people having access to order items off of TV, getting off the shelf equipment when something more was needed, and, in general, having a vendor have complete control of the process with no skilled therapist involvement. Clients that I know personally had power chairs drop shipped to their homes with no in-home evaluation done, no instruction given, and many of those clients cannot use the PMD they received. Since they did receive it and Medicare did pay for it, however, they are stuck until the five years pass until they can get more appropriate equipment. There are, of course, exceptions if you can document a physical or medical decline or change which creates the need for a different type of PMD that the current chair cannot be adaptedd to provide. CMS is not requiring an ATP for every PMD eval. It is for certain types of chairs with certain types of features. I am absolutely not saying that there is an easy answer to this question/dilemma, but I am frustrated that AOTA seems to be jumping in now that another organization has stepped up and been recognized by CMS. Who even knows if the rule will actually go into effect? Very few have, at least on the original planned date. We still have to make it through competitive bidding that the dealers are going through. I live in one of the test markets that is requiring competitive bids now with the anticipation that CMS will announce the winning companies that can require equipment in this area. I think CMS has too many things going on at once with no idea where any of them will lead. It is an interesting time to be in this field and specifically in this specialty. Mary Alice On Oct 30, 2007, at 3:25 PM, Chuck Willmarth wrote: Mary Alice, Our position is not that every OT fresh out of school can perform PMD evaluations. OTs are required by state licensure laws and the Code of Ethics to only provide those services for which they are competent. We do not believe that RESNA certification should be required for payment under Medicare. Such a policy would put us on a slippery slope. Should Medicare require certification for payment when providing others interventions such as wound care? PAMs? Should there be different certifications for the various practice settings? We understand that CMS wants to ensure that they are paying for quality services provided by competent therapists. We think that is a fine goal. However we do not have information about the problem they are trying to solve. If beneficiaries are getting the wrong chairs, is it because of the OT or PT? Is the problem fraud? Is the problem overutilization? We don't know. Would requiring RESNA certification solve the problem? We don't think so, plus we believe that the certification requirement will cause a whole new set of problems including access to care. Chuck -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary Alice Cafiero Sent: Tuesday, October 30, 2007 3:43 PM To: OTlist@OTnow.com Subject: Re: [OTlist] ATP I have to say more on this subject. Sorry if I'm boring some of you! Unless things have changed dramatically in OT schools since I graduated, OTs do not come out of school with knowledge of seating and positioning or function-based wheelchair assessment. I have spoken with many students on their internships in the past 7-8 years, and they report that they still get the 1/2 to 1 day education on what a wheelchair is but nothing more in depth than that. Do I think OTs are the best profession ultimately to be doing this type of assessment? Absolutely! BUT, I don't think being an OT automatically makes you qualified to be recommending complex rehab equipment and advanced seating. RESNA respects and requires hours of direct experience in the field before you are even qualified to take the exam. Currently AOTA does not have a way to acknowledge or recognize OTs that are specialists in this field. How can AOTA expect CMS to turn to them for definitions and qualifications of who should be performing this type of evaluation? I'm not just trying to be stubborn
Re: [OTlist] ATP
Well, I think something needs to be done to have the therapist more involved in the decision making process of what type of equipment is prescribed. Identifying the need for a manual or power chair is merely the first step. After that there are literally thousands of choices out there for seating and manual and power bases. If the therapist is not an active part of the evaluation with knowledge of what is available and best for the client, the dealer/vendor is free to provide anything in the category. For example, if you, the therapist, says to a vendor, that a patient needs a power chair that will maneuver in their home. The vendor can then provide a well-built chair from a reputable manufacturer that will last for years and stand up to every day use, or they can provide a cheapo chair and reap the benefits of increased profit. Medicare classifies chairs by group and reimburses at a single rate for any chair in that group. Their is a lot of dissent among the seating and mobility crowd about how Medicare has grouped chairs, since often they are not comparing apples to apples. Medicare made this rule because of the rampant fraud in a few places in the country. They are making it sound like the power wheelchair scandal was responsible for the condition Medicare is in today, which is not true. I forgot the exact percentage, but the fraud amounted to less than 1/100 of Medicare's budget for a year. That is not to say the fraud didn't need to be stopped. Dealers were billing Medicare for one type of chair and providing another cheaper chair and reaping the profits. The real loser was the clients who ended up with something they couldn't use because it was inappropriate for them. I still go into homes to do w/c evals now and see the giant assembly line power chair sitting in the corner being used as a clothes rack (kind of like many of the treadmills in the world :-). Because these chairs are often only a few years old and Medicare has a record that they paid for a better quality, more appropriate chair for that client, the client is often stuck. Medicare will not replace a wheelchair for five years unless there has been a significant medical change. Medicare first looked to AOTA and APTA to ask what the standardized education and monitoring was for therapists who performed high end wheelchair evaluations. Neither organization had an answer, so Medicare expanded it's search to RESNA (Rehab Engineering Society of North America), some of the top manufacturers (Sunrise-who makes Quickie chairs, Invacare, Permobil, and Pride) to ask the same questions. The only credential available to show that a therapist has specific knowledge of assistive technology is the ATP exam through RESNA. There is also an ATS exam/credential for suppliers. RESNA requires that you have a certain number of hours in the AT field before you can take the exam and also requires continuing education applicable to the area in which you practice to keep your credential current. Medicare isn't going to require an ATP for every power eval. It is only for Group 2 chairs with a power function such as tilt or recline and any Group 3 chair. Group 3 is for more complex rehab and, in my opinion, should always require a therapist's evaluation. It is a good checks and balances system as well as a good way for clinicians and suppliers to collaborate. I personally think the therapist should be involved in the delivery of higher end equipment every time. So, after all that, my answer to your question is that, yes, it is a good idea to require the ATP. Mary Alice Cafiero, MSOTR, ATP On Oct 27, 2007, at 7:19 PM, Ron Carson wrote: Hello All: Mary, your recent message and your credentials prompted to write this message. Starting in 2008, Medicare will require the ATP credential for certain types of wheelchair evals. How do list members feel about this? Is an ATP credential necessary to satisfactorily evaluate a patient for power mobility? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] contraindicaions for lumbar roll
Tough question!! In the world of seating and mobility, the first thing to know is if the person who needs the lumbar roll is in a fixed position or a flexible position at the pelvis. If their pelvis is fixed in posterior pelvic tilt, a lumbar roll isn't going to do anything except make them slide forward and away from it. If the position is flexible, it's trial and error. Try a small roll and see if the person is more comfortable and/or sits more upright. Lumbar rolls often help people who have lumbar lordosis since the roll can fill in the gap and help the person make full contact with the back of their chair. If you are in the position that most skilled nursing facilities are in, you're probably trying to modify a transport or hospital chair...the bright silver frame with navy, maroon, etc. naugahyde sling seat and back. This type of chair already puts people at a disadvantage because the sling effect promotes posterior pelvic tilt and rounded shoulders. It is very hard to sit up straight in one of those chairs even if you are completely able-bodied with good muscle tone/control. Wow..can you tell that's one of my soapboxes? It's a very frustrating situation to try to position everyone adequately when you are given very few tools/resources to do it well. I guess I would say the general rule is if the posture is flexible, you can try using external positioning to promote a more midline/ upright position. If the posture is not flexible, don't try to change it. Just support it. That's my 2 cents. Since seating and mobility is my passion and also most of my practice now, I look forward to hearing the opinions of others. Mary Alice Cafiero, MSOTR, ATP On Oct 27, 2007, at 8:52 AM, [EMAIL PROTECTED] wrote: I work in a skilled nursing setting. Positioning is a major part of the OT's job. We are looking for information regarding possible contraindications with use of a lumbar roll. Also, the staff would like to know in what situations would you use this roll. We all have our own opinions but would like input from others on this matter. thanks for your help! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Ethics of D/C Treatment
I have notified doctor's before when the home conditions were unclean or unsafe. Most of those cases were when the patient was also being seen for wound care, and I thought that it was probably futile to treat the wound in the patient's current environment. This was in addition to the policy/procedure of the home health company. Mary Alice On Oct 2, 2007, at 4:19 PM, Mary Giarratano wrote: Hi Ron! If the patient is in danger from the poor conditions, have you considered calling protective services? We have had several situations where we have received patients as a result of a protective service placement - I'm in an SNF. We have also had situations where the local home care agency refuses to provide care unless the home environment is cleaned up to keep everyone safe (patient and their staff). It certainly is an ethical dilemma! Mary -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Tuesday, October 02, 2007 3:15 AM To: OTlist@OTnow.com Subject: [OTlist] Ethics of D/C Treatment Hello All: I would like to hear opinion on the ethical considerations of discharging patient treatment because the home environment has a very foul smell and very unclean? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** ** ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** ** ** No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.13.35/1039 - Release Date: 9/29/2007 9:46 PM No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.13.35/1039 - Release Date: 9/29/2007 9:46 PM -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Occupational Deprivation
OK, I will jump in really quickly before I have to put kids in bed. I've seen situations in dementia units where the patients range from mid to late stage where they sort the silverware as it comes out of the dishwashers for the facility. It is then used for mealtimes. The same with sorting and folding socks and towels when living in a facility so the laundry isn't necessarily the client's own. Do you think those situations make these activities any more of an occupation? By the way, I'm not in this setting anymore, but find the discussion very interesting. Mary Alice On Sep 11, 2007, at 8:21 PM, Terrianne Jones wrote: No, in my never to be humble opinion, it is not much different. Some would argue there is a difference between an activity such as sorting silver ware and cone sorting because one is recognizable task (taken out of its usual context) and the other is totally contrived task (at least I've never seen spontaneous cone stacking!), but I maintain that if the client finds no value in the activity then from a therapeutic perspective there isn't much difference. Terrianne Ron Carson [EMAIL PROTECTED], now.com wrote: Hey Terrianne: I love the Canadian Model of Occupational Performance! Thanks for sharing that definition from the Enabling Occupation book!! A great resource for ALL OT's!! Continuing on with questions. In the context that we are discussing, is sorting silverware any different than sorting cones/pegs? I FULLY understand that if a patient has a true goal of sorting silverware of if sorting silverware is a subset of a higher level task (making a meal) and that patient has difficulty sorting, then this is appropriate. But anythign else seems like cones, just a little more shiny . Ron - Original Message - From: Terrianne Jones Sent: Tuesday, September 11, 2007 To: OTlist@OTnow.com Subj: [OTlist] Occupational Deprivation TJ Hi Ron and others- TJ I've been lurking and decided to jump in with the mention of occupational deprivation, and TJ your question Ron about assumptions with persons who cannot indicate they are truly engaging TJ in occupation. This question almost brings occupation to a philosophical level. If TJ occupations are are defined as “activities …of everyday life, named, organized and given value TJ and meaning by individuals and a culture” (Law, Polatajko, Townsend, 1997, p. 32), then can TJ we really ever know if a person is engaging in occupation if they cannot tell us or somehow TJ indicate the value of the engagement? In my opinion, we cannot, and thats ok. Sometimes the TJ best we can offer our clients who cannot tell us whether or not they value an activity as an TJ occupation is an enjoyable experience that meets some physical or sensory need and supports TJ their overall wellbeing. But I don't think we can call this occupation. According to the OT TJ practice frame work, while occupation is the goal and main TJ modality of the OT, there is also room when appropriate for purposeful actives (ie, sorting TJ silverware) if they enable participation in other aspects of daily life. TJ Terrianne TJ Occupation is so subjective. TJ Ron Carson wrote: Man, you write at an advanced level!! I THINK I TJ understand what you are TJ saying but if my response is way off base let me know. TJ Occupational deprivation is a common age-associate malady. I see it TJ everyday in my practice. But, IF a person is unable to verbalize TJ (vocally or non-vocally) the meaning and worth of an engaged activity, TJ are we justified in assuming they are engaged in occupation? TJ I understand about being isolated. I work alone and have for several TJ years. The OTlist is about the only place where I can freely exchange TJ ideas. I wish more subscribers would feel the same! TJ Ron TJ - Original Message - TJ From: Joan Riches TJ Sent: Monday, September 10, 2007 TJ To: OTlist@OTnow.com TJ Subj: [OTlist] Sorting Silverware? JR Well - if occupation is what people do and occupation is idiosyncratic to JR the person, then meaning seems to have many different levels. People at this JR level certainly have emotions - and those emotions are often mitigated by a JR sense of doing. Certainly we need the concept of occupational deprivation to JR comprehend behaviour changes when opportunities 'to do' are provided. JR Thank you to you. The list has been such a source of professional JR connection. TJ -- TJ Options? TJ www.otnow.com/mailman/options/otlist_otnow.com TJ Archive? TJ www.mail-archive.com/otlist@otnow.com TJ ** TJ Enroll in Boston University's post-professional Master of Science for OTs Online. Gain
Re: [OTlist] In Home Rehab Business
Greg, I am in the beginning stages of doing this under a different treatment model (wheelchair and high end equipment evaluations for both adults and peds). It is fun and exciting. Will you doing the billing yourself or outsourcing that? What I am finding is that billing is the hardest thing for me. I am not a business person and have never claimed to be! Just curious on how you are planning on setting it up, Mary Alice On Aug 20, 2007, at 9:30 AM, Gregory Stelmach wrote: I am going to offer both Physical and Occupational Therapy. Working with geriatric population. I have referral contacts including assistive livings and senior housing. Ron Carson [EMAIL PROTECTED] wrote: Greg, I am in private practice doing in-home rehab. I've been doing it for almost 4 years. It's a great model of care but does have some distinct drawback/disadvantages. Are you going to offer OT only or OT/PT? Adults, peds or both? Do you already have referral contacts? Give me some more information about what you are thinking? Ron -- Ron Carson MHS, OTR/L Hope Therapy Services, LLC www.HopeTherapyServices.com www.OTnow.com - Original Message - From: Gregory Stelmach Sent: Sunday, August 19, 2007 To: otlist@otnow.com Subj: [OTlist] In Home Rehab Business GS To All: GS Is anyone currently or seeking to develop a in-home business model where you bill Med B in GS the home setting? I am aggressively seeking to do this. I have not determined a significant GS con to this business model. Please let me know your thoughts and experiences. GS GS Greg -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
[OTlist] Just had to share this funny for the day!
Just came across this exercise suggested for older people, to build muscle strength in the arms and shoulders. It seems so easy, so I thought I'd pass it on to some of my friends. The article suggested doing it three days a week. Begin by standing on a comfortable surface, where you have plenty of room at each side. With a 5-lb potato sack in each hand, extend your arms straight out from your sides and hold them there as long as you can. Try to reach a full minute, then relax. Each day, you'll find that you can hold this position for just a bit longer. After a couple of weeks, move up to 10-lb potato sacks. Then 50-lb potato sacks and then eventually try to get to where you can lift a 100-lb pot ato sack in each hand and hold your arm straight for more than a full minute. (I'm at this level) After you feel confident at that level, put a potato in each of the sacks. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] In Home Rehab Business
Greg, I am an ATP and have been for about five years. Who knew how insightful I was being? I have actually been doing w/c evals as about 60% of my business since last September, and was doing some while I was working full time before that. I also ran the w/c clinic at a children's hospital here for about 7 years. I actually got my Medicare provider number in Jan '06. Again, showing foresight but purely by accident! I actually had to have decompression surgery for Chiari 1 malformation this summer and am still recovering from that. As I've started to feel better and begun to be able to think more clearly. I've decided that I really need to turn this into a business and not just taking referrals as they come. It's done well so far, but the business organization and billing side of things is sorely lacking because I am a therapist..not a business person! I am in the Dallas, TX area. How did you find a company to outsource your billing to? Will they do your diagnosis coding as well? The reason I ask that is that I often get referrals from equipment vendors who will pass along the ICD-9 (10?) codes that they use, and I will use the same ones. The vendor gets paid for the equipment, and I get the claim kicked back saying the code wasn't coded to the necessary level of specificity. Just trying to figure out when I am back up to full speed with work (Which I anticipate being sometime in September) how I will do all the evaluations and paperwork that involves and all the billing and coding. Any advice (from anyone who is doing this type of thing!) is welcomed! Mary Alice On Aug 20, 2007, at 4:39 PM, Gregory Stelmach wrote: Mary Alice: Good for you for starting this new adventure. I will be outsourcing the billing portion. Are you a ATS or ATP. I am using a more traditional model with geriatric population with clinical specialities. What part of the country are you located. The reason I ask about ATP/ATS is the new Medicare guidelines for providing power mobility devices starting in April of 2008. Where are you in the process of developing your business? Greg Mary Alice Cafiero [EMAIL PROTECTED] wrote: Greg, I am in the beginning stages of doing this under a different treatment model (wheelchair and high end equipment evaluations for both adults and peds). It is fun and exciting. Will you doing the billing yourself or outsourcing that? What I am finding is that billing is the hardest thing for me. I am not a business person and have never claimed to be! Just curious on how you are planning on setting it up, Mary Alice On Aug 20, 2007, at 9:30 AM, Gregory Stelmach wrote: I am going to offer both Physical and Occupational Therapy. Working with geriatric population. I have referral contacts including assistive livings and senior housing. Ron Carson wrote: Greg, I am in private practice doing in-home rehab. I've been doing it for almost 4 years. It's a great model of care but does have some distinct drawback/disadvantages. Are you going to offer OT only or OT/PT? Adults, peds or both? Do you already have referral contacts? Give me some more information about what you are thinking? Ron -- Ron Carson MHS, OTR/L Hope Therapy Services, LLC www.HopeTherapyServices.com www.OTnow.com - Original Message - From: Gregory Stelmach Sent: Sunday, August 19, 2007 To: otlist@otnow.com Subj: [OTlist] In Home Rehab Business GS To All: GS Is anyone currently or seeking to develop a in-home business model where you bill Med B in GS the home setting? I am aggressively seeking to do this. I have not determined a significant GS con to this business model. Please let me know your thoughts and experiences. GS GS Greg -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * * Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * * -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * * Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * * -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science
Re: [OTlist] Why are YOU on this list
I also am practicing in a pretty unique niche, so don't often contribute. I am an ATP (Assistive Technology Practitioner) through RESNA and focus on high end wheelchairs and other equipment for both children and adults. I am now doing this as a solo independent contractor and am very much learning as I go. If Medicare in the US follows through with their plans (which is always a crap shoot), by April 2008, they will require a therapist who is a ATP do the W/C evaluation along with an accredited vendor for all wheelchairs of a certain complexity. It is a big change, and there is a lot of scrambling going on. It does present some unique marketing hurdles for me. I'm not sure who to market. Vendors who are the ones that patients usually call when their doctors give them a prescription for a w/c. Neurologists/ Neurosurgeons/Rehab Docs, etc who need to know of the imperative need for a knowledgeable therapist to be involved. The docs obviously have less time to listen. It's a conundrum. I had the fortune/misfortune of having pretty extensive neurosurgery myself this summer and am just beginning to think about work again. My doctors office was very interested and said they will definitely refer patients to me. I wish I knew how the reception would be other places. Anyway, didn't plan to say that much, but now you know where I'm coming from. Mary Alice On Aug 16, 2007, at 9:49 AM, Christi Vicino wrote: Pat... Please talk more about what you are doing in pain management I am very interested Christi Vicino OTA Program Director Grossmont College 619-644-7305 -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Pat Sent: Thursday, August 16, 2007 6:00 AM To: OTlist@OTnow.com Subject: Re: [OTlist] Why are YOU on this list Hi Ron, For my part, I am here to learn. Believe me, if there was a topic I was well versed on, or even knew enough about to converse on, I would jump in. Take, for example, the recent posts about NDT. Sure, it was gone over in school, but I have never used it, and have never even seen it used with a real patient (we role played in school). I think that someday I might want to work with stroke patients. So I read, and pay attention, and am interested in what others have to say... but I have absolutely nothing to contribute. I also do not do marketing, and wouldn't know where to start. Like you, I am still struggling to even put into words lay people could understand, what we do and how it differs from PT. That is why I didn't post anything when you were posting your questions. I am not doing traditional OT, and no one else on this list works in my field (pain management), nor do I have experience in their fields. I keep trying to learn all that I can, in case this job ever goes away and I end up working in a traditional OT job. I may not contribute much, but I do enjoy this group when it's active. Pat At 06:09 AM 8/16/2007, you wrote: Hello All: The OTlist has been around a long time. But I believe this is the least amount of participation that I've ever seen. What is going on? I know that every topic is not important to every person, and I know that all of us have busy lives. But this list has NO purpose if YOU don't participate! I don't know if people are scared, uninterested, uninformed or what, but this is the only place that I know to discuss the topics that have recently come up. Please put your fingers to the keyboard and share your thoughts, questions and opinions. Thanks, Ron -- ... as a profession that offers unique services that are ideally suited to meet the health, participation, and quality of life needs of people of all ages, occupational therapy is well- positioned to succeed and flourish in the 21st century. [Fred Somers, AJOT, April, 2005, p. 127] The part of convalescence that I found most profoundly humiliating and depressing was [OT]... I was reduced to playing with brightly colored plastic letters ... like a three-year-old... [AJOT, April, 2005, p. 231] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * ** *** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * ** *** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** ** ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to
[OTlist] The old days
I remember from my days back doing home health (probably 8 years ago) when the decision was made that OT could not be a stand alone service initially with a patient. I am not sure of the current rules. It was explained to me by one of the top gurus of Texas home health that OT could not be a stand alone service because you could make case that every single patient needs OT. I'm not sure what happened to those days. I know that I don't now, nor have ever, thought of myself as an upper extremity therapist. I mean other than the fact that you use your arms to do things. One of my favorite OTs who does pediatric power chair conferences often points out that PT is wonderful and she has many friends that are PTs and means no offense BUT, so what if you can walk if you can't do a bleeping thing when you get there! I have a tons of examples from my own fourteen year career. I'll share one now. I was doing home health in North Carolina and received a comprehensive D/C summary from the rehab unit. I got to the gentleman's two room 85 year old farm house and saw his tub transfer bench and bedside commode sitting outside in pristine condition. As I did my evaluation, I asked him about the equipment. He bragged on how nice and pretty it was and said it was a shame he couldn't use it. He said he just warmed up water in a pot on the stove to take a bath since they didn't have a bathroom (or indoor plumbingthe water came from the well 30 yards out in the back yard). Of course I couldn't wait to hear about the bathroom. He told me that his therapists (and obviously OT and PT are equally involved in this story) asked how far his bathroom was from his bed. He told them he reckoned it was about 30 feet. He then got his walker and showed me how he walked from his bed, through the kitchen, out the backdoor and to the outhouse. Now I don't know for sure what I would have done if I had all the correct information if I had been the treating therapist, but it certainly shows the necessity of asking all the right questions. My experience has been that OT is best equipped to problem solve with patients and families. There, a rambling post from me. Mary Alice On Aug 16, 2007, at 5:43 PM, Joe Wells wrote: Arley Johnson stated WE are the only profession that knows enough about each area to put it all together in a functional, real world context, identify the limitations and address that area for remediation. All within our practice guidelines! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] On-line Collobration[6/5 Update]
The name of the hinges is offset door hinges. You can get them at most hardware storeseven Home Depot, but you probably have to ask. They aren't all that expensive. If I remember right, they give you about 4 of extra clearance. they allow the door to swing even with the frame when it opens. Mary Alice On Jun 5, 2007, at 10:45 PM, susanne wrote: Ron Carson [EMAIL PROTECTED] wrote: (snip) ...Of course, I don't think a manual chair is going to fit into her current bedroom doorway. So much to consider!! Some ways to go for a narrower chair: No pushrims is an option if it's only for indoor use. No armrests, or backfitted armrests will fit a larger bottom into a narrower chair. Some ways to go for a wider door: A special kind of door hinges, that makes the door swing totally out of the frame - don't remember the name. Last resort: Pull down door AND door frame - put a sliding door if you absolutely need one. Back to the slide board. I do not think it is possible to slide board transfer onto a tub bench. Does anyone have a different opinion and suggestions? I think the hard plastic board will slide on the bench. It may be possible to place a piece of dycem under the board to reduce slipping. What do you think? Checked my gurus - here is how they do: http://sci.rutgers.edu/forum/showthread.php?t=6770highlight=slide +board+tub http://sci.rutgers.edu/forum/showthread.php?t=67285highlight=slide +board+tub So yes, some do use slide boards for this. I also read this: Do not use Dycem. I tried that and talk about slippery when wet! susanne -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] OTnow Colloboration With Spinal Cord Injury
Ron, The program that I'm talking about does not require that you qualify for state assistance. It is not based on income. It was formerly called Texas Rehab Commission. I am not sure how to find out if there is an equivalent in every state. If I have a chance later today, I will try to do a little exploring on their site and see if I can tell. In case you just have loads of spare time, here is the web site: http://www.dars.state.tx.us/. Mary Alice On May 27, 2007, at 6:37 AM, Ron Carson wrote: Hello Mary Alice: Just to clarify, I practice in the US. Also, at the moment, the patient is ineligible for state assistance. The patient has a small amount of money that has been donated. Prioritizing where to spend that money is going to be an important goal! Ron - Original Message - From: Mary Alice Cafiero [EMAIL PROTECTED] Sent: Saturday, May 26, 2007 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] OTnow Colloboration With Spinal Cord Injury MAC Another thought I had, I don't know if there is anything similar in MAC Canada to what we have in Texas called DARS which is the Department MAC of Adult Rehabilitation Services. This is a state agency which steps MAC in when a person has an injury, accident, illness etc and the person MAC has a goal of returning to work. The agency will provide counseling, MAC training, and/or funding to help make the going to work possible. MAC Some examples that are very helpful are that they will pay to adapt a MAC vehicle with hand controls, adapt a vehicle with a lift for a power MAC chair. Sometimes they will pay for the actual wheelchair when there MAC isn't other funding. MAC Obviously, I don't know a lot about funding in Canada, but I do know MAC a lot about equipment. Having the appropriate chair can make a huge MAC difference in so many aspects of life that I think it is one of the MAC most important parts of rehab. I know you said your patient doesn't MAC have insurance, but I wonder what other creative funding sources are MAC available. Does the family have any financial resources for MAC equipment? I just wonder if this is something that you have explored. MAC Mary Alice MAC On May 26, 2007, at 5:24 PM, Joan Riches wrote: Hi Ron I've read Rob's post and agree for the most part. However he left out what does the client WANT to do? If ever there was a place for the COPM it is here. My mind is full of questions. What was her life before the injury? What does she miss most? Is the four adult household the previous norm or is it temporary? Is there someone at home with her or does she need to manage alone for part of the day? Not sure why Rob thinks there are no child care demands (the child's age perhaps). I like Rob's emphasis on analysing every task for simplicity and accessibility. Be aware that she is forming habits and routines that need to last her for many years. People with SCI age just like the rest of us so staying open to continuous adaptation is a good attitude to develop. Energy conservation is critical so available energy is focused on the most meaningful things. Down the road some thought then to how to manage if she gets the flu, is especially tired etc. Is employment or further education a possibility? Are there community resources? I'd be looking at the Canadian Paraplegic Association for support both physical and emotional. What about the social network? Is there someone with the skills to lower closet rods, install railings etc. What has been addressed in rehab? What were this couple's plans for their family? Were they planning more children? If no-one else is addressing issues of sexuality and family planning you need to be prepared to do this or refer. One of the most satisfying experiences I've ever had was a very similar situation helping my client to manage and enjoy pregnancy, birth and newborn care. She was already independent in her w/c when I met her. I really like your request for collaboration. It will be easier to focus when the questions are more specific. A thought to end - Independence doesn't always mean doing everything yourself with no help. A critical part of independence is taking responsibility for your own activities, planning, supervising, negotiating and appreciating the assistance that others provide. Go for it, Ron. She's a lucky client. Joan -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Friday, May 25, 2007 3:24 PM To: Ron Carson Subject: Re: [OTlist] OTnow Colloboration With Spinal Cord Injury Here are some specifics: 1. There is no insurance 2. The patient is young, late 20's, mid 30's 3. She lives with her husband, sister and her husband 4. She has a 4 y/o daughter 5. There is no primary care doctor; She typically uses the ER 6. We have just starting weaning
Re: [OTlist] OTnow Colloboration With Spinal Cord Injury
I only know some of the areas of SCI treatment, but will happy to respond to questions or offer ideas when I think I can do so productively! Mary Alice On May 25, 2007, at 9:35 AM, Ron Carson wrote: Hello All: I recently agreed to treat a patient who suffered a T9-T10 SC injury late last year. She has just been d/c to her home after several months of rehab. While I have worked with SC injury patients, I do not consider it a speciality. There are SO many issues to manage and address that it can be a bit overwhelming. Given that I work alone, I don't have a 'team' to bounce off ideas, so I'm hoping that OTnow members will be my surrogate team? smile I would like to give and receive advice on topics relating to this case. Do you think this will work? Will people participate?? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] OT-Care.com
I don't have any specific information and only have a quick second to answer, but RESNA is a great place to look for information on any ECU type devices. That is the Rehab Engineering Society of North America, and their website is www.resna.org. They have a research publication that comes out quarterly I believe and also have an AT special interest section. I know they have had ECU information in the past and much of it has focused on cogntive challenges. Good luck, Mary Alice Cafiero On May 14, 2007, at 8:14 AM, OT Department wrote: Dear Ron This is a message which I hope will produce some leads for me from our well informed reader list! I am currently researching information on the use and application of Environmental Control Systems for those with Cognitive impairments. Any pointers on this topic would be most welcome. Best regards Frank Sutcliffe, O.T. - Original Message - From: Ron Carson [EMAIL PROTECTED] To: OTlist OTlist@OTnow.com Sent: Monday, April 30, 2007 7:53 PM Subject: [OTlist] OT-Care.com Hello All I just read a neat article in OT Practice called; Teaching Children with Disabilities to use the Computer Keyboard. The author, Sue Hossack, OTR/L, ATP, is a former student of mine. Prior to becoming an OT, Sue was a software engineer. Her website, www.ot-care.com may be of interest to those readers working in peds! Thanks, Ron Carson -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * * Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * * -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
[OTlist] more about ATP/ATS requirement in 2008
I found the reference from CMS for what I had mentioned the other day about changes coming soon to Medicare rules. Here it is for your information. Excerpt from CMS Local Coverage Determination L23613 on Power Mobility Devices “For claims with dates of service on or after April 1, 2008, the specialty evaluation required for patients receiving a Group 2 single power option or multiple power option PWC, any Group 3 or Group 4 PWC, or a push rim activated power assist device for a manual wheelchair must be performed by a RESNA-certified Assistive Technology Practitioner (ATP) specializing in wheelchairs or a physician who is board-certified in Physical Medicine and Rehabilitation. The ATP or physician may not have any financial relationship with the supplier. In addition, the wheelchair must be provided by a supplier that employs a RESNA-certified Assistive Technology Supplier (ATS) specializing in wheelchairs who is directly involved in the wheelchair selection for the patient.” Mary Alice -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] ethical wheelchair question
I think I had mentioned earlier that I am an ATP. I agree with you that users who truly need a standard chair or even a scooter should not require the services of a therapist with an advanced knowledge of seating and mobility. I do think that it is something to consider for the more involved client. Remember that ATPs are PTs as well as OTs. I think both AOTA and APTA will probably raise enough of a fuss that the CMS regulation will not actually go into effect, but I think it is interesting that they are trying something like this. I hope they will be able to institute something that indicates a higher level of knowledge for therapists prescribing high end custom chairs. I know that the one class session I had in school would not qualify me to make this type of decision or make recommendations to a client about something that is so serious! Mary Alice On Feb 6, 2007, at 6:32 AM, Ron Carson wrote: Hello Mary: Thanks for the recap. What you typed is what I remembered. About a year ago, when AOTA was providing input to CMS on pending changes to the PMD regs, I asked them to include a statement about REQUIRING a OT eval for all PMDs. I don' know if they included such a statement but as you said below, a therapist eval is currently not required. I think the RESNA cert is crazy. In my experience there are really two distinct category of w/c users. Those with positioning/mobility needs and those with mobility needs. For example, the vast majority of w/c evals that I've done are for clients who have no specific seating needs and where standard seating is very satisfactory. In this types of situations, no specific seating knowledge (beyond what we get in school) is necessary. On the other hand, there are those patients who need extensive seating and positioning equipment. In these situations, I think RESNA certification is indicated. Ron - Original Message - From: Mary Alice Cafiero [EMAIL PROTECTED] Sent: Monday, February 05, 2007 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] ethical wheelchair question MAC I don't have the current CMS reference but currently CMS is not MAC requiring a therapist evaluation. They are requiring that a MAC patient be seen for a face-to-face evaluation with their MAC physician within 60 days of the wheelchair prescription. Many MAC physicians are able to identify and document the mobility MAC limitation of their patient but are not able to sufficiently MAC document the patient’s functional ability to perform MRADLs MAC within their home. Whereas a therapist is more able to thoroughly MAC address the patient’s mobility limitations and identify which MAC piece of Mobility Assistive Equipment will meet the patient’s MAC needs. Keeping in mind that the least costly alternatives must be MAC tried or at least considered and ruled out if a PMD is going to MAC be considered for payment. Medicare has made it clear that for MAC these situations the ordering physician may refer the patient to MAC the PT/OT to perform a wheelchair assessment. However, the MAC therapist performing this wheelchair assessment cannot have a MAC financial relationship with the supplier of the equipment. This MAC physician ordered wheelchair assessment is reimbursable through MAC Medicare Part B. The physician may then sign the therapist's MAC evaluation to show their agreement with the findings. MAC So at this point, the therapist is not technically required to do MAC the evaluation, but is often called upon to do the evaluation MAC that the physician then signs off on. The word is that the future MAC of Medicare will be a therapist evaluation as a requirement for a MAC power wheelchair. Even more interesting is that the current plan MAC is that the therapist will have to be an ATP (Assistive MAC Technology Practitioner through RESNA) by 2008 (I think April). MAC Does that make sense? MAC Mary Alice MAC On Feb 5, 2007, at 6:32 PM, Ron Carson wrote: -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Medicare
There is a website where you apply. The link is available on the CMS.gov website. On Feb 6, 2007, at 10:42 AM, Jessica R. Gross wrote: I need a provider number. Currently working at a not-for-profit agency and a home-care agency. Neither place discussed NPI, but I am sure that I will still need one. Who do I contact? Is it a national or local office? -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Gregory Stelmach Sent: Monday, February 05, 2007 7:13 AM To: OTlist@OTnow.com Subject: Re: [OTlist] Medicare To All: I think this is a very interesting topic. Ron, do you have a provider number? What type of setting are you providing your treatment? Who out there is an independent contractor? What do you see are the pros and cons? I am currently operating a divsion of a medical supply company and always looking to supplement my income. Thanks. Greg Ron Carson [EMAIL PROTECTED] wrote: 1. I do all my billing. 2. I electronically bill Medicare and paper bill secondary insurance companies when necessary. 3. Time from submission to payment is approximately 10 days 4. Yes, part B 5. I normally bill my patients once a month. - Original Message - From: Mary Alice Cafiero Sent: Saturday, February 03, 2007 To: OTlist@OTnow.com Subj: [OTlist] Medicare MAC OK, do you actually do the billing yourself or do you have an MAC office staff who does the dirty work? Do you do electronic billing MAC or paper billing? MAC What is typical time between submission and receiving payment? Are MAC you doing part B? How/when do you collect the co-pay? MAC That's the ?s I can think of right now! MAC Mary Alice MAC On Feb 3, 2007, at 6:29 AM, Ron Carson wrote: Hello Mary: I bill Medicare almost every week. I am glad to help however I can. We should probably take this OFF the list as it won't apply to many people. Ron - Original Message - From: Mary Alice Cafiero Sent: Friday, February 02, 2007 To: OTlist@OTnow.com Subj: [OTlist] Medicare MAC Does anyone on the list have the wonderful experience of billing MAC Medicare directly? This is something that I have been doing lately MAC since I have just recently left a hospital position and begun an MAC adventure as an independent contractor. I would love to hear anyone's MAC experiences. I feel like I'm climbing a serious uphill trek. MAC Mary Alice -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * * Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * * -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** ** ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** ** ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** ** ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** ** ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Medicare
Sorry for my too late reply. Didn't read that you already had the complete answer before I sent my answer! On Feb 6, 2007, at 10:42 AM, Jessica R. Gross wrote: I need a provider number. Currently working at a not-for-profit agency and a home-care agency. Neither place discussed NPI, but I am sure that I will still need one. Who do I contact? Is it a national or local office? -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Gregory Stelmach Sent: Monday, February 05, 2007 7:13 AM To: OTlist@OTnow.com Subject: Re: [OTlist] Medicare To All: I think this is a very interesting topic. Ron, do you have a provider number? What type of setting are you providing your treatment? Who out there is an independent contractor? What do you see are the pros and cons? I am currently operating a divsion of a medical supply company and always looking to supplement my income. Thanks. Greg Ron Carson [EMAIL PROTECTED] wrote: 1. I do all my billing. 2. I electronically bill Medicare and paper bill secondary insurance companies when necessary. 3. Time from submission to payment is approximately 10 days 4. Yes, part B 5. I normally bill my patients once a month. - Original Message - From: Mary Alice Cafiero Sent: Saturday, February 03, 2007 To: OTlist@OTnow.com Subj: [OTlist] Medicare MAC OK, do you actually do the billing yourself or do you have an MAC office staff who does the dirty work? Do you do electronic billing MAC or paper billing? MAC What is typical time between submission and receiving payment? Are MAC you doing part B? How/when do you collect the co-pay? MAC That's the ?s I can think of right now! MAC Mary Alice MAC On Feb 3, 2007, at 6:29 AM, Ron Carson wrote: Hello Mary: I bill Medicare almost every week. I am glad to help however I can. We should probably take this OFF the list as it won't apply to many people. Ron - Original Message - From: Mary Alice Cafiero Sent: Friday, February 02, 2007 To: OTlist@OTnow.com Subj: [OTlist] Medicare MAC Does anyone on the list have the wonderful experience of billing MAC Medicare directly? This is something that I have been doing lately MAC since I have just recently left a hospital position and begun an MAC adventure as an independent contractor. I would love to hear anyone's MAC experiences. I feel like I'm climbing a serious uphill trek. MAC Mary Alice -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com * * Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn * * -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** ** ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** ** ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** ** ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** ** ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Medicare
I am the one that is new to this, but I did just get my provider number and am an independent contractor. The problems I am running into are that I provide services in the patient's home but am not part of a larger home health agency. That is making it tricky, and there are not a lot of people available who can answer questions. I don't think they are being mean or unwilling. I just think they don't know the answers. Mary Alice On Feb 5, 2007, at 6:13 AM, Gregory Stelmach wrote: To All: I think this is a very interesting topic. Ron, do you have a provider number? What type of setting are you providing your treatment? Who out there is an independent contractor? What do you see are the pros and cons? I am currently operating a divsion of a medical supply company and always looking to supplement my income. Thanks. Greg Ron Carson [EMAIL PROTECTED] wrote: 1. I do all my billing. 2. I electronically bill Medicare and paper bill secondary insurance companies when necessary. 3. Time from submission to payment is approximately 10 days 4. Yes, part B 5. I normally bill my patients once a month. - Original Message - From: Mary Alice Cafiero Sent: Saturday, February 03, 2007 To: OTlist@OTnow.com Subj: [OTlist] Medicare MAC OK, do you actually do the billing yourself or do you have an office MAC staff who does the dirty work? Do you do electronic billing or paper MAC billing? MAC What is typical time between submission and receiving payment? Are MAC you doing part B? How/when do you collect the co-pay? MAC That's the ?s I can think of right now! MAC Mary Alice MAC On Feb 3, 2007, at 6:29 AM, Ron Carson wrote: Hello Mary: I bill Medicare almost every week. I am glad to help however I can. We should probably take this OFF the list as it won't apply to many people. Ron - Original Message - From: Mary Alice Cafiero Sent: Friday, February 02, 2007 To: OTlist@OTnow.com Subj: [OTlist] Medicare MAC Does anyone on the list have the wonderful experience of billing MAC Medicare directly? This is something that I have been doing lately MAC since I have just recently left a hospital position and begun an MAC adventure as an independent contractor. I would love to hear anyone's MAC experiences. I feel like I'm climbing a serious uphill trek. MAC Mary Alice -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] ethical wheelchair question
As an OT who does wheelchairs as a primary part of my practice, this whole scenario just makes me cringe! The DME company has set you up to be such the bad guy! No, it is not ethical! Also, who knows if the wheelchair the client has is the appropriate one for them to have?? Why is the DME company even having a therapist do an eval now? Rules didn't change until very recently. Unless they have not billed until recently, and are trying to cover themselves, there should not be a reason to have a therapist eval. (Of course I think every client getting a chair should have a therapist eval. I'm just saying it was not a requirement until recently. And still technically isn't in a lot of ways!) I would stay a long way from this as a therapist. I would also seriously consider letting Medicare know about this situation. Mary Alice On Feb 5, 2007, at 10:37 AM, Jenny Daup wrote: Here is an ethical question for all of you. -DME company dispenses a number of wheelchairs to clients with the promise that medicare or insurance will pay for them. - DME company then requests that an outpatient clinic send a therapist to evaluate clients for the wheelchairs that they already have and then file paperwork for medical necessity. Here is the clincher...the patients have had their wheelchairs for an extended length of time, anywhere from 6 months to 18 months! Many of the clients are openly hostile to the OT because they don't see a reason that she is there to do a wheelchair evaluation. They are afraid she is going to take their wheelchair away. What do you think? Is it ethical to perform the eval after the fact? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] ethical wheelchair question
I don't have the current CMS reference but currently CMS is not requiring a therapist evaluation. They are requiring that a patient be seen for a face-to-face evaluation with their physician within 60 days of the wheelchair prescription. Many physicians are able to identify and document the mobility limitation of their patient but are not able to sufficiently document the patient’s functional ability to perform MRADLs within their home. Whereas a therapist is more able to thoroughly address the patient’s mobility limitations and identify which piece of Mobility Assistive Equipment will meet the patient’s needs. Keeping in mind that the least costly alternatives must be tried or at least considered and ruled out if a PMD is going to be considered for payment. Medicare has made it clear that for these situations the ordering physician may refer the patient to the PT/OT to perform a wheelchair assessment. However, the therapist performing this wheelchair assessment cannot have a financial relationship with the supplier of the equipment. This physician ordered wheelchair assessment is reimbursable through Medicare Part B. The physician may then sign the therapist's evaluation to show their agreement with the findings. So at this point, the therapist is not technically required to do the evaluation, but is often called upon to do the evaluation that the physician then signs off on. The word is that the future of Medicare will be a therapist evaluation as a requirement for a power wheelchair. Even more interesting is that the current plan is that the therapist will have to be an ATP (Assistive Technology Practitioner through RESNA) by 2008 (I think April). Does that make sense? Mary Alice On Feb 5, 2007, at 6:32 PM, Ron Carson wrote: I am no longer 100% up to date on Medicare regs, but I'm pretty certain that a therapist eval is NOT required. I believe it is true that there must not be any monetary exchange between the therapist and the DME. Will someone cite a CMS reference concerning the therapist requirement for an eval? Thanks, Ron - Original Message - From: Chris Smith [EMAIL PROTECTED] Sent: Monday, February 05, 2007 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] ethical wheelchair question CS Absolutely not! The DME's have to have a therapist do the CS eval and write the med necessity letter. If you don't cooperate CS they won't be able to make their sale. If you are in a snf you CS need to explain to the administrator why is this unethical and the CS snf needs to protect their residents against these scum bag CS vendors by not allowing them into the facility. However if the pts CS are in independent living or their own homes then you can't do as CS much to prevent this. This is why medicare now requires a CS therapist not employed by the vendor to do the eval. I would talk CS to the reputable vendors about the problem they want it stopped, CS too. Often they will work to educate health care managers. Good CS luck. Chris CS ___ CS Join Excite! - http://www.excite.com CS The most personalized portal on the Web! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
[OTlist] Medicare
Does anyone on the list have the wonderful experience of billing Medicare directly? This is something that I have been doing lately since I have just recently left a hospital position and begun an adventure as an independent contractor. I would love to hear anyone's experiences. I feel like I'm climbing a serious uphill trek. Mary Alice -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Medicare
OK, do you actually do the billing yourself or do you have an office staff who does the dirty work? Do you do electronic billing or paper billing? What is typical time between submission and receiving payment? Are you doing part B? How/when do you collect the co-pay? That's the ?s I can think of right now! Mary Alice On Feb 3, 2007, at 6:29 AM, Ron Carson wrote: Hello Mary: I bill Medicare almost every week. I am glad to help however I can. We should probably take this OFF the list as it won't apply to many people. Ron - Original Message - From: Mary Alice Cafiero [EMAIL PROTECTED] Sent: Friday, February 02, 2007 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Medicare MAC Does anyone on the list have the wonderful experience of billing MAC Medicare directly? This is something that I have been doing lately MAC since I have just recently left a hospital position and begun an MAC adventure as an independent contractor. I would love to hear anyone's MAC experiences. I feel like I'm climbing a serious uphill trek. MAC Mary Alice -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Central post-stroke pain
You can also do desensitization since it sounds like it is nerve pain being treated by Neurontin. I have found that desensitization works best when the patient is the one that is putting different textures on their skin. Good things to use are lotion, cotton balls, cotton fabric, corduroy fabric, etc working up to tolerating having your hand/arm in sand, rice, beans and other strange textures. It all is working toward getting the nerves to process the information correctly again. It doesn't always work because sometimes the pathways stay broken. If that seems to be the case, you have to teach compensation. That is a quick and dirty answer. Sorry to be so brief. I have to run feed hungry children! Mary Alice On Jan 22, 2007, at 4:19 PM, Orli Weisser-Pike wrote: Hullo, I have a lady who is 44 y.o. s/p CVA affecting the left, non- dominant side, with hemianesthesia. Her motor strength is fine, her FMC is poor due to decreased proprioception, etc. She is increasingly suffering from pain in her left arm, side of her face, ear, sometimes down to her toes. Her neurologist has put her on Neurontin which seemed to help at the start, but her symptoms are increasing. Does anyone have any knowledge about this, and what may help facilitate functional use of her left arm? One therapist told me to teach her to regard her arm as a prosthesis and learn how to use it again--this makes sense to me. Any other advice will be helpful! Thanks again, Orli Orli Weisser-Pike, OTR/L, CLVT, SCLV Low Vision Rehabilitation Baptist Rehabilitation Germantown * 2100 Exeter Road * Germantown, TN 38138 http://www.baptistonline.org/facilities/germantown/services/ lowvision.asp *(901)757-3458 ext. 308 *(901)757-3497 MailTo:[EMAIL PROTECTED] This message and any files transmitted with it may contain legally privileged, confidential, or proprietary information. If you are not the intended recipient of this message, you are not permitted to use, copy, or forward it, in whole or in part without the express consent of the sender. Please notify the sender of the error by reply email, disregard the foregoing messages, and delete it immediately. Orli Weisser-Pike.vcf - Smart Medicine. Inspired Care. And the awards to prove it. Recognized as a Top 50 Healthcare Network. To learn about other recognition and awards Baptist has earned, visit: http://www.bmhcc.org/aboutus/awards/index.asp This message and any files transmitted with it may contain legally privileged, confidential, or proprietary information. If you are not the intended recipient of this message, you are not permitted to use, copy, or forward it, in whole or in part without the express consent of the sender. Please notify the sender of the error by reply email, disregard the foregoing messages, and delete it immediately. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
[OTlist] Just a word about w/cs
I don't get a chance to post often just because in addition to being an OT with a sort of widely varied practice I also have three fairly young kids (10,7, and 4). You can imagine my vast amounts of free time! :) I do enjoy reading the posts though, and manage to pop in now and then to get my two cents heard! I wanted to point out that I am also an ATP which is an Assistive Technology Practitioner through RESNA the Rehab Engineering Society of North America. I do lots of wheelchair evaluations and modifications. Primarily this is for custom wheelchair for kids and adults who have pretty involved injuries or diagnoses (i.e. CP, Spinal cord injury, MD, MS, Spina Bifida, etc). I do both power and manual chairs and work very closely with the actual DME providers. I do actually carry tools around and do repairs at times. Now, it is rare that I do things to a standard issue Medicare geriatric chair. Although I have been known to switch a standard chair to hemi height when a CVA patient is stuck going in circles cause their left arm doesn't work at all and their feet won't touch the floor! The point being, there is a time and a place for lots of things to be appropriate for OT. I personally think that if it is not possible of both an OT and a PT to be involved in a comprehensive wheelchair evaluation, that most often OT has more to offer. We tend to be better problem solvers and are better at thinking of all the possibilities and planning well. Medicare is changing many of the rules that apply to wheelchairs and the reimbursement that affects wheelchairs, so for anyone doing geriatrics, it is something to pay attention to. Once Medicare has it in place, it will most likely trickle over and affect private insurance and eventually state Medicaid programs. Gotta run watch the Saints and the Bears second half. Just wanted to mention this. Obviously it is a passion of mine, and it is not a huge area of practice in OT. I do think it is very important. Go Saints!! Mary Alice -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
[OTlist] Role of OT
This discussion brings to mind a recent experience I had. I have recently moved from working full time in a pediatric hospital to working on my own in a variety of PRN contract positions in home health, SNF, and high end independent wheelchair evaluations for Medicare and Medicaid. Interesting stuff. I have been out of OT school since 1993 (scary that I am an OLD OT!!) and have pretty much practiced in all areas. I did a couple of days in a well-respected upscale nursing home with a high capacity rehab unit attached. They have a large full time therapy staff and a big patient population that actually goes home. It was a deal where I was just filling in for a few days so didn't really get to know the staff at all.just came in, quickly got oriented to the paperwork and where to find things, and was turned loose with a patient list. I was horrified to see all the OTs and COTAs sitting in the gym watching their patients sit in little clusters doing arm bikes, pinching clothespins, etc. I didn't see any cones, but I'm sure they were lurking in a corner somewhere. With so little time and preparation coming in, it was very difficult not to get sucked in to just plopping my patients right down with the rest of them and letting the patients do their time and count their minutes. Instead, I spent a little time figuring out what each patient was planning on doing after d/c and what they actually liked to do with their time (how novel!). I actually incorporated that into treatment (again, such a rebel!) With one guy, who was returning to live alone, we did actually work on him showering by himself. I was chastised severely by one of the other OTs and by the rehab director (a PTA) because the said now nursing would expect for OT to help with all the showers for the rehab patients. It is just sad and frustrating that we seemed to be damned if we do and damned if we don't. How hard is it to incorporate function and a person's individual needs and goals into a treatment plan? It isn't that hard! AND it quickly shows how unique and wonderful OT can be. Now, I've had my little moment on the soap box. I will let someone else have a turn! Mary Alice, Texas -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Swallowing
I practice in Texas and am, admittedly an old OT. Most places I work, OT is definitely part of the dysphagia team. In certain settings, OT is much more involved in oral motor and dysphagia than speech. Often it seems that is based on who has the higher comfort level which often depends on your school program and work experience. I have been involved with adults and children in everything from evaluation of aspiration risk, oral motor sensitivity and aversion, delayed swallow, oral motor apraxia to actually being involved in the video swallow studies. I don't think OT is out of swallowing in any global sense across the board. Mary Alice On Nov 30, 2006, at 7:47 AM, Joan Riches wrote: I think speech has taken over. I wonder why. How long have you been practising, Chris? If not long do you know any 'old' OTs that you can ask about this? Was dysphasia addressed in your training? Is swallowing a potential issue with any of your clients? Do you assess for swallowing problems? Do you have any friends who are speech paths? How does swallowing figure in their practice? Adult speech pathology is in short supply here. The dysphasia team is Dietician, OT and Speech Pathology. Followup is Dietician for diet and OT for positioning, staff and family training. All may do family and discharge support. Joan -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.15.2/559 - Release Date: 11/30/2006 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
