Re: [OTlist] doubling patient in acute rehab
Bill, I think I hear what you are saying. If I may be so bold as to add a few thoughts. First, I do think healthcare should be viewed as a business. However, I think we look at it as a national commodity when in fact it is a service...a vital service, none the less a service. To further complicate matters we have taken this "commodity" and made it a "right" to "have access" in our conversations around how to regulate. So, strictly speaking from a business model, or more specifically an economic model we do not have true "free market" economic principals in play. Namely, supply and demand. Here is another way to look at it. If you or I had to take what we do as therapist and "package" it in a way that the consumer would buy it, I fear that most consumers would not buy. When I say consumer I do mean the end user not the "fiscal intermediator" or any other entity that holds the purse strings. So what is the answer? I think in part is lies (at least in the US) with "cleaning up" the insurance industry. This includes Medicare and all private insurances. It would involve new innovative ways of thinking that are actually not new. Give the consumer control. One of the "products" that I think could be useful in changing the paradigm is HSA's (healthcare savings accounts). You can find plenty of info on-line (try HSA.com) that speak to particulars. In a nutshell, these are insurance products that are a high deductible policy matched with a savings account that is interesting bearing and is yours. It is not dependant upon your employer. Something like this would have to be phased in gradually starting with 18 year olds. The power in a product like this is the same as any interest bearing accounts--compounded interest over time and it rolls over from year to year. This is so unlike any of the so called FSA's that do not encourage saving but spending. Anyway, at the end of the day we would be "selling" our services to the consumer and not to congress. I do see a place for congress to be involved, but on a limited basis and simply to provide oversight and safeguards where necessary (like making sure it is portable from state to state). Hope this makes sense. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Bill Maloney Sent: Saturday, November 08, 2008 12:28 PM To: OTlist Subject: Re: [OTlist] doubling patient in acute rehab On the subject of DB/DT: ethics, rules, varying standards of individual clinical practices, etc. notwithstanding, the bottom line is PROFIT. If you look very closely at ALL clinical settings, the bottom line has to be "healthy" (seemingly at whatever cost) or the business fails. With the US economy faltering, business owners, board members and trustees are more than likely interested in the path of least resistance when it comes to ethics, i.e. as long as you're not doing anything harmful enough to hurt business, rock on. I am absolutely and certainly not implying, in any way, that the "suits" don't hold themselves to high standards of ethical business behavior (perhaps some do, perhaps some don't). I am just jaded, I guess, by all the improprieties that are regularly surfacing from behind the scenes in the corporate world. Healthcare is no different, it is a business. The questions I would have are two: 1. The cart before the horse: does the business side of healthcare exist and do what it does to keep the wheels spinning in order for us to provide excellent care to our recipients; or do we provide our service to the recipients as a means of generating revenue for the business (is the dog wagging the tail, or vice-versa)? and 2. When you've applied ethical framework guidelines to how you're practicing, and asked all the appropriate questions, and answered them to the best of your interpretation, do you stay put or move on to something that better aligns with your personal practice philosophy? Thanks, Ron and others for allowing freedom of expression on this site. Bill Maloney, OTR -- 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] doubling patient in acute rehab
On the subject of DB/DT: ethics, rules, varying standards of individual clinical practices, etc. notwithstanding, the bottom line is PROFIT. If you look very closely at ALL clinical settings, the bottom line has to be "healthy" (seemingly at whatever cost) or the business fails. With the US economy faltering, business owners, board members and trustees are more than likely interested in the path of least resistance when it comes to ethics, i.e. as long as you're not doing anything harmful enough to hurt business, rock on. I am absolutely and certainly not implying, in any way, that the "suits" don't hold themselves to high standards of ethical business behavior (perhaps some do, perhaps some don't). I am just jaded, I guess, by all the improprieties that are regularly surfacing from behind the scenes in the corporate world. Healthcare is no different, it is a business. The questions I would have are two: 1. The cart before the horse: does the business side of healthcare exist and do what it does to keep the wheels spinning in order for us to provide excellent care to our recipients; or do we provide our service to the recipients as a means of generating revenue for the business (is the dog wagging the tail, or vice-versa)? and 2. When you've applied ethical framework guidelines to how you're practicing, and asked all the appropriate questions, and answered them to the best of your interpretation, do you stay put or move on to something that better aligns with your personal practice philosophy? Thanks, Ron and others for allowing freedom of expression on this site. Bill Maloney, OTR -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] doubling patient in acute rehab
A couple of quick thoughts and observations. First, Wikipedia has good info on basic definitions of ethics and morality. Second, ultimately after one reads these definitions or others one comes to the question: Says who? On what authority does any "man" or system of "man" e.g. government, religion, etc. make their claim? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brent Cheyne Sent: Thursday, November 06, 2008 6:52 PM To: otlist@otnow.com Subject: Re: [OTlist] doubling patient in acute rehab To Ron, Chris and the List, For the sake of continuing the doubling/dovetailing conversation, I'd like to talk about ethics...the labels of "ethical and unethical" situations get freely tossed around a lot in talk about the OT world. To say that something is "unethical" because it is against the rules means if you follow the rules your are supposedly"ethical". However, truly ethical conduct goes beyond the mere act of following the 'rules', and is far more complicated. As we have already observed one clinical setting (acute rehab) may have different "rules" than another (SNF, Peds etc.). And often the rules are hard to find, pin down, verify, or subject to multiple interpretations. Rules change frequently...does that mean our ethics are also constantly in flux based on corporate,medicare, or insurance provider policies? The AOTA has a Code of Ethics (2005) with 7 principles as components: Principle 1.demonstrate a concern for the safety and well-being of the recipients of their services. (BENEFICENCE) Principle 2. take measures to ensure a recipient’s safety and avoid imposing or inflicting harm. (NONMALEFICENCE) Principle 3 respect recipients to assure their rights. (AUTONOMY, CONFIDENTIALITY) Principle 4. achieve and continually maintain high standards of competence. (DUTY). Principle 5.comply with laws and Association policies guiding the profession of occupational therapy. (PROCEDURAL JUSTICE) Principle 6. provide accurate information when representing the profession. (VERACITY) Principle 7. treat colleagues and other professionals with respect, fairness, discretion, and integrity. (FIDELITY) According to the AOTA these are the ethical principles we follow to determine if a situation or even a rule is ethical. Additionally these ethical principles are held in conjuction with the OT Core Values (AOTA 1993): Altruism, Equality, Freedom, Justice, Truth and Prudence. So...Based on AOTA Ethical Principles and Core Values, we take a look back at doubling/dovetailing patients for treatment and we know there are certain rules to follow in a variety of contexts of clinical practice, Questions Come Up: Should doubling/dovetailing (DB/DT) always be considered "unethical" regardless of the clinical setting ? If DBDT is allowed by rule is it still unethical? If it is generally unethical by what ethical principle? Is DBDT only unethical because it is harder (or easier) work for the therapist, or can it be proven to be less (or more) efficient in providing the most effective treatment to the most people for the least cost? I think all these questions should have good answers before we go to our colleagues, managers, and administrators to talk about the ethics of practices and policies such as DBDTing. Any other thoughts or responses? Brent, an OT --- On Thu, 11/6/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Subject: OTlist Digest, Vol 44, Issue 7 To: otlist@otnow.com Date: Thursday, November 6, 2008, 3:00 PM 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 Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: doubling patient in acute rehab ([EMAIL PRO
Re: [OTlist] doubling patient in acute rehab
I think what we are really talking about is ethical dilemmas. By definition an ethical dilemmas occurs when there is more than one correct choice and the dilemma is choosing the most correct. Dilemmas often occur in the face of competing entities, in this case; the patient, payeer, employer and employee. As health care providers, we SHOULD be compelled to do what is best for the patient. But, there are competing forces which makes this choice very difficult at times. In fact, doing what's right for the patient can cost a therapist their job. Ron -- Ron Carson MHS, OT - Original Message - From: Brent Cheyne <[EMAIL PROTECTED]> Sent: Thursday, November 06, 2008 To: otlist@otnow.com Subj: [OTlist] doubling patient in acute rehab BC> To Ron, Chris and the List, BC> For the sake of continuing the doubling/dovetailing conversation, BC> I'd like to talk about ethics...the labels of "ethical and BC> unethical" situations get freely tossed around a lot in talk BC> about the OT world. To say that something is "unethical" because BC> it is against the rules means if you follow the rules your are supposedly"ethical". BC> However, truly ethical conduct goes beyond the mere act of BC> following the 'rules', and is far more complicated. As we have BC> already observed one clinical setting (acute rehab) may have BC> different "rules" than another (SNF, Peds etc.). And often the BC> rules are hard to find, pin down, verify, or subject to multiple BC> interpretations. Rules change frequently...does that mean our BC> ethics are also constantly in flux based on corporate,medicare, or insurance provider policies? BC> BC> The AOTA has a Code of Ethics (2005) with 7 principles as components: BC> Principle 1.demonstrate a concern for the safety and well-being BC> of the recipients of their services. (BENEFICENCE) BC> Principle 2. take measures to ensure a recipient’s safety and BC> avoid imposing or inflicting harm. (NONMALEFICENCE) BC> Principle 3 respect recipients to assure their rights. (AUTONOMY, CONFIDENTIALITY) BC> Principle 4. achieve and continually maintain high standards of competence. (DUTY). BC> Principle 5.comply with laws and Association policies guiding the BC> profession of occupational therapy. (PROCEDURAL JUSTICE) BC> Principle 6. provide accurate information when representing the profession. (VERACITY) BC> Principle 7. treat colleagues and other professionals with BC> respect, fairness, discretion, and integrity. (FIDELITY) BC> BC> According to the AOTA these are the ethical principles we follow BC> to determine if a situation or even a rule is ethical. BC> Additionally these ethical principles are held in conjuction with BC> the OT Core Values (AOTA 1993): Altruism, Equality, Freedom, Justice, Truth and Prudence. BC> BC> So...Based on AOTA Ethical Principles and Core Values, we take a BC> look back at doubling/dovetailing patients for treatment and we BC> know there are certain rules to follow in a variety of contexts of BC> clinical practice, Questions Come Up: Should doubling/dovetailing BC> (DB/DT) always be considered "unethical" regardless of the BC> clinical setting ? If DBDT is allowed by rule is it still BC> unethical? If it is generally unethical by what ethical BC> principle? Is DBDT only unethical because it is harder (or BC> easier) work for the therapist, or can it be proven to be less (or BC> more) efficient in providing the most effective treatment to the most people for the least cost? BC> BC> I think all these questions should have good answers before we go BC> to our colleagues, managers, and administrators to talk about the BC> ethics of practices and policies such as DBDTing. BC> Any other thoughts or responses? BC> Brent, an OT BC> --- On Thu, 11/6/08, [EMAIL PROTECTED] BC> <[EMAIL PROTECTED]> wrote: BC> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> BC> Subject: OTlist Digest, Vol 44, Issue 7 BC> To: otlist@otnow.com BC> Date: Thursday, November 6, 2008, 3:00 PM BC> Send OTlist mailing list submissions to BC> otlist@otnow.com BC> To subscribe or unsubscribe via the World Wide Web, visit BC> http://otnow.com/mailman/listinfo/otlist_otnow.com BC> or, via email, send a message with subject or body 'help' to BC> [EMAIL PROTECTED] BC> You can reach the person managing the list at BC> [EMAIL PROTECTED] BC> When replying, please edit your Subject line so it is more specific BC> than "Re: Contents of OTlist digest..." BC> Today's Topics: BC>1. Re: doubling patient in acute rehab ([EMAIL PROTECTED]) BC>
Re: [OTlist] doubling patient in acute rehab
Great point of discussion Brent. I think doubling/dovetailing can be used ethically, but I also think it can be used unethically. I have seen some rehab departments use doubling/dovetailing quite well that was actually therapeutic psychosocially as well. I have also seen rehab departments that have become machines in which the same type of exercises are used for no apparent reason except to capture time. This might be an unspoken truth in the therapy world, but I guarantee that most of us have seen this happen at one time or another. To me personally I have a hard time with doubling because it takes away my therapeutic sense at that moment. Usually when I am doubling I am thinking about the activity that will occupy the individuals without truly focusing on the individual that I am trying to help. When I am one on one I can give my all to that individual to focus on the key areas that they are dealing with. So to me personally it could be argued that I would be violating principle 1 in the area of the client's well being. I am sure that there are individuals who can overcome this, perhaps it takes much practice. But in the eight years that I have been practicing I continue to struggle with it, so I try to avoid it. Chris Nahrwold MS, OTR -Original Message- From: Brent Cheyne <[EMAIL PROTECTED]> To: otlist@otnow.com Sent: Thu, 6 Nov 2008 6:51 pm Subject: Re: [OTlist] doubling patient in acute rehab To Ron, Chris and the List, or the sake of continuing the doubling/dovetailing conversation, I'd like to alk about ethics...the labels of "ethical and unethical" situations get reely tossed around a lot in talk about the OT world. To say that something is unethical" because it is against the rules means if you follow the rules your re supposedly"ethical". However, truly ethical conduct goes beyond the mere act of following the rules', and is far more complicated. As we have already observed one clinical etting (acute rehab) may have different "rules" than another (SNF, Peds etc.). nd often the rules are hard to find, pin down, verify, or subject to multiple nterpretations. Rules change frequently...does that mean our ethics are lso constantly in flux based on corporate,medicare, or insurance provider olicies? he AOTA has a Code of Ethics (2005) with 7 principles as components: rinciple 1.demonstrate a concern for the safety and well-being of the ecipients of their services. (BENEFICENCE) rinciple 2. take measures to ensure a recipientʼs safety and avoid imposing or nflicting harm. (NONMALEFICENCE) rinciple 3 respect recipients to assure their rights. (AUTONOMY, ONFIDENTIALITY) rinciple 4. achieve and continually maintain high standards of competence. DUTY). rinciple 5.comply with laws and Association policies guiding the profession of ccupational therapy. (PROCEDURAL JUSTICE) rinciple 6. provide accurate information when representing the profession. VERACITY) rinciple 7. treat colleagues and other professionals with respect, fairness, iscretion, and integrity. (FIDELITY) According to the AOTA these are the ethical principles we follow to determine f a situation or even a rule is ethical. Additionally these ethical principles re held in conjuction with the OT Core Values (AOTA 1993): Altruism, Equality, reedom, Justice, Truth and Prudence. o...Based on AOTA Ethical Principles and Core Values, we take a look back at oubling/dovetailing patients for treatment and we know there are certain rules o follow in a variety of contexts of clinical practice, Questions Come p: Should doubling/dovetailing (DB/DT) always be considered "unethical" egardless of the clinical setting ? If DBDT is allowed by rule is it still nethical? If it is generally unethical by what ethical principle? Is DBDT nly unethical because it is harder (or easier) work for the therapist, or can t be proven to be less (or more) efficient in providing the most effective reatment to the most people for the least cost? think all these questions should have good answers before we go to our olleagues, managers, and administrators to talk about the ethics of practices nd policies such as DBDTing. ny other thoughts or responses? rent, an OT -- On Thu, 11/6/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> ubject: OTlist Digest, Vol 44, Issue 7 o: otlist@otnow.com ate: Thursday, November 6, 2008, 3:00 PM 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 r, 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 Subject line so it is more specific han "Re: Contents of
Re: [OTlist] doubling patient in acute rehab
To Ron, Chris and the List, For the sake of continuing the doubling/dovetailing conversation, I'd like to talk about ethics...the labels of "ethical and unethical" situations get freely tossed around a lot in talk about the OT world. To say that something is "unethical" because it is against the rules means if you follow the rules your are supposedly"ethical". However, truly ethical conduct goes beyond the mere act of following the 'rules', and is far more complicated. As we have already observed one clinical setting (acute rehab) may have different "rules" than another (SNF, Peds etc.). And often the rules are hard to find, pin down, verify, or subject to multiple interpretations. Rules change frequently...does that mean our ethics are also constantly in flux based on corporate,medicare, or insurance provider policies? The AOTA has a Code of Ethics (2005) with 7 principles as components: Principle 1.demonstrate a concern for the safety and well-being of the recipients of their services. (BENEFICENCE) Principle 2. take measures to ensure a recipient’s safety and avoid imposing or inflicting harm. (NONMALEFICENCE) Principle 3 respect recipients to assure their rights. (AUTONOMY, CONFIDENTIALITY) Principle 4. achieve and continually maintain high standards of competence. (DUTY). Principle 5.comply with laws and Association policies guiding the profession of occupational therapy. (PROCEDURAL JUSTICE) Principle 6. provide accurate information when representing the profession. (VERACITY) Principle 7. treat colleagues and other professionals with respect, fairness, discretion, and integrity. (FIDELITY) According to the AOTA these are the ethical principles we follow to determine if a situation or even a rule is ethical. Additionally these ethical principles are held in conjuction with the OT Core Values (AOTA 1993): Altruism, Equality, Freedom, Justice, Truth and Prudence. So...Based on AOTA Ethical Principles and Core Values, we take a look back at doubling/dovetailing patients for treatment and we know there are certain rules to follow in a variety of contexts of clinical practice, Questions Come Up: Should doubling/dovetailing (DB/DT) always be considered "unethical" regardless of the clinical setting ? If DBDT is allowed by rule is it still unethical? If it is generally unethical by what ethical principle? Is DBDT only unethical because it is harder (or easier) work for the therapist, or can it be proven to be less (or more) efficient in providing the most effective treatment to the most people for the least cost? I think all these questions should have good answers before we go to our colleagues, managers, and administrators to talk about the ethics of practices and policies such as DBDTing. Any other thoughts or responses? Brent, an OT --- On Thu, 11/6/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Subject: OTlist Digest, Vol 44, Issue 7 To: otlist@otnow.com Date: Thursday, November 6, 2008, 3:00 PM 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 Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: doubling patient in acute rehab ([EMAIL PROTECTED]) ------ Message: 1 Date: Wed, 05 Nov 2008 19:05:30 -0500 From: [EMAIL PROTECTED] Subject: Re: [OTlist] doubling patient in acute rehab To: OTlist@OTnow.com Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" I think doubling and dovetailing in unethical in acute rehab, since it is a rule from medicare.? I have not read the rules for SNFs. -Original Message----- From: Brent Cheyne <[EMAIL PROTECTED]> To: Ron Carson Sent: Tue, 4 Nov 2008 6:16 pm Subject: Re: [OTlist] doubling patient in acute rehab Hello everyone and good topic, I've worked in SNF rehab geriatrics for the better part of 15 years and doubling/dovetailing has often been part and parcel of business as usual especially since the PPS RUGs category system was put into place. Coupled with this? RUGs phenomena is a fairly high productivity standard which usually between 85% to 95% in companies I've known or worked for.?( 8 hour day means 408min?or 6.8 hours?to 456 min or 7.6 hours of therapy contact and 24-72 minutes?to do everything else including meetings, and documentation). As Jennifer Mc Laughlin OT/L?has said "MCR has changed and allows Med A to be treat
Re: [OTlist] doubling patient in acute rehab
I think doubling and dovetailing in unethical in acute rehab, since it is a rule from medicare.? I have not read the rules for SNFs. -Original Message- From: Brent Cheyne <[EMAIL PROTECTED]> To: Ron Carson Sent: Tue, 4 Nov 2008 6:16 pm Subject: Re: [OTlist] doubling patient in acute rehab Hello everyone and good topic, I've worked in SNF rehab geriatrics for the better part of 15 years and doubling/dovetailing has often been part and parcel of business as usual especially since the PPS RUGs category system was put into place. Coupled with this? RUGs phenomena is a fairly high productivity standard which usually between 85% to 95% in companies I've known or worked for.?( 8 hour day means 408min?or 6.8 hours?to 456 min or 7.6 hours of therapy contact and 24-72 minutes?to do everything else including meetings, and documentation). As Jennifer Mc Laughlin OT/L?has said "MCR has changed and allows Med A to be treated concurrently and billed for the minutes engaged in tx as this is a minutes billing vs a modality treatment billing." The MCR B patients?I've seen have always been one-on-one. ? There seem to? be a lot of different interpretations of the? Medicare Rules and Regs and different? Rehab companies and many?therapists/managers are often convinced that they have it all straight.?Curiously, this?doesn't explain the vastly different ranges of accepted practices and?policies?amongst? different settings and companies. As a therapist who has done a fair share of doubling/dovetailing...I am keenly aware of the advantages and limitations of it's use. And yes--there are times when it is completely inappropriate for conducting skilled intervention related to occupations.However, there are times when it is appropriate to double up patient?when? it is selectively used to conduct treatment efficiently and free up more time to work one-on-one with a more involved patient in the same caseload. This takes good treatment?planning,time management,?and? clinical judgement ??? The real problem is when the dovetailing/doubling becomes an everyday-all day practice in which no 1:1 time is available at any time for anybody. Then caseloads simply become a? corporate billing mechanism but not skilled service. ? ??? The question I have is (as I play devil's advocate)Is doublling really unethical in all circumstances?, or which circumstances? And if it is please explain what is meant by unethical, in what manner is doubling unethical...that assertion is?one worth specifically articulating. I'd be interested in hearing from any of you, Respectfully, Brent the 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] doubling patient in acute rehab
Hello everyone and good topic, I've worked in SNF rehab geriatrics for the better part of 15 years and doubling/dovetailing has often been part and parcel of business as usual especially since the PPS RUGs category system was put into place. Coupled with this RUGs phenomena is a fairly high productivity standard which usually between 85% to 95% in companies I've known or worked for. ( 8 hour day means 408min or 6.8 hours to 456 min or 7.6 hours of therapy contact and 24-72 minutes to do everything else including meetings, and documentation). As Jennifer Mc Laughlin OT/L has said "MCR has changed and allows Med A to be treated concurrently and billed for the minutes engaged in tx as this is a minutes billing vs a modality treatment billing." The MCR B patients I've seen have always been one-on-one. There seem to be a lot of different interpretations of the Medicare Rules and Regs and different Rehab companies and many therapists/managers are often convinced that they have it all straight. Curiously, this doesn't explain the vastly different ranges of accepted practices and policies amongst different settings and companies. As a therapist who has done a fair share of doubling/dovetailing...I am keenly aware of the advantages and limitations of it's use. And yes--there are times when it is completely inappropriate for conducting skilled intervention related to occupations.However, there are times when it is appropriate to double up patient when it is selectively used to conduct treatment efficiently and free up more time to work one-on-one with a more involved patient in the same caseload. This takes good treatment planning,time management, and clinical judgement The real problem is when the dovetailing/doubling becomes an everyday-all day practice in which no 1:1 time is available at any time for anybody. Then caseloads simply become a corporate billing mechanism but not skilled service. The question I have is (as I play devil's advocate)Is doublling really unethical in all circumstances?, or which circumstances? And if it is please explain what is meant by unethical, in what manner is doubling unethical...that assertion is one worth specifically articulating. I'd be interested in hearing from any of you, Respectfully, Brent the OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
