750 Quiz 2

_ Act of 2018 (Sec. 50202 of the Act): elimination of therapy cap on Medicare Part B Patient Driven Grouping Model (PDGM) for home health agencies _ Driven Payment Model (PDPM) for skilled nursing facilities

Bipartisan Budget, Patient

Privatization of Medicare and Medicaid Medicare Advantage Part _ plans Medicaid expansion under managed care model

C

Describe the situation Express the emotion or effect Specify Consequences

DESC

Managed care approach to limit unnecessary healthcare services. Approval typically required.

HMO

Penalties can be applied for Medicare readmissions

Hospital Readmission Reduction Program (HRRP

Important to address because of _ Begin search on PubMed.gov using keywords Results: Addressing ADL/IADL limitation- key to reducing hospital readmissions Functional cognition, fear of falling, functional mobility, safety, vision, and overall frailty result in higher rates of readmissions

Hospital Readmissions Reduction Program (HRRP)

Quality measures & assessment data be submitted, tracked and shared by post acute settings

IMPACT Act of 2014

Use of info gained during organization and environmental assessments to validate perceptions of the wants/needs of target populations that will receive a new product or service

Markey analysis

Enacted in 1965 Jointly funded by fed govt and state Health coverage for low income persons; individuals that have LT disability 50% of beneficiaries are children State determines eligibility and coverage OT is not covered in all states Rates vary between states Home and Community Based Services (HCBS) Waiver program- available to vulnerable target populations Intent- improve quality of life OT is included in many states waivers ex: training of staff, short term restorative services CHIP: Childrens Health Insurance Program Created in 1997, part of the balanced budget act School therapy coverage Part of IEP School districts can bill Medicaid

Medicaid

Medicare Advantage Plans Managed Care model Rates for services change frequently The company can dictate DC destination, therapy and length of stay

Medicare Part C

Out - patient services Follow physician fee schedule Use of CPT coding for billing Private practice therapists - must become approved Medicare providers Once approved cannot opt out of medicareenrollment and charge for their services thru cash payments

Medicare part B

_ that align to words spoken make communication effective Kinesis Oculesics Haptics Proxemics Paralinguistics

Nonverbal cues

Addresses OT professional identity and perspective Defines the professions nature and purpose Human needs addressed by OT Problems that we solve And how we solve the problems Include theory to address these areas in a broad fashion ex. Assists in answering what the OT program focus is

OT paradigm

Tools that specify what changes, how change proceeds, the conditions under which an intervention achieves beneficial results and why a change may occur for certain groups of consumers and not others

OT paradigm

Places limits on providers an insured can access

PPO

Cost containment and shifts in fee structures _ payment model did not sustain the program therefore Development of Medicare Prospective Payment System in 1983. Intent to shorten length of acute stay Rate established: dx + hospital region=payment

Retrospective

Used frequently in nursing S-situation B-background A-assessment R-recommendation

SBAR

Fee for service has gained popularity Requires that client seek reimbursement by their insurance company Alternative medicine - often fee for service and has gained popularity

Self-pay

Application has gained momentum since 2020 E synchronous Assure you have consent Assure that your "hands" are competent Often OTA/PTA are onsite Other times use of facility staff

Telehealth

Largest integrated healthcare system 1,255 healthcare facilities 170 medical centers 1,074 OP sites Serve 9 million enrolled

VA

Mandated by federal govt in all states Each state has industrial commission Determine payment and rules regarding what the employer or the employer's insurance company must cover

WC

Groups of providers associated with a defined population of clients that are accountable for the quality and cost of care delivered to that population

accountable care organization

ex. hospital, specialists, grp of primary care physicians

accountable care organizations

individuals attempt to incorporate health behaviors into their routine.

action

3 generations currently in work force What does this mean? Must understand your audience and id best methods for communication

adapting your message to the audience

•Patients dealing with difficult situations •Organizational hierarchical in nature •Must be _ for our patients •IDT

advocates

Speak loudly Are confrontational Perceived as intimidating Responses- reactionary Angry/forceful

aggressive communication style

Payment systems that incentivize value-based care by focusing on reduced costs and high-quality care

alternative payment models

Like to get along with everyone High value on relationships Frequently do not assert their views

amiable

Logical and fact oriented Accuracy is valued Objective data valued

analytical

Respectful, firm, and clear articulation of the speaker's needs A means to act in one's own interest Enables the setting of boundaries Facilitates trust Provides a way to express difficult ideas constructively

assertive communication

Thoughtful Respectful in response Direct Want to have 2-way discussion

assertive communication style

Make eye contact Maintain an open posture Own your opinions, needs, words. "I" statements Firm, clear voice State the issue and the outcome you desire Stay focused and calm

assertive communication techniques

Language differences Timing of message Use of medical jargon Conflicting nonverbal communication

barrier to communication

level of arousal can affect readiness to attempt new occupational behavior. Ie. Fatigue, over arousal due to nervousness, under the influence of meds, etc

being aware of physiological state

Encompasses all costs associated with an episode of care.

bundled payment program

Utilize resources available through the official documents from AOTA Understand documentation requirements for reimbursement by Medicare and Medicaid Specific guidelines for documentation Use of quality measures under the IMPACT Act Consider the use of organizational clinical or critical pathways for managed or episodic care Access local district- or state-level educational resources for school-based practice guidelines Investigate any pertinent facility standards required for accreditation Explore other related disciplines' studies and guidelines pertinent to client population and setting

clinical practice requirements

Plans may dictate if individuals access OT treatment Consumers are more likely to compare costs Must be aware of _ requirements Illegal to waive - negates contractual agreements between provider and insurer

co pay

Improves Access to and coordination of services Appropriate use of specialist resources Health outcomes for people with chronic disease Patient care and safety

collaborative practice

Not publicly funded Held by individuals or nongovernmental org Frequently available thru employer-sponsored plans or individually thru brokers Most are for profit Typically HMO or PPO High deductible plans (w/HSA accounts)

commercial/private insurance

As health professionals we are a part of complex environments Miscommunication within health care can have profound implications. As healthcare professionals, it is our ethical obligation to study, practice, and grow in our ability to _

communicate

Usually improves quality of care

competition

Generates theory and methods to apply the theory (these methods referred to as technology for application) Each model focuses on specific phenomena or areas of function therefore typically apply a combination of models Generate theory unique to OT

conceptual practice model

Tool used to help generate theory and methods therapists use in their work to apply that theory (eval, intervention)

conceptual practice model

persons are aware of a health problem; are considering taking action but have not committed to any specific action thinking about making a change

contemplation

Specifies the requirements for continuing education and other means to demonstrate

continuing competence

members are excited about tackling new problems in a creative manner even if mistakes are made.

creativity

Composed of persons with specific expertise and knowledge Work together to achieve an assigned goal or fulfill a specific purpose for the organization

cross-functional work teams

misinterpretation: be mindful when engaging with other cultures •Become literate in cultural norms; termed "cultural intelligence"

cultural competence

shared elements of identity and communication patterns of a group

culture

When supply is > demand= _ in cost When demand is > supply = costs _

decrease, increase

collaborative practice _ Patient complications Length of hospital stay Tension and conflict among caregivers Staff turnover Hospital admissions Clinical error rates and mortality rates

decreases

Stop talking Put the speaker at ease Do not interrupt; especially if the person is upset Empathize Paraphrase Ask open ended questions Use silence Allow reflection

development of good listening

members carry out roles and responsibilities with discipline even when it is not convenient or comfortable.

discipline

Optimal communication should be a leader's primary concern The leader's influence is continually earned, reinforced, and established through communication Impressions of leadership are built over successive interactions

discursive model of communication

Focused on task completion Efficient Do not place high value on relationships

drivers

The United States is the only industrialized country that does not have government-funded health care for all its citizens. A key concept is "_," which is a major element of the current debate on healthcare reform.

dualism

reflects the involvement of both govt and private industry in healthcare

dualism

The goal of every _ is to allocate scarce resources (Mansfield, 80). Assumption is that there is a finite amount of resources (e.g., Medicaid, Medicare, etc. have finite budgets) Much of the healthcare reform debate has been focused on access to limited services Is health care a right or a privilege? The answer lies at the intersection of values, economics, and systems

economy

Keep to 60 min; no greater than 90 min Invite only those needed Make agenda available ahead of time Assure that at meeting end all have assignments to bring to next meeting Choose appropriate meeting space

effective meetings

Acknowledges a difficult situation and attempts to redirect the conversation to the issue and to inspire action

empathic

Examination of data, info and other forms of evidence, including needs of target populations, that will guide the development and promotion of a new service

environmental assessment

Things to evaluate for your target populations: Population demographics (age, marital status, socioeconomic data, insurance status, etc.) Payer mix Targeted areas of expansion for your org Organizational plans for future space and resource allocation Strategies Id and review websites of competitors to learn about their products and services Interview leaders of community-based org or public health officials concerned with your target population Establish focus groups Engage in a health fair etc where you can collect data Id physicians and gain feedback

environmental assessment

Bundled Payments for Care Improvement Initiative (BPCI) Comprehensive Care for Joint Replacement (CJR)

episode payment models (bundled payment)

Action-oriented Follow up technique Directs the recipient of the message to complete that which is needed and explains consequences

escalating

Enthusiastic Seek attention Value relationships Like personal recognition

expressive

_: NOISE, DISTRACTIONS, SERVICE PROVIDERS VYING FOR PT ATTN _: FATIGUE, DIVIDED ATTN, EMOTION OR PERSONAL THOUGHTS Poor listening skills

external, internal

Delineates beliefs, assumptions, def and concepts within a specific area of practice. Employ existing theory and focus on dev methods of applying that theory in OT

frame of reference

Typically assumed that economies do better when people are free to choose

free choice based on information

Healthcare functions differently in the _ Involvement of 3rd party payers and managed care limit the effects of supply and competition IE. PPO - What effect can this have on quality? IE. HMO - use gatekeepers to control access to specialists (must have referral). If referred must use one of their specialists

free market

Composed of persons from several vertical levels of the organization who perform specific organizational functions

functional work teams

Exclusion as an interprofessional team member for primary care initiatives Other disciplines step forward as key players Medicare payment reductions Reduced presence in community and outpatient settings if our role in addressing SDoH is not established Failure to meet and/or exceed quality measures defined by CMS

future challenges in occupational therapy

_ : Number of individuals assembled together or having some unifying relationship, Do not share responsibility, Focus on achievement of ind goals, Typically only 1 leader, Discuss problems and delegate tasks to members _ : Group of people who perform interdependent tasks to work toward a common, Share responsibility, Focus on _ goals, Can have multiple leaders, discusses the problem and id way to solve it completing it collectively

group, team

Study of touch Can convey warmth, reassurance, caring etc May be perceived differently by different people and cultures

haptics

Perceived susceptibility Perceived seriousness Perceived barriers Perceived benefits Cue to action

health belief model

US- adult population basic or below basic _ 43% for reading and comprehension 39% for reading and using forms 55% for working with numbers _- Agency for Healthcare Research and Quality (AHRQ) define as ability to obtain/understand health information and make appropriate decisions

health literacy

Increased from 4% in 2006 to 30% 2019 Higher _ rates- $2900-$6900 Majority of ACA plans are high _ and also require co pay

high deductible health plans

Shared vision and goals Shared leadership and accountability Continuous learning and development Customer focus Capability to gather and use feedback and data

high-performing teams

value honesty and transparency about aims, decisions, uncertainty, and mistakes.

honesty

Includes ulcers, falls, med errors and infections Results in payment penalty for all Medicare DC at hospital

hospital-acquired condition reduction program

members value one another's training and do not believe that one perspective is always superior to another, relying on one another to avoid mistakes.

humility

intentional act; requires conscious attention from the listener Listening is vital to establishing trust Must set aside judgement and criticism and be open to the message Tips: Eye contact maintained Open and engaged posture Offer acknowledging responses

importance of listening

the structures within organizations and their programs, policies, and procedures

institutional

Members provide care to a common group of patient/clients. Members develop common goals for patient/client outcomes and work toward those goals. Appropriate roles and functions are assigned to each member, and each member understands the roles of the other members. The team possesses a mechanism for sharing information. The team possesses a mechanism to oversee the carrying-out of plans, to assess outcomes, and to make adjustmentsbased on the results of those outcomes.

inter professional teams

Composed of members from several disciplines working interdependently in the same setting Coordinate work and communicate more formally to contribute to an interdisciplinary plan of care Problem solving typically in team meetings Example: inpatient rehab facilities

interdisciplinary teams

relationships and interactions with persons such as friends, family, and peer groups.

interpersonal

provides for expanded knowledge, creativity, and diversity of insights Teams develop through stages Group members strengths need to be id to best utilize each member High-functioning teams have shared/clear goals, mutual trust, and respect for others

interprofessional collaboration

Recognizing need for effective communication Need to recognize factors such as jargon that can limit understanding Effective communication both written and verbal or electronic

interprofessional communication

occurs when students from two or more professions learn about, from, and with one another to enable effective collaboration and improve health outcomes

interprofessional education

individual factors and characteristics such as knowledge, beliefs, and values that may influence behavior.

intrapersonal

Teamwork Understanding role and responsibilities Shared values and ethics Effective communication skills

key to communication between OT/OTA

Study of gestures, postures and facial expressions Self assessment may be helpful if you do not know how you reflect these areas Gestures can provide animation; or at extreme can be distracting Posture/body orientation- standing or sitting upright facing others with slight lean says you are open Arms not crossed indicates openness

kinesis

Provides highest level of public protection by prohibiting unlicensed individuals from practicing OT or referring to themselves as OTs/OTAs. laws reserve a scope of practice for those _

licensure

health behaviors are successfully incorporated into daily routines, and attempting to prevent relapse.

maintenance

Method of controlling utilization of healthcare by requiring approval of services; negotiation of fees with providers is typical

managed care

Protects the public by prohibiting uncertified persons from referring to themselves as OTs/OTAs. Unlike licensure, individuals under certain circumstances can practice if they do not refer to their services as occupational therapy. _ laws may provide a definition of occupational therapy.

mandatory certification

Validate perceptions of target populations: Data, information, and evidence from your organizational assessment and environmental assessment Outcome of this will be your marketing plan Ex: dev of a hand program What would you do?

market analysis

Must consider expenses and revenue "free" service or indigent care - what does this mean? Who is covering that cost? Must look at revenue - what is the payment system around your new service?

marketing

Process of organizational assessment, environmental assessment, market analysis and marketing communications

marketing

Methods devised to reach your target populations to promote your product or service

marketing communication

State run funded by state and federal govt for individuals with limited income

medicaid

Federal program; over 65 y/o who have worked for at least 10 years and some individuals with disabilities that have been present for at least 2 yrs

medicare

Largest payer of healthcare services Managed and funded by federal govt Administered by Centers for Medicare and Medicaid Services of the Dept of Health and Human Services Requirements 65 y/o Disability and receiving social security for 2+years ESRD ALS Use of MACs _ administrative contractors Contracted for a period of 5 years Set their own requirements May require certain documentation May exclude some coverage

medicare

Hospital payments follow prospective payment model Based on dx, facility location & characteristics

medicare Part A

Incentives were created for physicians to increase efficiency and value. Led to performance measures that also apply to therapists under the Medicare Physician Fee Schedule (out-patient therapists use this system) Payment incentives provided when reporting on quality measures & improvement activities

merit based incentive payment system

Focusing the mind to be centered in the present moment Can be used to manage stress Meditation, silence Self-reflection Deliberate reflection

mindfulness

Composed of members from several disciplines so the team can offer a greater breadth of services to patients Team members work independently and interact formally Example: short stay acute care settings

multidisciplinary teams

Understanding can be gained through the sharing of stories Example: abused indiv referring to self as abuse survivor vs as one that has been abused

narrative paradigm theory

What we say is less important than how we say it as words are only 7% of our communication. Paralinguistics- the explanation of non verbal aspects

non-verbal communication

An individual's behavior is affected by those with whom the individual interacts Social norms inferred from cultural & group contexts Examples: support groups, mentoring relationships

normative social behavior theory

Define what type of supervision is required for occupational therapy assistants, including amount of time, frequency, and documentation requirements.

occupational therapy assistant supervision requirements

Eye contact Helps to engage audience Breaking of the gaze can break the flow of communication

oculesics

1.the _ (seek explanation of what is) questions related to what is most real for OT 2.the epistemological (theory of knowledge, minds relation to reality) questions related to what is known and understood in OT the _ (study of values and of value judgements especially in ethics) questions related to what is the right action in occupational therapy

ontological, axiological

the interrelationships between organizations or within existing social networks

organizational

Examination of the factors within an org that will influence the dev and promotion of a new product or service

organizational assessment

SWOT analysis Perspectives from stakeholders Mission statement review Assures you are in line with the org objectives If not clear - need to be ready to provide explanation for need If asked to engage in an activity that does not align - can allow you to have leverage to not complete that task Conduct informational interviews w/other dept directors to gain perspective on their needs Ask for input using newsletter, media etc Id if there is info already present to support your venture Conduct a survey of needs, resources or limitations to internal customers SWOT analysis; compare between depts Review web page from your org - id services that may have synergy w/what you are proposing

organizational assessment

First impressions Internal Telephone communication Waiting room Therapy area External Parking Travel distance

packaging

Chronemics: time ex. someone who is chronically late; always early Disposition/attitude Voice Quality Pitch, tone, volume, pace, enunciation, rhythm, use of silence

paralinguistics

Speak softly May agree even when they do not Back-down Difficult for other to know their opinion

passive communication style

IHIs: "Triple Aim" expanded to "quadruple aim" Health insurance marketplaces to provide affordable care Increase coverage by regulating insurance plans Medicaid expansion Facilitate innovation of programming and alternative payment models that generate better health outcomes

patient protection and affordable care act of 2010

Medicare Medicaid WC VA Private Insurance Out of pocket/ self-pay

payers for OT services

Do your employees understand your product and its place in the organization? Prepare employees to talk to others about your product(s). Define the distinct value of the occupational therapy or other services you are providing.

people

learning by doing; providing a hands-on opportunity for an individual to engage in the actual task.

performance accomplishments

Client testimonials Client satisfaction surveys

physical evidence

traditional clinic services: the client comes to your location. On-site: you go to the client's location. tTelehealth: client calls a phone service.

place

Tracking of outcomes for a group of people

population health

Established in 2019 Measure to evaluate and report the frequency of readmission from post acute settings Applies to SNF, HHA, IRF

potentially preventable readmission

persons are un- or underaware of a health problem or the benefit of performing a health behavior. No intention to change behavior

pre contemplation

intention to begin performance of a health behavior is combined with criteria for action that include a time frame to begin acting

preparation

Implications: Develop readmission prevention program identifying those at risk Train occupational therapy staff Track readmission data Bottom Line: OT can take a leadership role in implementing targeted evidence-based programs to minimize risk of readmissions and measure impact of programs

preventing hospital readmissions

Value Associated costs: Time costs Emotional or psychological costs Physical costs Monetary costs

price

Generate data specific to your product or service Existing customers or potential customers Referral sources, payers, employees, suppliers etc

primary data sources

Resources that generate data specific to your product or service Existing customers, referral sources, payers, employees, suppliers, consultants etc

primary data sources

Completeness- relays all the facts Conciseness- brevity Consideration-words chosen & how they may be received Clarity-clear message Concreteness-basis in fact; how literal it is Courtesy-respect toward receiver Correctness-accuracy of content

principles for effective communication

Clearly define for everyone in: Development Delivery Marketing communications Know what you can and cannot deliver

product

Seven P's of mixed marketing: _ Price Place Promotion Physical evidence Packaging _

product, people

`Develop an external action plan: 1.Who is the target population? 2.Who are internal or external customers? 3.What are your consumers' and customers' goals? 4.Who will be involved in deciding where to go for services? 5.What is the most efficient and effective way to reach your consumers and customers?

promotion

Optimal use of face- to- face engagement How to: Promptly address issues Plan ahead Focus on behavior not person; description not judgement Be specific Check to ensure message was received

providing constructive feedback

Role of personal space Intimate personal space in US: 18" or less Conversational personal-space: 18"-4' Social distance/professional: 4-8' Public distance: >12' (attending a speech)

proxemics

the policies, programs, and regulations of local, state, and federal bodies are examined for opportunities to influence or regulate behavior.

public policy

Use of _ to demonstrate positive outcomes across the healthcare continuum Capture meaningful measures that demonstrate: Safe community discharge Reduced length of hospital stays Prevented hospital-acquired conditions Adopt more service delivery options, such as population health, primary care, telehealth, and disaster relief

quality metrics

Incentivizes providers to meet quality measures by the potential of earning a bonus or incurring a penalty reduction in future payments

quality payment program

Specify if a physician referral is necessary for evaluation and/or treatment.

referral requirements

Comes from outside of OT Investigated by other disciplines ex. Motor learning OT applies this information to allow persons following CVA to dress; relearning familiar activities

related knowledge

Must know own role Understand the role of the other disciplines IPEC focus: the need to address complex health promotion/illness problems, in the context of complex care delivery systems, calls for recognizing the limits of professional expertise and the need for cooperation, coordination and collaboration between professionals

roles and responsibilities

Defines the domain of OT, such as defining the roles of OTs and OTAs. May include specifics (such as orthotics, physical agent modalities, activities of daily living intervention, and environmental modification), or may be more general in nature.

scope of practice

Already exist - reports, stats, surveys etc

secondary data sources

Research that already exists Govt census reports, economic statistics about a potential target population, info from news sources etc Stakeholders persons, groups, org that support OT practice and the mission of OT

secondary data sources

Face-to-face meetings Brochures and direct mail Telephone solicitations Seminars TV/radio/print ads Website Social media

selecting promotional media

Operate with a high level of autonomy and responsibility Still held accountable for outcomes and projects assigned to the team

self-directed work teams

Behavior is determined by expectancies and incentives Efficacy expectations related to one's confidence about performing a behavior Incentives related to the value an individual places on an outcome

social cognitive theory

nonmedical factors that influence health provide an incentive for healthcare providers to address population-wide needs Create the justification for addressing population health Track the health outcomes of groups of people Acknowledgment that medical models must recognize social factors related to health of populations

social determinants of health

Communication is for mutual benefit Example: therapeutic use of self or outcomes from a good support group

social exchange theory

Relates to online relationships Can achieve the same or > intimacy as in-person but will take longer Example: may be applied to telehealth

social information processing theory

Internal customers External customers Clients: Persons Organizations Populations Patients Third-party payers

target populations

Cooperation Working to avoid duplication of service Working toward consensus Recognizing expertise of others Shared accountability Working to maintain positive relationships

teams and teamwork

Defines the process for unlicensed personnel to obtain permission to work while waiting for their licenses.

temporary license/work permit

Explanation of how or why a particular phenomenon occurs and how that might be influenced

theory

explanation of how or why a phenomenon occurs and how it may be influenced Key: explanation, •Providing a reason for how something works Found in paradigm, frames of reference, in conceptual practice models, and in knowledge

theory

Managed care controls utilization of healthcare services by requiring approval Fees are negotiated at reduced rate Aim is to improve efficiency and reduce costs Competition and choice in a free market are restricted What are some examples of the various types of managed care?

third-party payers

Accept that superior communication abilities require a lifelong learning perspective Reflect, self-assess Seek continual improvement and learning to become a better communicator Practice; engage with others

to be a better communicator

engage in teaching and learning across disciplinary boundaries May train others to complete some work tasks or functions in their absence Example: community-based settings

transdisciplinary teams

2018 - 10.4% under age 65 28 million _!

uninsured

Purchasers of health care hold providers accountable for delivering a hi-quality level of care in a cost effective manner

value-based payment

Codes of Ethics OT- includes altruism, equality, freedom, justice, dignity, truth, prudence, beneficence, nonmaleficence etc IPEC indicated a need for a focus on the values that should undergird relationships among the professions, joint relationships with patients and the quality of cross professional exchanges in delivering health care and in establishing policies

values and ethics

learning by listening; trying to convince someone to adopt a behavior.

verbal persuasion

learning by observation; best if the "model" is perceived as being like the client and to achieve mastery through effort rather than ease.

vicarious experience