Professional Management Final
CHIP (children's health insurance program):
Part of Medicaid established in 1997 to expand services to children not eligible for Medicaid, benefits are similar however may include limitations of services or deductibles. For those under the age of 19 whose families make too much to qualify for Medicaid
Autonomy
individual rights, confidentiality
The market
is defined as all actual or potential buyers of the product, service or idea
Part D of Medicare
outpatient prescription drug coverage through private plans that contract with Medicare
OTA 3+ years as a supervisor
◦Advanced Practice Practitioner ◦Dependent upon State Licensure Requirements ◦Continues previous supervision roles Potential Management Positions
motivation
◦the ability to increase one's desire to achieve a goal or desired outcome, intrinsically vs. extrinsically motivated, typically better leader if intrinsically motivated, especially in healthcare.
OTA is legally responsible
◦to provide skilled services only under the supervision of an OT.
Federal Advocacy
AOTA: national professional organization in the USA that is responsible for guiding and developing professional standards, professional development and advocacy on behalf of occupational practitioners and clients served by occupational therapy, federal level. ◦AOTPAC- American Occupational Therapy Political Action Committee
Scholarship
Activities designed to build the knowledge base and further advance the practice and teaching of occupational therapy
Environmental Analysis
Changes and trends may impact OT services, need to examine the following to determine marketing target Demographics Political and regulatory systems Cultural environment Economic/financial environment Psychographics Technological developments
Person
Client, OT practitioner, clinician, caregiver, family member, teacher, physician, case manager, or anyone involved in a client's care. (generally measured by progress)
Population
Clients with a certain diagnosis, clients at a facility, residents of a facility or location, students in a school, students in an OT or OTA program - what procedures or treatments can produce better results-EBP
Marketing planning
FIRST EXAMINE THE MARKET AND LISTEN CAREFULLY TO NEEDS AND SECOND DESIGN THE PROGRAM TO MATCH THE NEEDS AND DESIRES OF POTENTIAL CUSTOMERS
social service director
Makes sure the emotional and social needs of clients are being met
3 steps in targeting marketing
Market segmentation: grouping into distinct group of buyers Market targeting: evaluating and selecting one or more of the markets to enter Product positioning: formulating a competitive position for the product
self-regulation
ability to manage emotions, moods and impulses and channel these feelings in useful ways, you will show compassionate and professional behaviors, you will remain calm in stressful or difficult situations.
Formal Assessment
administrators, program directors and surveyors look at quality measures to determine if it is good enough and if not what needs to change.
Health Insurance Marketplace
allows for health care exchanges
veracity
honest and truthful
professional integrity
practice of consistently acting in an honest manner while upholding the standards of the profession
outbound marketing
promoting such as advertising, publicity, sales promotion and personal selling
"SWOT" stands for:
strengths, weaknesses, opportunities, threats
emotional intelligence
the ability to perceive, access, generate and regulate emotions to promote emotional and intellectual growth, need self-awareness, self-regulation and motivation.
Action plan
this is the plan to meet goals and should be dynamic to allow for change as new opportunities and problem arise. Actions should ideally be assigned to specific individuals to complete by specific dates.
OTA 1st year as a supervisor
◦Entry Level—Learning your skills ◦Dependent upon your state licensure requirements, you may oversee: ◦Volunteers ◦Occupational Therapy Aides
Director of Nursing
◦In charge of the nursing Team.
Director of Rehabilitation
◦In charge of the rehabilitation process. Common for a "therapist" to be in this role. However, if another discipline is in this role, One must follow your discipline's licensing practice act and state code of regulations. Also supervises non-professional rehab personnel, (aides).
OTA 1-3 years as a supervisor
◦Intermediate Level—Increase and begin to master skills ◦Dependent upon your state licensure requirements, you may: ◦Volunteers ◦Occupational Therapy Aides ◦Levels I and II Fieldwork OTA Students ◦Level I OT Fieldwork Students
LEVELS OF EVIDENCE WHICH REFLECT EXPERIMENTAL RESEARCH (or quantitative research)
◦Level I: Systematic reviews, meta-analyses, randomized controlled trials ◦ Level II: Two groups, nonrandomized studies (e.g., cohort, case-control) Level III: One group, nonrandomized (e.g., before-and-after, pretest and posttest)
LEVELS OF EVIDENCE WHICH REFLECT QUALITATIVE RESEARCH
◦Level IV: Descriptive studies that include analysis of outcomes (single subject design, case series) ◦Level V: Case reports and expert opinion that include narrative literature reviews and consensus statements
Direct supervision
◦OT is at the same site at OTA is providing services and within speaking distance.
Immediate supervision
◦OT provides face-to-face observation of OTA.
Routine supervision
◦OT provides guidance initially to the OTA. Reviews all aspects of the OTA services no less than every 2 weeks and interim supervision provided by phone, electronic or other written methods.
General supervision
◦OT provides initial guidance to the OTA and periodically reviews all aspects of services of OTA no less than every 30 days and interim supervision through phone, electronic or other written methods.
Common situations which may produce moral distress
◦Productivity ◦Supervision ◦Caseload competence
transactional leadership
◦based on exchanges between a leader and a follower in which followers are rewarded only when meeting specific goals or exceeding performance criteria using rewards or the avoidance of penalties (quite behavioralist).
OT has legal responsibility to supervise
◦the OTA in order to demonstrate that the OTA is not operating independently from the OT.
research validity
◦the degree to which research methods and findings are sound in that they reflect actual phenomena in the world and are not distorted by inaccuracies in conceptual or theoretical foundations, design, measurement or analysis. -Or how trustworthy is the research findings.
Leadership
◦the practice of encouraging others to purposefully accomplish an outcome that will achieve the fullest potential of the individual, department, professional or community (very different than manager)
charge nurse
Nurse in charge of the a particular unit for that particular day
Close supervision
OT provides guidance with daily contact with the OTA.
OT Supervisor
OT who is working with the care of a specific client. May have more than one OT Supervisor.
Group
A facility (hospital, clinic, school), an OT department, an OTA or OT educational program (there has been a shift from problem-oriented focus to quality management and performance improvement to prevent errors rather than fix them once they have happened) ◦Quality management: chart audits and reviews, satisfaction surveys, monitoring client results ◦Performance improvement: focus on clinicians or faculty such as are evals being done withing 24 hours, are student grades posted within expected timeframes. Review areas that are lacking and determine how the processes can be improved.
◦Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (AOTA, 2014)
Are generally reviewed every 5 years
minimal supervision
As-needed basis and can be less than monthly.
Consumer Analysis
Assess potential consumers (individuals, groups, populations, colleagues, other health professionals, etc.)
Accountable Care Organization (ACO)
an integrated network of providers working together to provide healthcare
three types of marketing control
1.Annual plan with steps to take to monitor and correct deviations. 2.Profitability control is efforts to use to determine actual profit or loss. 3.Strategic control is systematic evaluation of market performance in relation to current and forecasted marketing environment.
Three types of Codes
1.International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): official system of assigning codes to diagnoses and procedures, the physician is responsible for determining these codes. 2.CPT (Common Procedural Terminology) Coding System: system practitioners use to bill services; list of standardized descriptions of services and procedures to payers for reimbursement, services must match the ICD-9-CM code. 3.HCPCS (Healthcare Common Procedure Coding System)are codes based on CPT to provide standardized coding and are not private, so it allows use by all healthcare providers (CPT owned by AMA and is copyrighted)
The four dimensions of a scholarship
1.The scholarship of discovery: conducting research 2.The scholarship of integration: seeking new insights from existing research to integrate and synthesize for new patterns of connection, adds to new perspectives of theories within OT 3.The scholarship of application: Linking theory and practice and between academia and service provision, uses insights to address novel issues in practice or in teaching 4.The scholarship of teaching and learning: contributes to the knowledge base needed for high-quality teaching of OT or OTA students and for public sharing of the knowledge of the profession.
AOTA, NBCOT, SRB
3 Entities that establish practice standards and enforcement procedures for OTs and OTAs
Competitive Analysis
How adequately are the needs of the current marketplace being met, what areas are not being served, where are there duplications and overlap occurring, where are opportunities for collaboration or joint ventures, or new ideas to come forth.
Two types of marketing
Inbound (market research, analyzing competing, finding market niche, pricing products and services) and outbound (promoting such as advertising, publicity, sales promotion and personal selling)
Why the need for Scholarship?
Justify practice patterns Demonstrate what was done and how so others can replicate
entitlement legislation
Laws that guarantee rights to benefits to specific groups of individuals (Social Security, Medicare, Medicaid, Children's Health Insurance Program [CHIP], Supplemental Nutrition Assistance Program, IDEA, Patient Protection and Affordable Care Act) •There are other legislation that impact the practice of OT such as ADA and budgets within laws.
Timeline
Period of time to examine specific objectives to determine if goals are being met typically over 12-month period
The 4 "P's" are the strategies that can be used to influence the demand for a product:
Product: what we do or provide Place: where we will provide the service Price: fee for service Promotion: how will we advertise, promote, sale product
Factors to be assessed in SWOT might be:
Reputation of your facility in the community Staff and their qualifications Physical size of program Location Convenience of your location Type and quality of the equipment Available budget Support from administration
Steps when engaging in inquiry to answer a clinical question when all information is not at hand
STEP 1: seek specific knowledge-ask a clinical question to answer- use PICO (or PICOT) P=Person, problem or population I= Issue or intervention being considered C=Comparison of an alternative intervention or no intervention O=Outcome that would be affected by the intervention T=Timeframe STEP 2: complete a systematic search of the published literature for directly related research evidence STEP 3: critically appraise the evidence STEP 4: draw an unbiased conclusion, based on integration of information from all the studies for answering the question (clinical bottom line) STEP 5: use the information with clinical expertise to make decisions for intervention STEP 6: evaluate outcome
the market can be analyzed through?
Self-audit Consumer analysis Competitive analysis Environmental assessment
Relationships in which an OT practitioner can be a leader
Self: goes back to emotional intelligence such as being self-aware, knowing your goals, your strengths and weaknesses, and your motivators. Client: (client is person, group or populations) may be the most important relationship, evident through client-centered practice, use of OP and EBP assists with ensuring client centered practice (narrative and scientific reasoning) Interdisciplinary Care Team: essential for optimal communication and collaboration for excellent patient care, includes members of he team who are responsible for the patient's care (interprofessional collaboration-often called an interdisciplinary team) Multidisciplinary approach (model) found to be most effective (often seen in medical world) Interdisciplinary model most seen in school setting, transdisciplinary often seen in early childhood. Community: includes populations and settings outside of the client and care team relationships including professional organizations. The relationship with the community and the impact that occupational therapy can have on external stakeholders is the key to the future of the profession. Being a member of AOTA and state associations allow for greater impact on communities and legislation. Volunteer opportunities can reflect the power of OT by participating in OT or non-OT related organizations.
Administrator (rehab team)
Sets the tone for the culture of work environment
Social Marketing
Social media Engaging organizations to get public recognition
State Advocacy
State professional organizations also have a political action committee who work with AOTA to gather information from position statements, practice guidelines and language for OT. The states work to get this information from positions, guidelines and verbiage into state legislation/licensure.
What is advocacy?
The process of supporting a cause, such as an idea, policy or activity that can directly affect a person's or a group's well-being. ◦Important for optimum care for clients ◦Necessary for the strength of the profession
Leadership Styles
Transactional Leadership Transformational Leadership
Scholarly Practice(EBP)
Using the knowledge base of the profession in one's practice and in teaching.
self audit
assesses the strengths, weaknesses, opportunities and threats (SWOT) of your department or program.
marketing control
attempts to assist with maximizing probability the product will achieve goals and measure program results, diagnose thee results and take corrective actions if needed.
Three key characteristics of true experimental students include
control, randomization and blinding.
self-awareness
deep understanding of one's own emotions, strengths, weaknesses, needs and drives.
Informal Assessment
did that treatment session go well? is that note good enough?
Beneficence
doing good and preventing harm
Justice
fair treatment
Fidelity
faithful or loyal
transformational leadership
leaders create connections with followers that inspire and motivate others to exceed an outcome beyond exchanges and rewards. This leadership style tends to have greater influence on employee and colleague satisfaction by targeting intrinsic motivators with use close supervision relationship.
Medical Home Model
led by personal physicians to coordinate care
SRB
legal entity that has jurisdiction over practitioners licensed in that state, each state has different requirements and procedures for filing a complaint, has the ability to restrict or revoke a Practioner's license.
nonexperimental research
longitudinal research, case studies, cohort designs
inbound marketing
market research, analyzing competing, finding market niche, pricing products and services
AOTA
national professional organization, not a credentialing agency, membership is voluntary, has an Ethics Commission which writes and revises OT Code of Ethics and Ethics Standards, can only review ethics complaints of AOTA members at the time of misconduct
Nonmaleficence
not doing harm
Medicaid Benefits
•At a minimum states are required to provide coverage for the following •Inpatient and outpatient hospital services •Physician, midwife and nurse practitioner services •Laboratory and x-ray services •Nursing faculty services, home health care for individuals aged 21 years and older •Early and periodic screening, diagnoses and treatment for children younger than 2 years •Family planning services and supplies •Rural health clinic and federally qualified health center services
The Iron Triangle
•Cost •Access •Quality Improving one or two of these tends to have a negative effect on the other such as: Reduce cost can increase access but decrease quality.
Americans with Disabilities Act
•First federal legislation to prohibit discrimination against people with disabilities with the Rehabilitation Act of 1973, Section 504. this program only applied to federal government programs. •In 1990 with ADA, civil rights extended to people with disabilities in all areas of society. •Under ADA people with disabilities have the right to equal access to opportunities to live, work, and ply within society. •ADA provides equal opportunities in employment, state and local government services, public accommodations, commercial facilities and transportation. •In 2008 it was amended to place less emphasis on the need for the individual to prove the severity of an impairment
Individuals with Disabilities Education Act (IDEA)
•History can be traced by to SS Act of 1935 which included funding for crippled children •In 1975 the Education for all Handicapped Children Act (EHA) was passed to ensure all children ages 6-21 received FAPE in LRE with use of an IEP. OT coined as a related services at this time. •EHA was amended in 1986 to include children ages 3-5. •EHA was expanded and renamed in 1990 with the passing of IDEA which placed greater emphasis on the access of students with disabilities to education the same as their peers. Clearer guidelines provided. •Revised again in 1997 and 2004 to include AT, early interventions for birth to 3, transition services beginning age 14, and programs for children with ED.
practice settings
•Hospitals •Outpatient clinics •SNU •Home and community settings •Schools •Industry •Private practice
Medicare History and Facts
•Medicare came out of the same discussion of national health insurance that began before the passage of the Social Security Act. •Truman pushed for national health insurance, but Congress did not pass. •Elderly were widely perceived as a sympathetic group and Americans realized they would be part of that group someday. •People past retirement did not have insurance. •Medicare passed into law 1965 under Lyndon B. Johnson •The initial law was for people over age 65 and there was only Part A (hospital services) and Part B (outpatient services-including OT). •Between 1965-2010 there were many expansions and revisions •1972 extended to people under age 65 with disabilities and end-stage renal disease (OT could now serve these populations) •1981 Budget Reconciliation Act eliminated OT as a qualifying service with home health (only nursing, speech or PT could qualify)-still an issue today •1982 reform enacted hospice benefits which OT could work under as well as SNU •1983 reform reduced the length of stay in acute inpatient settings •1997 initiated caps for outpatient services
Current Medicare Coverage
•Over 65 years of age, US citizens or resident for over 5 years who have paid (or spouse paid) Medicare taxes for the past 10 years. •Younger than 65 with permanent disability who have received Social Security benefits for past 2 years. •Younger than 65 who receive SS disability benefits for ALS •Younger than 65 who need continuous dialysis or kidney transplant
Social Security Act
•Passed by President Roosevelt in 1935 during the depression. •Laid down the foundation for future laws •This act included federal grants to states for programs to help those in need at the time-no mention of state or national insurance (grants for old age, dependent children, hospitals, crippled children, blind, maternal and child health, vocational rehabilitation, child welfare) •Dependent on a compromise between political positions of many groups to keep insurance in the private sector through employment and union membership.
Medicaid History
•Passed in 1965 under LBJ at the same time as Medicare •Medicaid is a federal-state partnership and states can elect whether or not to participate. •States receive funding from federal government, but programs are regulated by each state. •To receive funding states must cover individuals whose income is 20% less than federal poverty level and fit one of these eligibility groups: children, parents with dependent children, pregnant women, people with severe disabilities, and seniors.
Quality Health Care
•Passed in 2010 •Some portions of the law took place immediately and some later •Required people to have health insurance and paid penalty if people could not prove insurance (individual mandate) •Also used employer requirements and expansion of Medicaid •Included requirements for prevention and wellness services •Primarily addressed the problem of access to healthcare
Telehealth
•Providing services through "telephonic or web-based intervention" •Medicare now paying for OT services via telehealth
Part C of Medicare
•also called Medicare Advantage; provides options to purchase insurance from private companies who contract with Medicare and may provide additional benefits.
NBCOT
•credentialing agency, functions independently of AOTA, has its own practice standards outlined in the Candidate/Certicant Code of Conduct, there is a process outlined if a Practioner as violated one or more of the ethical principles, NBCOT has the ability to suspend or revoke an OT practioner's ability to legally practice.
reimbursement
•getting moneys for services provided •Public and private health insurance •OT reimbursement for services differ depending on plan •Reimbursement consists of the following: •Fee for service •Fee schedules •Per diem rates •Per episode of care rate
Part A of Medicare
•inpatient (hospitals, SNU, home health, hospice)
Part B of Medicare
•outpatient (doctor appointments, other health care providers, preventative services, home health visits, DME)
Supervision
◦A cooperative process ◦Two or more people that participate in a joint effort to: ◦Establish ◦Maintain ◦Elevate ◦To a level of competence and performance. A mutual understanding between the supervisor and supervisee about each other's competence, experience, education and credentials.
OTA:
◦verifies that supervision by a licensed OT is available. ◦ demonstrate competence in skills required for setting/patients ◦should not perform activities that are not within scope of practice, nor advanced skill activities that skill competence has not been established. ◦documents session and verifies OT has cosigned according to entity, state and national guidelines. ◦verifies that the State's verification of Supervision Forms are being maintained. ◦needs to be aware of their State's regulation regarding the number of OTAs an OT may supervise at one time.
