OTA 240 Exam 2

Regulatory or Advisory Boards for Regulated Jurisdictions

- (SRBs) State Regulatory Boards: have authority to establish procedures for licensure, investigate violations of practice act, & publicize rules to regulate profession - handful of states do not have OT SRB or advisory council & rely on administrative officials to publicize & enforce regulations for profession - Some states placed regulation of OT practitioners under direction of state's medical board - OT SRBs may discuss need to amend state OT practice acts or regulations to keep them up-to-date w/current practice - SRBs or individuals can propose changes in practice act or status through legislative amendments

ACOTE A Standards

- 1st section - addresses administrative & institutional support; credentials of OT/OTA faculty, program director, academic fieldwork coordinator; & informational materials - OT/OTA program must carefully document program has sufficient resources & institutional supports to meet requirements of educating OT practitioners - includes: strategic plan, SWOT analysis that includes external & internal quality assurance

ACOTE C Standards

- 3rd section of ACOTE standards focused on fieldwork education for OT/OTA student - fieldwork program should be aligned w/curriculum & make clear linkages w/content covered in coursework - include role of academic fieldwork coordinator, mechanism used to secure fieldwork sites, process of review of fieldwork sites, & specific requirements of OT/OTA program or institution

Scholarship of Application, Practice, or Engagement

- Applies findings generated through Scholarship of Integration or discovery to solve real problems in professions, industry, government, & community - ex: Development of clinical knowledge, Application of technical or research skills to address problems, Participatory action research involving collaboration w/community groups, Efficacy of tx approach, Developing valid outcome measures - demonstration: Peer-reviewed publications of research, policy analysis, case studies, integrative reviews of the literature; Activities related to faculty member's area of expertise (e.g., consultation, technical assistance, policy analysis, program evaluation, development of practice patterns); Peer-reviewed/invited professional presentations related to practice; Consultation reports; Reports compiling & analyzing patient or health services outcomes; Products, patents, license copyrights; Peer reviews of practice; Grant awards in support of practice; Reports of meta-analysis related to practice problems; Reports of clinical demonstration projects; Policy papers related to practice - documentation: Formal documentation of record of activity & positive formal evaluation by users of work, Bibliographic citation of accomplishments, Positive external evaluation of body of work, Documentation of role in multi-authored products

Disciplinary Action

- Boards protect public by providing consumer information, monitoring, regulated practitioners, & investigating complaints - have power to discipline practitioners through sanctions = reprimand to revocation of license - revocation removes practitioner's rights to practice in state & used only in extreme cases - less harsh actions may require peer review of records, educational meetings, supervision with or w/o mentor, CE, payment of fine, tx for addition or mental health issues, & suspension of license

Scholarship of Integration

- Contributes to critical analysis & review of knowledge w/in disciplines or creative synthesis of insights contained in different disciplines or fields of study - ex: Inquiry that advances knowledge across range of theories, practice areas, techniques, or methodologies = works that interface among OT & variety of disciplines, including but not limited to occupational science - demonstration: Peer-reviewed publications of research, policy analysis, case studies, integrative reviews of literature; Copyrights, licenses, patents, or products; Published books; Positive peer evaluations of contributions to integrative scholarship; Reports of interdisciplinary programs or services; Interdisciplinary grant awards; Peer-reviewed/invited professional presentations; Policy papers designed to influence organizations or governments; Service on editorial board or as peer reviewer - documentation: Bibliographic citation of accomplishments. Positive external evaluation of body of work, Documentation of role in editorial/review processes

Scholarship of Teaching & Learning

- Contributes to development of critically reflective knowledge about teaching & learning - ex: Application of knowledge of discipline or specialty applied in teaching-learning in academic and/or fieldwork setting, Development of innovative teaching & evaluation methods, Program development & learning outcome evaluation of academic and/or fieldwork education, Professional role modeling - demonstration: Peer-reviewed publications of research related to teaching methodology or learning outcomes, case studies related to teaching-learning, learning theory development, & development or testing of educational models or theories; Educational effectiveness studies = comprehensive programs reports; Successful applications of technology to teaching & learning; Positive peer evaluations of innovations in teaching; Published textbooks or other learning aids; Grant awards in support of teaching & learning - documentation: Peer-reviewed/invited professional presentations related to teaching & learning, Bibliographic citation of accomplishments, Positive external evaluation of body of work

Scholarship of Discovery

- Contributes to development or creation of new knowledge - ex: Primary empirical research, Historical research, Theory development, Methodological studies, Philosophical inquiry - demonstration: Peer-reviewed publications of research, theory, or philosophical essays; Peer-reviewed/invited professional presentations of research, theory, or philosophical essays; Grant awards in support of research or scholarship; Positive peer evaluations of body of work - documentation: Bibliographic citation of accomplishments, Positive external evaluation of body of work

Types of Mentorship

- Formal mentoring - Informal mentoring - Group mentoring - Peer to Peer mentoring - E-mentoring

NBCOT Certification Renewal

- Maintaining NBCOT certification entitles individuals to continued use of NBCOT's registered certification marks OTR/COTA - Individuals who choose not to renew this certification required by NBCOT to no longer use its certification marks - Professional title w/o NBCOT certification = OT/L or OTA/L - Relationship of Nongovernmental Certification to State Regulation, Private or Public Employment, and Third-Party Reimbursement - State or jurisdictions commonly require OTs & OTAs to be initially certified (i.e., pass the NBCOT entry-level certification exam) before they can qualify for license - Most states or jurisdictions do not require practitioners to renew this certification to maintain their licenses to practice - NBCOT recertification is not legal requirement to practice OT unless state mandates it as condition of licensure

Entry-Level Certification

- NBCOT is private, not-for-profit credentialing organization that oversees & administers entry-level certification exam for OTs & OTAs - NBCOT certifies eligible individuals as OTR/COTA - OTR & COTA registered certification marks owned by NBCOT & should not be used unless practitioner is registered - Certification by NBCOT indicates to public that OTR/COTA has met all of NBCOT's educational, fieldwork, & exam requirements

Disciplinary Actions by NBCOT

- NBCOT undertakes disciplinary action against OTRs, COTAs, & examination candidates who are incompetent, unethical, or impaired (e.g. by substance abuse) - People who are not exam candidates or who are not currently certified by NBCOT would not be subject to discipline by NBCOT - All OTs & OTAs regulated by state are subject to discipline by their state regulatory body, & all members of AOTA subject to discipline by AOTA's Ethics Commission - Reminder for exam candidates: Eligibility Determination - Background Checks

Profession Reentry

- OT practitioners who leave profession for period of time need to understand provision in their state's practice act & regulations that establish requirements to re-enter profession - States have variety of requirements to regain licensure - ex: + Completion of continuing competence activities + Supervised work experience + # of yrs out of practice may dictate required activity

Articulate Importance of Membership in Organizations that Promote OT

- Organizational influence through membership & leadership is imperative to influence policy - groups such as AOTA & AOTPAC have key role in acceptance or obstruction of agenda through formation of coalition

4 Mentoring Stages

- Preparing - Negotiating - Enabling - Closure

Importance of Scholarly Activities & How They Contribute to Profession of OT

- Scholarly practice involves using knowledge base of profession or discipline in one's practice - evidence-based practice - When engaged in scholarly teaching, educators draw on knowledge base on teaching & learning & their discipline or professional knowledge bases - engaged in scholarly practice or scholarly teaching reflective practitioners who assess & discuss their actions in light of current knowledge base - contrast, scholarship or research = systematic investigation designed to develop or to contribute to generalizable knowledge - Scholarship made public, subject to review, & part of discipline or professional knowledge base - It allows others to build on it & further advance field - OT practitioners view scholarship = important contribution to profession, academy, & society - engaging in scholarship = professional responsibility - Every OT practitioner should contribute independently or collaboratively to building evidence base for OT practice and OT edu

How OT Impacted by Contextual Factors, Policy Issues, & Social Systems

- W/O ADA, persons w/disabilities would not be able to access certain spaces due to environmental factors. ADA provides policies & guidelines must be followed to allow equal access for individuals. - If OT not allowed in schools = directly affect contextual factors, policy issues, & social systems. Children w/OT needs not have equal access to learning spaces - direct interventions in home provide safety & establish developmental skills for children discharged from NICU. w/o NICU patients not be able to perform everyday activities in natural setting - quality inclusive classrooms for children w/disabilities provide increased self-esteem, confidence & happiness for children & parents or caregivers. - working w/people living in shelters, providing schedule & defined area to enable clients to engage in self-care, education, work preparation, & play & leisure activities physically accessible for all benefit & support needs of people situated in homeless context

Bloom's Level - Apply

- calculate, predict, apply, solve, illustrate, use, demonstrate, determine, model, perform, present - student able to calculate kinetic energy of projectile

School System - Contract

- charter school, public school, private school: contracted through private company to serve schools, or hired by schools directly - all contracts negotiated differently: rates, duration, etc. - each school may have own documentation system - billing schedules vary: weekly, bi-weekly, monthly - IEP (individualized education program): + IDEA (individuals w/disabilities education act) + dictates frequency, duration, # of visits + IEP meetings: annually = therapist, special education coordinator, parents, teacher

Bloom's Level - Evaluate

- choose, support, relate, determine, defend, judge, grade, compare, contrast, argue, justify, support, convince, select, evaluate - student will be able to which method to use: conservation of energy or conservation of momentum(which more appropriate for solving dynamics problem)

Bloom's Level - Analyze

- classify, break down, categorize, analyze, diagram, illustrate, criticize, simplify, associate - student able to differentiate btn potential & kinetic energy

Bloom's Level - Understand

- describe, explain, paraphrase, restate, give original examples of, summarize, contrast, interpret, discuss - student able to describe Newton's 3 laws of motion in her/his own words

Bloom's Level - Create

- design, formulate, build, invent, create, compose, generate, derive, modify, develop - student will be able to design original homework problem dealing w./principle of conservation of energy

Skilled Nursing Facility - Short Term Rehab

- falls, shoulders, knees - medicare A/managed care A/commercial - not driven by units (8 min. rule), driven by dx - managed care A: private contractors covering medicare A - PDPM (patient driven payment model): based on dx (not minutes seen); funding is provided to rehab facility based on what person's dx is, amt of time spent w/ them not factored in; can mean practitioners no longer have full days - orders/eval/section GG/certification: not done by OTAs; outlines patient's functional levels - group: seeing 2+ people doing same thing (outlined as minimum of 25% of your Txs by insurance, but cap by facilities) - concurrent: when you have 2 patients doing different activities at same time - ICD-10 coding: dx codes; more dx codes put on someone, more money facility can get - hospital documentation: medical records, EMRs - reimbursement: OTAs play big role, making sure documenting appropriately for reimbursement; ensure to get info from CNAs

Bloom's Level - Remember

- list, recite, outline, define, name, match, quote, recall, identify, label, recognize - student able to recite Newton's 3 laws of motion

Private Practice Outpatient - Payers

- medicaid (does not allow charges for cancellations/no shows) + CCME (Carolina Center for Medicaid Excellence): working for authorization for child; putting together tx plan + up to 21 y/o + up to 6 month certification period: authorization period (period of time client is authorized to receive services - commercial: Cert Periods, # of visits, co-pays will vary - medicare part B: subject to therapy cap - tricare: if primary payer, doesn't cover OTAs; if secondary payer, may be fine - managed care (medicare/medicaid): case workers controlling contracts insures for medicare/medicaid clients - private pay

Skilled Nursing Facility -Outpatient

- medicare B/managed care B/commercial: same payers as long term - workers comp (med risk): sometimes contract w/workers comp - part B therapy cap ($3,000): caps still apply - cannot accept medicaid: if clinic attached to SNF, cannot accept Medicaid prevent people to "double dip" getting services paid by facility w/o reimbursement (most PRIVATE clinics DO NOT accept Medicaid for therapy send to hospital clinics likely can get reimbursement)

Skilled Nursing Facility - Long Term Care

- medicare part B/managed care B/commercial: funding sources for long term care; funding units (8 min. maximum) - restorative (RNP)/functional maintenance program (FMP) - part B therapy cap (KX modifier): OT capped @ $3,000 annually; PT/Speech share combined $3,000 annually; KX modifier = able to exceed cap = have appropriate justification/documentation - therapy referral process: screens, orders (come from MD), insurance verification (from billing director), eval (from OT) - referrals from screens = come from anywhere (make sure justified)

Supervision & Role Delineation of OT Assistants & Aides

- most states look to AOTA's Professional Standard's on supervision = + Guidelines for Supervision, Roles, & Responsibilities During the Delivery of Occupational Therapy Services + Model State Regulations for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services - some states have established ratio for # of OTAs & aides that OT may supervise - aides who provide supportive services to OT practitioners (OT or OTAs) = non-licensed or unregulated personnel - State regulations may list types of activities that aides can/cannot perform under OT/OTA

Licensure Renewal Requirements

- most states require licensure renewal every 1-2 yrs - fee for renewal, completion of specific amt of continuing competence activities - acceptable activities vary in states or jurisdictions & range from attending or presenting courses to supervising fieldwork students or participating in research - # of required points or contact hrs of CE activities varies from state to state; averaging from 6-20 hrs/yr

Private Practice Outpatient - Tx Areas

- pediatrics - teens - adults - geriatrics

PDPM (Patient Driven Payment Model)

- reimbursement system driven by dx & NOT by minutes - ensures that you provide right lvl of care to clients - SNF who overdeliver services won't get reimbursed beyond their patient classification aka dx - more diagnosis codes = more reimbursement

Additional Requirements for Certain Interventions & Settings

- several states have created additional education & experience requirements to provide certain interventions &/ work in certain settings - Ex: Several states have established requirements for practitioners to use PAMs + Other states = requirements for other interventions - Ex: California Occupational Therapy Practice Act requires OTs offering services in hand therapy, PAMs, &/ swallowing assessment, evaluation or intervention to demonstrate, through post professional education & training = competent

CPT Codes

- standardized format for healthcare providers. 5 numerical digits - general & cover variety of interventions - based on time = 15min

Employee Agreements

- term of agreement - compensation - benefits - non-competes - holidays - read what you sign - orientation programs & how you feel when jumping into your 1st day

Benefits of Virtual Reality

1 - connects human to technology 2 - reinforcing voluntary repetition 3 - improve motor function - VR Products: Neofect, Sabo, FitMi, & Music Glove

ICD-10 Codes

2 types: medical dx codes or tx dx codes, alphanumeric characters

Essential Considerations for Policy

Health advocacy refers to actions taken by health care professionals to promote, social, economic, educational, & political changes that ease suffering or address threats to individual or public health identified through health care professional's work & expertise

End-User Considerations for Telehealth

Managers & practitioners should be cognizant & aware of how clients' impairments may affect technologies in use

Mobile or Digital Health

Uses mobile devices (e.g., notebook computers, tablets, smartphones) to deliver health care services

Remote Patient Monitoring

Uses technologies in client's home to record physiological data (e.g. vital signs) & transmit data remotely to contracted health care entity

Federal Policy

all practitioners, regardless of service delivery model, must adhere to Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Leadership Styles

approaches that leaders use to motivate followers - Autocratic - Democratic - Laissez-faire - Transformational - Charismatic - Transactional

Peer to Peer Mentoring

btn individuals on same professional level or status = OT practitioners w/same level of experience providing skill training, experience, & sharing w/ea other

E-Mentoring

by phone or video conferencing, social media based, national databases, etc.

Group Mentoring

conducted w/in network of mentors = blog groups, support groups, small groups where people come together to review journals, work on projects, or mentor ea other

Hub-and-Spoke Model

consists of 1 hospital w/several community clinics sharing same technology & providers

Democratic Leadership

gather info from team; listen to ideas & thoughts through small focus groups

Autocratic Leadership

leader makes decisions w/informed knowledge

Laissez-faire Leadership

make no decisions & allow process to work itself out

GG codes

measures patient's need for assistance w/self care & mobility while documenting PT's prior level of fxn

Negotiating Stage of Mentoring

mentor & mentee discuss how learning will occur throughout relationship = developing framework of specific & measurable goals & benchmarks, signifying success

Enabling Stage of Mentoring

mentor offers support, guidance, & encouragement for mentee regarding specific goals initially set

Informal Mentoring

natural & spontaneous w/ minimal to no structure & oversight, may or not be clear or specific goals set forth

Development of Political Influence

process that begins w/policy literacy, moves forward to policy acumen, & continues to policy competence & policy influence

Synchronous Technologies

services presented in real time through interactive videos, audios, videos, conferencing, gaming technologies w/any type of telehealth application

Asynchronous Technologies

stored & forward data including videos, digital images, archived wearable devices or sensor data (heart monitor), no live interactive component

Licensure

strongest form of state regulation = process = agency of govt grants permission to individual to engage in given occupation upon finding applicant attained minimal degree of competence required to ensure public health, safety, & welfare will be reasonably well protected

Formal Mentoring

structured w/oversight & very clear & specific organizational goals

Transformational Leadership

takes action & uses innovation to make changes

Transactional Leadership

uses reward-based system & able to identify "carrot" for ea. teammate = identify what is of value to teammate & outcome that can support their desires

Direct-to-Business Model

vendors license service platforms or applications to businesses for service delivery

Direct-to-Consumer Model

website or portal where consumers purchase & receive select services through telehealth

Preparing Stage of Mentoring

when mentor & mentee agree on groundwork for relationship, most critical stage in process; explore & evaluate appropriateness of mentoring relationship

ACOTE B Standards

- 2nd section of ACOTE standards - required evidence that educational requirementsmet through specific coursework & assignments - process of selecting best evidence requires collaboration & careful examination of demands of standard & demands of specific coursework or assignment - single course may meet several of these standards through different assignments - OT/OTA program present ea. assignment as evidence & included in ACOTE Self-Study document

Legislative Process

- AOTA & states OT associations frequently collaborate to write & advocate for legislation that would benefit OT profession through changes to scope of practice, licensure requirements, disciplinary procedures, or requirements to perform certain practice interventions = telehealth or PAMs - each state's legislature has regular legislative session legislative proposals introduced - most state legislatures meet for annual sessions of varying duration - state's political environment can help determine best method of introduction (House, Senate, or both) & potential sponsors most appropriate to individual state - If bill is voted on favorably, moves to other legislative chamber, where reading process repeated - If both chambers pass bill, goes before governor, who will either approve bill by signing or disapprove bill, or veto it, by not signing it - some states allow bills to go into effect w/o governor's signature of approval

Self-Assessing Competence

- AOTA mandates OT self-assess their strengths & weaknesses = knowledge, skills, & attributes for quality service delivery - part of life-long learning, self-assessment contributes to understanding inherent learning needs to shape effective & reflective practice - self-assessment tools not limited to online platforms - strategies implemented w/in workplace on individual level & at company-wide level - CFCC annual self-assessment through professional reflection ea. semester for OTA students

OTAs in Management

- Can I, as an OTA, be a manager? Yes, an OTA can be a manager and leader - management role requires more task-based duties = scheduling patients, managing practitioners, time off requests, preparing result reports, logistics of how things work & other times role requires more of leadership duty moving dept forward as collective unit, strategic planning, & budgeting - OTA cannot clinically supervise OT, manager (OTA) can lead dept & administratively supervise any OTs who are on team - clinical supervision = develop therapeutic competence - administrative supervision = leadership w/ oversight of staff performance & other personnel management tasks - Management = process of guiding organization by planning for future work obligations, organizing employees into functional units, directing employees completing daily work tasks, & controlling work processes systems to ensure adequate quality of work output - duties fit w/in OTA's scope of practice & align w/role of OTA carrying out tx protocol - find theory/best practice to use when deciding best task approach

Professional Commitment to Policy

- AOTA's policy related resources = importance of professional commitment to policy issues - Advocacy & policy issues prominent pillars of organization - AOTA's advocacy & Policy Homepage: provides info abt new Current Procedural Terminology (CPT codes) for reimbursement & info on latest legislative updates & advocacy efforts by profession - Involvement in policy by OT practitioners is important to achieve Triple Aim = improving individual experience of care, improving health of populations, & reducing per capita cost of care for populations - close exam of what policymakers & system view as important demonstrates need to address relevant issues related to Triple Aim = hospital readmissions, lack of care coordination, & chronic conditions - Hildenbrand & Lamb described how OT professionals can play key role in improving health of population by reaching out to communities & organizations & by working w/clients in managing chronic conditions - authors argued policymakers want to hear abt evidence-based strategies are cost effective & efficiently use intervention resources - absence from policy table equates to absence from policy itself (e.g., direct access to home health) - authors concluded that OT must be more visible & vocal in policy overall to ensure inclusion of OT by name & function

Institutional Expectations

- Academic institutions that offer OT programs have distinct mission statements reflecting institution's purpose - Ex seen by comparing missions statement across variety of institutions = mission statement of private, non-profit institutions, compared to private, for-profit institutions compared to faith-based institutions or by comparing mission statements of public institutions primarily focused on teaching to public institutions primarily focused on research endeavors - OT educational programs = accredited, mission will influence focus of OT curriculum - meet institutional expectations, OT program includes courses where students & faculty engage in community outreach & community-built programs

Managers Should Consider Following Benefits of Professional Development

- Advancement - Power - Knowledge - Presence - Authenticity

Benefits of Mentoring to Organizations

- Based on review of literature, "because of mentoring, health care organization may experience less staff turnover, see improvement in employee morale, & employ staff who are more committed to & have better understanding of organization" - Higher levels of performance, job satisfaction, & organizational success reported in vocational & organizational management research due to mentoring - Scandura (1992) found that mentoring encourages effective organizational socialization & reduced turnover of employees

Clinical Instruction

- Clinical instructors play a crucial role in development of future practitioners - opportunities to become involved in fieldwork education come soon after certification - professional development opportunities to be gained from taking on clinical instructor role = FWE's own professional development enhanced by students they are supervising via exposure to current trends, EBP, & research

Learning to Be a Manager

- Every OTA starts somewhere on their management & leadership journey, 1st place OTA introduced to leadership concepts is in OTA School - ACOTE OTA Standards outline minimal expectations that OTA must have to practice as entry-level practitioner - lay foundation to support OTAs moving in to management roles - standards are learned in school is great jumping off point for learning about OTA's role in management & leadership activities - Ex: ACOTE Standard B.5.2- "Explain role & responsibility of practitioner to advocate for changes in service delivery policies, effect changes in system, recognize opportunities in emerging practice areas, & advocate for opportunities to expand OT assistant's role - maintaining role delineation & scope of practice, OTA manager able to generate conversations to do so, & being aware of responsibility = 1st place to start - OTA understand how advocacy affects team as whole + advocating for clients, for team will enable to be successful manager + OTA leadership = described in ACOTE Standard B.6 = states OTAs should "identify need & demonstrate ability to participate in development, marketing, & management of service delivery options"- how OTAs need to be able to market services in appropriate manner + OTA managers able to support team in identifying what it is they want to be providing & ensuring it is done ethically for clients- OTAs & OTs need to continue to grow & learn, & OTA managers can support staff & team members in lifelong learning & professional development

Mentoring for New Practitioners

- Findings in study by McCombie & McElroy recommended that new OT graduates investigate prospective place of employment & engage in discuss w/employers regarding work & clinical caseload & availability of mentor - study revealed that having mentor related to receiving adequate feedback, high job satisfaction, & good clinical fit

Models of Care

- Hub-and-spoke model - Direct-to-consumer model - Direct-to-business model - Remote patient monitoring - Mobile or digital health

Promoting Public Policy

- Increasing public's awareness of varied & valuable services of OT is responsibility of every individual in profession of OT - Educating government is equally important - One way to increase government awareness = contact legislators about any state or federal bills will affect delivery of OT & importance of including OT in any comprehensive health care plan

Practical Applications in OT Regarding Policy

- Individual: OT practitioners have ability to affect health policies; difficult w/o required knowledge of healthcare system; be aware of policy agendas, policy makers, & political backgrounds - Group: Policy-making requires teamwork & needs support, hard work, education on effective decision-making by &communication w/groups for OT practitioners - Organizational: AOTA, NBCOT, State organizations, WFOT; through membership & leadership through OT organizations - Community: OTs role contributing to society, educational reform, & challenge OT practitioners to advocate for policies outside of health sector focused on treating people

Equipping for Leadership & Leadership Readiness

- Leadership = art of motivating group of people to act toward achieving common goal - Leadership comes in many forms & levels as mentoring relationship progresses, OT managers can take incremental steps in delegating departmental projects to employee as appropriate & designate employee as team leader, working w/other employees on job & create sense of ownership in project

Types of Regulation

- Licensure - Licensure Law - Certification & Registration

Reimbursement for Telehealth

- Managers should contact their organization's lawyer or lawyer w/expertise in telehealth before providing & billing any services through telehealth & Medicare recipients. - be familiar w/reimbursement w/in organization & w/in state of practice - general rule = OTA should follow close communication & understand organizational policies related to telehealth

Servant Leadership

- focuses on serving for good of others & has been espoused by several OT leaders (Stoffel) - putting needs of others before their own [to] be truly effective - This type of leader is focused on: - helping others before themselves - improving community - being engaged

Documentation 2

- Medicare Benefit Policy Manual includes extensive section "Reasonable and Necessary Outpatient Rehabilitation Therapy Services," provides details to consider when documenting to defend necessity of OT services - Medicare is largest 3rd party payer in country- Skilled services sometimes needed to ensure maintenance of fxn or to prevent slow deterioration of fxn - Practitioners should include evidence services are skilled, safe, necessary, & effective - Medicaid rules vary by state & published online for practitioners to reference - State Medicaid programs & private insurance policies set amt & type of services that are covered & provide directives regarding referral & payment policies - Some regulations include seeking prior authorization before & evaluation is done, after evaluation submitted, or prior to tx beginning - Other regulations include type & # of codes & units submitted per day & w/in set range of time - Documentation of services must align w/codes submitted for reimbursement.

Governing Agencies

- NBCOT = national certification body for OT professionals in US (include OTAs) - OTR & COTA credentials cannot be used if certification not renewed during renewal yr - state licensure identifies to public individuals who have demonstrated some level of competence to provide professional services w'in specified scope of practice - required CE hours can range from no contact hrs required - up to 30 contact hours required every 2 yrs - renewal terms range from annual to biennial - State agencies vary in documentation required to submit w/your renewal application - AOTA's website has full breakdown of each state's requirement for license renewal

Practitioner Competencies for Telehealth

- OT practitioners may acquire through various means: CE courses & webinars, conference programs, live training sessions, and formal & informal mentoring relationships - Areas of competency: knowledge of device being used, critical reasoning, interpersonal skills, ethical practice, & performance skills. *Must demonstrate set up & able to walk someone through if technical challenges arise - IT staff or technical support from videoconferencing vendor should be available to assist w/more complex technical issues - Many popular OT assessments available for electronic administration & scoring = remote administration & scoring via telehealth

Policy & Practice

- OT practitioners work w/in policies & structures that set boundaries on their engagement with client who are often, because of their stigmatized status, in situations of inequity, such as those clients with mental health or substance use diagnoses - OT practitioners should act for social & political changes on basis of principles of occupational justice = subset of social justice concerned w/forms of enabling, mediating, or advocating needed to create doing environment just & health promoting for all, difference

Providing Feedback & Communicating Expectations

- OTA managers need to provide timely, accurate, & objective feedback - clinical reasoning process used w/clients applies to providing feedback as manager - Effective managers aware of their emotions & recognize how their feelings affect them & their job performance - awareness leads them to speak openly about their emotions or w/conviction about their guiding vision - key to providing feedback is to ensure it is timely, honest, consistent, and objective - do not provide feedback when frustrated, angry, or emotional - To ensure constructive feedback, best to prepare yourself 1st - some managers find it useful to write down feedback & practice delivering it before actually doing so, esp 1st time w/employee - provide feedback w/confidence while being mindful of tone, body language, timing, & approach - providing feedback can lead to disagreement, enabling, & putting teammates in strife - if no feedback may tend to think that everything is okay & nothing needs to change, may not be true - managers may only give feedback when something is not right; taking time to provide feedback when things are going well can make bigger impact - spend time to address what needs correcting, acknowledge and cultivate good

OTAs as Leaders

- OTAs can serve in leadership positions - Leadership = process of influencing employees to work toward achievement of objectives - can substitute word employees for peers, colleagues, teammates, staff, etc - OTA managers need to understand various aspects of leadership vs. management & use both to carry out duties of manager - 1 difference = scope of focus, w/managers more internally focused & leaders more externally focused - Leaders influence others by building consensus among people on vision for future & what action steps required for goal attainment - 2nd difference = managers tend to focus on short term, leaders focus on long term (big picture) - Managers control & direct work that needs to be done; leaders = inspire & empower others to succeed

Managing w/in Your Practice Act

- OTAs must be aware of, follow, & educate others on role delineation of OTAs vs OTs & ensure supervision processes & regulations being followed at all times - 3 separate entities = standards of practice established for OTs & OTAs - Each entity stands on its own & has its own process for grievances & sanctions: - American Occupational Therapy Association (AOTA) - State Regulatory Boards - National Board for Certification in Occupational Therapy (NBCOT)

ACOTE Self-Study Document

- Obtaining & sustaining accreditation require ongoing management & program evaluation - focus of external accreditation is on accountability, requires OT/OTA program to provide clear evidence of how ACOTE standards are met - documentation of how standards met includes multiple sources = specific course objectives, assignments, student surveys, & external reviews - what ea. program produces to demonstrate how ea. ACOTE Standard is met - requires ea. OT/OTA program to provide clear, objective evidence demonstrating how ea. standard met - document generated for initial OT/OTA program accreditation & periodic reaccreditation process - includes how specific ACOTE standard is met also notes outcomes data when OT/OTA program pursues renewal - current document divided into 3 distinct sections required for OT/OTA program to be accredited & reaccredited to continue to offer educational program: + A Standards + B Standards + C Standards

State Policy

- Practitioners must abide by any & all state laws, regulations, & policies governing use of telehealth & state OT licensing board regulations & policies (e.g. scope of practice). - Some states have additional requirements associated w/ use of telehealth = verbal or written informed consent, specific clinical or non-clinical documentation requirements, required presence of support person (e.g. "e-helper") - In most cases, practitioner must be licensed w/in state in which client is located - deemed as location of service/originating site - If working w/veteran populations - may be some exemptions

Practical Applications in OT Regarding Professional Development

- Pursuing professional development can be difficult because new challenges emerge over time: changes in policy; new protocols, technology, or clients; or change in specialization - competence can be short lived; practice can be competent today & incompetent tomorrow - to translate new knowledge into practice, managers & practitioners sometimes must move away from previously held ideas & incorporate new ways of thinking

Essential Considerations for Regulatory & Payment Issues

- Reimbursement is financial remuneration for series provided - payment process involves: + provision of OT services + documentation of services + coding of services + billing of claims + reimbursement for service - critical for OT practitioners & managers to understand important relationships & flow among these components - guidelines, regulations & policies set by professional organizations, institutions, accrediting bodies, & payers for ea. component of this cycle - Practitioners must identify what set of guidelines or regulations apply to their particular settings & cases & learn rules

Requirements for Licensure of Other Forms of Regulation

- Requirements for licensure generally include demonstration by applicant that they have successfully competed academic & fieldwork requirements of educational for OTAs & OTs accredited by ACOTE & passed NBCOT exam - States may have additional requirements = completion of criminal background check or passing exam on state's OT practice act & regulations - States may have less complicated requirements for licensure by endorsement for practitioners currently licensed & regulated in another state or jurisdiction

Political Action Examples Influencing OT

- Several examples of legislation influenced OT practice: + Individuals w/Disabilities Education Act of 1990 (IDEA) + Mental Health Parity & Addiction Equity Act of 2008 + Components of Patient Protection & Affordable Care Act of 2010 (ACA; P.L. 111-148), Medicaid expansion; & repeal of Medicare Part B Therapy Cap.

Research Regarding Policy

- System assessment of health consequences of policy, program, project, & planning decisions is important for protecting & promoting health b/c it allows people involved in decision-making process to consider health impacts of various policies & their implementation - Policy decisions modified to minimize adverse health consequences or to maximize health benefits - Failure to consider health consequences can result in untended harm or in lost opportunities for health improvement & disease prevention

American Medical Association (AMA)

- owns copyright for CPT codes - Current Procedural Terminology - January 2017, 3 new OT evaluation codes published w/specific criteria to guide therapists to code if evaluation was of low, moderate or high complexity - Medicare reimburses practitioners at same rate for these 3 codes; subject to change - Some insurance companies reimburse these 3 codes at different rates; up to 3rd-party payer to decide whether evaluation codes will be paid at single or different rates - majority of CPT codes used by OT practitioners found in Physical Medicine & Rehabilitation section of CPT manual - 9700 series of codes most common, 9600 series related to CNS - constantly reviewing, editing, deleting, & adding codes

Reimbursement

- When OT services provided, coded properly, covered by insurance carrier, & billed in proper sequence = likely that provider will be paid - Payment for OT services may or may not require following: + Preauthorization of services + Order from referring physician + Certification of plan of care - Traditionally, OT services reimbursed on fee-for-service basis = fee paid for ea. service provided - 1983, federal govt different model of payment in acute care setting; prospective payment system (PPS) designed pre-determined amt of money reimbursed to hospital based on diagnostic related groups - Medicare uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, & skilled nursing facilities - Therapy not reimbursed on fee for service basis when provided in setting where payment bundled w/PPS - health care leaders working to develop alternative payment models (APMs) - critical for profession of OT to participate in process of developing APMs to clearly communicate distinct value of OT services to those developing these systems so clients receiving "bundled care" can receive skilled services

Associations

- access to national & state associations important resource for fostering & pursing professional development - AOTA's website is strategically organized to provide a robust database of information: - Practice - Advocacy & Policy - Education & Careers - Conference & Events - Publications & News - About Occupational Therapy

Set Expectations as Manager

- basic 1st step = become aware of all expectations for yourself & team - ensure these expectations clearly shared & reviewed w/ea teammate - as OTA manager, emphasize service competencies as manager & keep in mind = you are manager b/c of your knowledge & skills

Billing

- billing executed by professional coder - professional coders work closely w/OTs = proper codes & modifiers used when billing claims - know what code to use & when to use it - be aware of whether & insurance company is providing primary, secondary, or tertiary coverage in case - insurance company = primary coverage for client but secondary coverage for another client - when insurance company provides primary coverage, responsible for larger portion of claim - clients often unaware of this info - OT practitioners & manager should be aware insurance industry has varied levels of responsibility regarding covering claims & rules of primary provider typically determine coverage & reimbursement - claims can be denied for very small technical details - may be asked to resubmit claim & common in billing process - billing specialists essential parts of admin team for efficient & just payments of services & work closely w/OT practitioners & managers to properly code skilled service provide & submit claims for reimbursement

Telehealth

- broad term that encompasses service provision & health education provided through information & communication technology - When applied to rehab disciplines, provision of services wherein practitioner & client are in different physical locations - Telemedicine describes remote services provided by many healthcare providers = nurses, physicisans, & other healthcare professionals w/in medical model

Creating Vision for Growth

- building vision statement is ongoing process = OTAs will modify & tweak as they grow in their careers - When building a vision statement: - identify what you want - identify where you want to go - identify how you want to get there

Why is Professional Development Important?

- constant accumulation of knowledge executed in different ways - traditional continuing education methods are only part of puzzle; knowledge is more useful if used appropriately in right context - emerging CE methods = video-based coaching, have given rise to dynamic approach to professional development - Hills et al. identified use of social networking to create communities of practice, groups of people informally bound together by shared expertise & passion for joint enterprise that focus on shared domain of practice to facilitate collective learning - practice scholar communities = groups of people who assist ea. other to learn abt practice they have in common through social learning - through collaborative discussion, group allows individual members to focus on professional development, decision-making, & reasoning

World Health Organization (WHO)

- created set of codes, currently at ICD-11 codes - Used to ID specific dx for clients served - OTs must choose which dx align w/purpose of OT evaluation & intervention provided & code those dx into claim - Practitioners should request physicians, optometrist, or nurse practitioner responsible for referring client for OT services provide ICD-11 codes used in their medical records - add "therapy diagnosis" that related to specific behavioral or client factors addressed in therapy

Coding Used To

- describe dx of client served - identify complexity of OT evaluation - type & amt of intervention provided

Transformational Leadership

- dynamic theory = suggests leaders' situation influences them to adapt style that fits situation & hand - charismatic; have vision, empathy, self-assurance, commitment & ability to take risks - Such qualities include: - inspiring others through actions & words - reflecting on decisions & actions & using that review to mold next decision - sharing vision that all teammates work towards - not fearful to make changes

Who Can Be a Mentor?

- essential for OT managers to recognize every staff member in organization can be potential mentor - mentoring relationship could develop based on potential mentor's experiential background, established practice competencies,& context where mentoring relationship might occur regardless of mentor's rank in organization's hierarchy

Why is Policy Important?

- health policy made up of decisions, plans, & actions that are undertaken to achieve specific health care goals w/in society - outlines priorities & expected roles of different groups, & builds consensus & informs people - despite medical advances & medical expenditures higher than most developed countries, many Americans unable to achieve their full health potential = creates disparities - affects quality & duration of their lives & reduces their ability to participate & engage as productive members of society - impact occupational justice & ability to engage in any areas of occupation equally - To assist OT practitioners in achieving this purpose, policy & advocacy mentioned in domain & process of OT Practice Framework - In domain OT practitioners may recognize areas of occupational injustice & may work to support policies, actions, & laws that allow people to engage in occupations that provide purpose & meaning in their lives - Participation in policy efforts by OT managers & practitioners can: provide empowerment to clients & enables clients to engage in meaningful & purposeful occupations that allow them to achieve health & well being in its broadest sense

Coding

- important for OT managers & practitioners to understand constantly changing world of coding to ensure payment for services

Ethical Considerations for Telehealth

- important to keep in mind that telehealth is service delivery model (service is OT) - Most, if not all, existing OT state practice regulations & standards address ethics in practice whether service is provided in-person or through telehealth

Licensure Law

- legally defines scope of practice & articulates domain of OT to facilities, providers, consumers, & major public/private health & educational facilities - clearly articulated scope of practice protects OT from another profession that may challenge qualifications of practitioners to provide certain services or may encroach on OT's scope of practice through unqualified expansion of its practice - Ex: OT & PT practice acts in given state may authorize use of PAMs, OT practice act might use wording "application of PAMs as an adjunct to prep for engagement in occupations" to distinguish unique focus of OT on occupation not on modality - All managers, private practice owners, & practitioners need to be aware of their state's or their jurisdictions scope of practice & need to ensure that practitioners under their supervision are not performing services that are outside of their legal scope of practice

Certification & Registration

- less stringent forms of state regulation than licensure & defined differently by individual state regulatory boards or councils - Certification in context of state regulation is NOT same as certification granted by NBCOT - State certifications protect public by requiring individuals who use titles OT or OTA to meet specific eligibility requirement, similar to licensure - Unlike licensure: individuals not certified or registered allowed to use OT techniques if they do not refer to their services as OT (ex: HW tutor, Life Coach, etc....)

State Regulation of OT

- major purpose of regulation = protect consumers in state or jurisdiction from unqualified or unscrupulous practitioners - regulation assures high level of professional conduct of OTs & OTAs

Supporting Transition & Professional Growth

- mentor encourages mentee's growth by challenging movement beyond their comfort zone to master communication & problem-solving skills in different roles & contexts - As employees begin to gain self-confidence, learn job, and imbibe work culture = important news tasks delegated by OT managers are tasks that employees can successfully perform - Effective OT managers encourage & inspire employees - Giving encouragement reported to be mentoring skill most valued by mentees - Examples of methods to encourage, inspire, & motivate employees in mentoring relationships: believing in their capacity to grow personally & professionally to reach their established goals, to offer positive comments, acknowledge accomplishments, understand where they are coming from, & praise when challenges occur

Professional Development

- multi-modal & personal commitment to life-long career learning to drive growth & stay current w/relevant aspects of profession - Continuing professional development (CPD): constant commitment to maintaining, updating, & modifying one's knowledge & skill base - CPD needed to ensure health care practitioners, administrators, managers, & organizations engage in or support process of life-long learning, targeting improvement of patient care & population health - OT practitioners use this to stay up to date w/techniques & approaches in their areas of practice to provide most effective tx, navigate career paths & refine leadership skills - continuing competence involves examination of current competence & capacity for future professional development - Continuing competency focuses on: one's capacity to perform job-specific professional responsibilities w/in particular situation - To work toward professional development, continuing competency must be established & maintained - To be competent, an OT practitioner must be able to: analyze assessment tools, intervention strategies, & outcome measures (w/evidence-based lens) to provide appropriate services & to meet client's needs

Documentation 1

- official written record that details or summarizes provision of OT services - After OT practitioners determine who is paying for services & understand what services or codes are covered & guidelines for coverage (3rd party-payer must properly document to fulfill those requirements) - Centers for Medicare & Medicaid Services (CMS) defines skilled services = services requiring skills of physical therapists, speech-language pathologists, or occupational therapists - Documentation of skilled services covered by Medicare must describe medical necessity of services & must be reasonable & necessary - Services are medically necessary if documentation indicates they meet requirements for medical necessity including skilled, rehabilitative services, provided by clinicians (or qualified professionals when appropriate) w/approval of physician/NPP (non physician practitioner), safe & effective (i.e., progress indicates that care is effective in rehabilitation of function)

Mentoring in Professional Development

- process of growing & developing professionally in one's career - growth in knowledge & skills for OT practitioners is continuing & evolving process throughout one's professional career - Lifelong learning: necessary to sustain & gain growth in knowledge, skills, & attitudes based on who you are as practitioner that spans length of your career - OT Code of Ethics = practitioners "maintain competency by ongoing participation in education relevant to one's practice area" - AOTA encourages OT practitioners to develop continuing professional development (CPD) plan using systematic self-assessment that includes reflection & understanding of current & future professional needs

Accreditation

- process where official recognition of status/abilities awarded - includes external review designed to scrutinize quality of educational institutions & assure public that quality education is provided at institution awarded accreditation - Accreditation Council for Occupational Therapy Education (ACOTE) I= accrediting body for all OT/OTA educational programs - educational standards for OT academic programs w/in US are responsibility of ACOTE - ACOTE develops educational standards for academic programs proactive in supporting client receiving OT services & advancing profession - ACOTE standards revised every 5 yrs by independent Educational Standards Review Committee, appointed by ACOTE to conduct a complete evaluation of the Accreditation Standards for all levels of OT/OTA education

Workplace

- professional development begins w/professional responsibility in workplace - managers should support their employees w/policies that encourage & promote professional development - evidence points to improved clinical practice, better client outcomes, enhanced work place satisfaction, increase workplace moral & betters clinical governance w/in organization when professional support is available - There are also collaborative options for promoting professional development, including: starting journal club, presenting evidence-based case study to colleagues, or making presentation on updated standardized assessments - AOTA developed Journal Club Toolkit to inspire evidence-based discussions among OT students, educators, & practitioners - everyday work situations provide context for learning in that OT managers & practitioners can find themselves working in highly contextual, biological, psychological, & personal environments - more adept managers & practitioners contextualizing learning experiences, stronger professional identities become, further validating cultures of academic & clinical settings - ability to connect w/patients & their meaningful occupations as form of client-centered practice is what separates OT practitioners from other health care professionals - working relationships important to successes of profession - strengthening these working relationships promotes professional development

Environmental Considerations for Telehealth

- room location - room size - equipment placement - lighting - position of camera(s) - wall color (light blues & light greys = considered optimal) - acoustics - all of the above may effect quality of telehealth sessions - CTRC's TeleHealth Program Developer Kit provides helpful info & useful checklist.

Evidence-based practice (EBP)

- roots in concept of evidence-based medicine, term first coined in 1980s & 1990s by researchers & doctors - bottom-up approach that integrates high-quality evidence w/clinical expertise & patient preference - not just about research; includes clinical experience & client perspective

What is Mentoring?

- situational relationship btn & experienced individual (i.e., mentor) & novice (i.e., mentee) to facilitate & support mutual professional growth - process assists professionals to grow, develop, & pursue goals through span of their careers - beneficial for both parties - two way active process that promotes professional excellence for both individuals - mentor & mentee work together in reciprocal relationship where both share, develop, & learn from ea other

OT Services

- skilled actions provided by OT practitioner - services = evaluations & intervention sessions - OT practitioners require referral from physician to initiate OT services; some states have direct access laws that permit provision of OT services w/o physician or other qualified provider's prescription or referral - term direct access refers to health care professional's legal right to provide services w/o doctor's referral - know who payer is prior to beginning OT evaluation - Knowing payer source necessary before submitting for reimbursement - Each 3rd-party payer has different language & specific requirements for services; some require physician's order & others require preauthorization of intervention - Medicare permits therapist to perform evaluation & intervention if qualified health care practitioner certifies need for service w/in 30 days of OT evaluation

Education Regarding Policy

- specific to OT, ACOTE, accrediting body for OT education programs at entry level = supports importance of policy in OT through development of standards addressing competence in health policy at all levels of education - ACOTE standards require that graduates of accredited educational programs "be prepared to advocate as professional for OT services offered & for recipients of those services" - policy area targeted for OT & other health care profession education = influence of social determinants of health, non-medical circumstances related to how people live, grow, & work (e.g., housing, education, income), affect health outcomes - how social factors affect health, health profession students need opportunities to learn about health policy & health advocacy - important for faculty & students to advocate for change to reduce health disparities related to social determinants of health

Essential Values of OTA Manager

- trustworthiness - respect - responsibility & fairness - caring attitude

Technical Considerations for Telehealth

- type of business model & clinical services to be provided through telehealth will dictate type of technology needed. - EX: client who will be seated throughout session may use desktop or laptop computer whereas pediatric client who is mobile during session may need portable device - In addition to hardware, software & data storage should conform to HIPAA & HITECH requirements - Videoconferencing & data storage vendors should provide business associate agreement obligating vendor to same privacy & confidentiality standards as practitioner - Many options for secure, HIPAA-compliant videoconferencing & data storage available & should be used for telehealth programs

Centers for Medicare and Medicaid Services (CMS)

- uses Healthcare Common Procedure Coding Set, referred to as HCPCS codes - 2 levels of HCPCS codes + Level 1 codes are 5-digit AMA CPT codes + Level 2 codes are owned by CMS & in alpha-numeric format

Program Development

- w/increased use of telehealth in health care, many health care organizations developing new telehealth programs or expanding existing telehealth programs to include additional disciplines & services. (e.g. Covid-19) - needs assessment: analysis of strengths, weaknesses, opportunities, & threats will provide managers w/important info to guide development

Charismatic Leadership

is inspiration & joyful to be around; possesses high energy = motivate other teammates

Mentors

individual who provides training & guidance to mentee at beginning of their careers, working toward competent, clinical, behavioral, & professional practice

Closure Stage of Mentoring

final stage & most difficult due to anxiety & resentment if relationship closes abruptly; once mentee has obtained professional competencies in goals outlined, important to be clear how long this relationship will last

Mentees

individual who is seeking training & guidance from mentor who will potentially assist in advancing identified professional career goals