Admin Flashcards
standardization
Uniformity: Content, administration, scoring.
Includes description of purpose, admin/scoring protocol, and established norms and validity.
What does administration protocol for eval/screen include?
instructions, ID’s required materials, provision of exact wording of directions to client.
What does scoring protocol include?
Ratings and criteria to determine ratings. Norms for range of ratings specific to population. Norm data= age, gender, diagnostic groupings
Validity
Accuracy of assessment to determine if tool measures what it meant to measure.
Face validity
how well assessment APPEARS to meet its stated purpose
Content Validity
Content in eval is representative of content that could be measured.
(Ex: role checklist = adequate list of roles?)
Criterion Validity
COMPARES assessment tool to another with established validity.
Correlation (compares). Higher correlation = better value
Concurrent criterion validity
COMPARES results of 2 instruments given at approx. the same time.
Predictive criterion validity
COMPARES degree to which an instrument can predict performance on future criterion
Reliability
Establishes consistency and stability of evaluation.
Good Reliability = scores same from time-time, place-place, eval-eval.
Correlation or % identifying degree that 2 items agree or relate.
Inter-rater reliability
interobserver. Different raters using same tool get same results.
Test-retest reliability
same results when administered 2x+ by same administrater
List of assessment tool types
observation interviews self-report checklists rating scales Goal Attainment Scales (GAS) Performance Tests norm referenced assessments criterion referenced assessments specific tools for : client factors, areas of occupation, performance skills/patterns, contexts.
Observational Skills
In diff contexts
structured/unstructured
assess environmental & physical contexts, and physical and sociocultural supports and barriers.
Interview Guidelines
Establish purpose and rapport
ask organized/formal questions
observe nonverbal comm
interpret incongruence of non/verbal comm
listen before talking
Answer personal questions directly/honestly
interpret verbal/nonverbal responses- hypothesize about situation
develop plan based on above.
maintain confidentiality at all times.
Developmental considerations in evaluation
family/teacher interviews & Home/Class observations
Consider developmental levels for toys and evaluate media
observe a/symmetries, trunk stability, pelvis/hips/shoulders at rest and movement.
Observe transitions: in/out sidelying, quad, prone/sup, sit/stand, kneel, half-kneel, tailor/long/heel/side sit.
assess quality of movement and FMC
Consider positioning, AE, seating, tech needs, visual and auditory aides.
Assess cognition in context of play & occ’s
Assess psychosocial skills- coping, frustration tol, social interactions
Types of OT Intervention
Prevention
Primary- create/promote/enhance health
secondary- early detection of problem in at risk population (screening preemies for dev delay)
Tertiary- eliminate/reduce impact of dysfunction on individual
Meeting health needs
change process
management
maintenance
Intervention planning
formulate plan collaborate with individual prioritize problems to address content= LTG, STG, possible referrals Intervention methods Duration/frequency. Number/type of sessions recommendation for referrals use clinical reasoning
Principles of OT Interventions
Interventions:
change agent to remediate or restore
establish performance skills and develop habits
valued = inherently motivating
ID values and interests
practice perf skills and reinforce performance
produces feedback
facilitate mastery or competence
promote participation
assume responsibility for own health/wellness
positive influence on health/well-being
means to adapt to changing needs/conditions
create and maintain ID
positive effect psychological fxn
meaning/purpose influence quality of performance
satisfaction and fulfillment
influence how ppl spend time and make decisions
code of ethics
aspirational code of core values to guide ethical actions
enforceable principles and standard of conduct to AOTA members
Beneficence
safety and well being of clients
nonmaleficence
do no harm
autonomy
respect pt right to self-determination, privacy, confidentiality, consent
justice
promote fairness and objectivity
veracity
comprehensive, accurate, objective information
fidelity
treat others with respect, fairness, discretion, integrity
nosocomial infection
hospital acquired
ethical distress
know correct action to take, but barriers prevent it.
ethical dilemma
2+ potentially moral ways to solve problem.
Abuse
duty to report = beneficence
minimum standard = report to supervisor
Ethical decision making
- ID issues/dilemmas
- Gather relevant info
- determine conflicting values/areas of agreement
- ID relevant alternative course of action
- Determine all possible neg/pos outcomes
- Weigh consequences of each
- Seek input from others
- apply professional judgment
- contact agencies assoc. with individual
- determine desired/potential outcome of filing complaint.
AOTA
jurisdiction: professional membership provides guidelines NO DIRECT authority - reports to AOTA ethics commission = extensive, confidential review process.
NBCOT
jurisdiction:
National credentialing agency
NO DIRECT authority over UNCREDENTIALED practitioners
* authority to investigate and discipline NBCOT certified practitioners
SRB - State Regulatory Boards
Jurisdiction:
Public/state bodies
protect public from potential harm.
Each state has own scope of practice guidelines and required qualifications
Most adopt AOTA code of ethics
AUTHORITY to discipline if public at risk
OT AIDES
not OT practitioners
OTA’s
can expand role by establishing service competency
primary role = implement tx’s
Can CONTRIBUTE to eval, devel/implement Interv plan, & monitor/document Pt responses
Must be supervised by OT
Types of supervision
Close - direct, daily
routine - direct @ least every 2 wks
General - direct, @ least monthly
Minimal - as needed
OT Aide Supervision
Can be supervised by COTA
intermittent - 0 Pt contact
Continuous - with client related tasks
Intradisciplinary
1 discipline/evaluation/tx
little to no involvement of other disciplines
NOT HOLISTIC
Multidisciplinary
Several disciplines assess/perform interventions INDEPENDENT of each other. ( like Franciscan med grp)
some formal communication btw team
resources/responsibilities individually allocated - may cause competition
Interdisciplinary
Jacobs Ladder
all disciplines collaborate for decision making
eval’s and interventions still independent
greater understanding of each disciplines role/perspectives
Transdisciplinary
Role Blurring.
Trans - man/woman. PT/OT….
Ongoing training, support, cooperation, etc, ensure integrity and quality of care.
Consumer
Most important member of care team (Pt.)
OT also collaborates with
PCA - personal care assistants
HHA - Home health aides
Role: Biomedical Engineer
Develop, design, fabricate CUSTOMIZED equipment and technologies. TECHNICAL EXPERT
Role: Certified Orthotist
Design, fabricate, fit ORTHOSES
OT, PT, or individual with specialized training.
Role: Certified Prosthetist
Evaluate, design, fabricate, PROSTHESIS
Role: job coach
1 to 1 and involvement fades over time
Role: Nurse Practitioner
Can refer to OT
Role: Registered Nurse
Can be Primary CASE manager
Role: Optometrist
Can refer to OT
Role: Physiatrist
Dr. of physical medicine and rehab. LEADS rehab team
Role: Primary Care Provider (PCP)
GATEKEEPER of services in managed health systems - MD or DO
Role: Psychiatrist
Mental Health Physician
Role: Psychologist
professional with PHD in psych
Role: Rec therapist
Bachelor or graduate degree
Healthcare system overwhelmingly insured by
Privately owned companies
Government pays for large portion of private sector services
medicare/medicaid
Healthcare system is:
Market Driven
most practices mandated by state/fed laws
CMS
Center for medicare/Medicaid services
division of HHS
develops rules/regs
participating facilities monitored for compliance
SNF’s strongly influenced by CMS regulations
CMS Centers
Center for Beneficiary Choices - medicare choice/medigap
Center for Medicare mgt - fee/4/service medicare
Center for Medicaid - state admin programs s/a
Medicaid and SCHIP
Center for program integrity - oversight
Center for Medicare/aid - develops. tests new service
delivery and payment models. Control program
costs
OSHA
sets/enforces standards related to safety
Beneficiary
Person receiving services
Capitation
payment system
provider paid PROSPECTIVELY (monthly). Paid set fee whether or not care has been provided.
PMPM - per member per month
healthier enrollees = more $ retained for Dr’s
Co-insurance
Co-pay. %
Clinical/Critical pathway
Standardized recommended intervention protocol for specific diagnoses
deductible
Typically annual.
amt patient pays b4 benefits begin to pay.
DRG
Diagnostic Related Group
descriptive categories that determine level of payment at per case rate
Fee for Service
Payer 80%, patient 20%
Health Insurance Mktplace
ACA
allows consumers to compare cost of insurance plans in their area (aka healthcare exchange)
HMO
Health Maintenance Organization
MOST COMMON
controls services by requiring enrollees to see only Dr.’s within network and get referrals before specialty/ancillary care.
Managed Care
HMO’s and PPO’s
PPO
Preferred Provider Organization
similar to HMO
higher monthly premium = greater access to provider choices in/out of network
Procedure Codes
describe specific services by healthcare professionals
PPS
Prospective Payment System
nationwide payment schedule determines medicare payment for each inpatient stay of medicare beneficiary based on DRG
Third Party Payer
Primary reimbursers in US (incl HMO/PPO)
TAR - Treatment Authorized Request
Medicaid form to document need for requested medically necessary covered services
UCR Usual and Customary Rate
Average cost of procedure in geographic area = max amount insurance will cover
Private Insurance/Managed Care Plans
LARGEST source of INSURANCE payments in US
intermediaries
private insurers that contract with medicare to handle day to day operations
ACA fed regulations for private insurance coverage
- provide essential benefits including rehab
- can’t refuse coverage d/t pre-existing conditions
- can’t raise premiums d/t gender, occupation, pre-existing conditions, or claim history
- young adults covered on parent plans until 26y/o
- no caps on annual and lifetime coverage
Medicare
Largest SINGLE PAYER for OT services
65y/o+
end stage renal/permanent kidney failure - any age
ppl with LT disability - ALS, MS, who have received disability benefits for more than 24 months
Retired Railroad Workers
Medicare Part A
inpatient hospital, SNF, home health, rehab, hospice
automatic when meet criteria & receives SS benefits
Acute care services receive DRG pmnts - includes OT and tx supplies
annual deductible and home health paid by pt. 20%
Medicare Part B
Supplemental- purchased by beneficiary
no specific time limits - 20% co-pay
hospital outpatient Dr.’s, services by Independent practitioners
Medicare part B criteria to cover OT
Rx from Dr or Dr approved performed by qualified OT or OTA services = reasonable/necessary no diagnostic restrictions MUST result in IMPROVEMENT increase level of functioning in reasonable amt of time
Medicare Part B - OT
covers outpatient 3days/wk
Medicare Part A - OT
covers inpatient OT minimum of 5days/wk
Medicare does not cover
Most chronic illnesses, LTC, or medical expenses incurred with illness.
Medicare - SNFs
Covered if skilled nursing/skilled rehab required on a daily basis
RUG reimbursement
Reimbursement incl: eval, caregiver training, design of maintenance plan, re-eval
Does NOT pay to carry out maintenance plan
Caregiver competency with maint plan must be documented by OT before D/C
Medicare - OT Home Care
Homebound status
requires intermittent skilled RN, PT, ST before OT can begin
DME excluded from payment
HHRG - Home health resource group
determines episode pay rate
episode = 60 day period. 1st billable visit - 60th day.
OASIS
initial home health medicare assessment
Outcome Assessment and Info Set
complete to verify eligibility for medicare HH benefits/ plan for rn, med, social, rehab, d/c needs.
Initial assessment MUST be completed within 48hrs of referral
OT conducts follow-up, transfers, d/c evaluations
Medicare - OT in hospice
terminally ill ( less than 6mo to live) maintain functional skills, adl performance, and or control symptoms
Medicare - OT in Outpt
by/with medicare provider OR as part of Comprehensive Rehab Facility Services (CORF)
Medicare - OT in Independent practice
payments according to fee schedule
Resource Based Relative Value Scale (RBRVS)
Medicare - OT in Dr. Office
OT employed by Dr
services related to condition Dr is treating
service fees included on Dr b ill to M/Care
Medicare - OT PHP - Partial hospitalization Services
In hospital affiliated or community mental health psychiatric day program
-otherwise requires inpatient psych care
-covered under general M/Care guidelines
-tx incorporates Independent multidisciplinary intervention plan to attain MEASURABLE, TIME-LIMITED, MEDICALLY NECESSARY functional goals related to reason for admission.
does NOT COVER = social, diversional, recreational, or vocational rehab under PHP Services.
Medicare DME, Prosthesis, Orthosis Coverage
DME - if necessary and used in home. Rx required
Self-Help items - not reimbursable (grab bars, raised toilet seats, etc)
Medicaid
State/Fed funding 50/50
Qualifiers: low income and / or disability
Mandated Services: inpatient and hospital services
outpatient and dr. home health EPSDT - early periodic screening diagnosis and treatment services (incl OT). and SNFs providing skilled rehab
Optional Medicaid Services
OT, PT, SLP DME Targeted Case Management Rx Meds Dental/glasses crisis services transportation psych inpatient below 21y/o or above 65y/o overlap services with IDEA
Medicaid must provide
same minimum benefits provided in insurance exchanges
Workers comp
Job related illness/injury
joint state/employer funding
state - WC committee board determining regulations and benefits
cash and medical benefits
primary focus - rehab and disease management for return to work
OT documentation purpose
record justification information resource increase communication btw professionals data EMR (EHR) = digital format
Documentation Standards
legibility spelling/grammar
concise/complete objective
current/accurate standard abbrev’s
uniform terminology person 1st lang
name, ID# on ea pg. complete data
type of document ID’d confident, compliant
full signature at end (therapist)
Documentation Content
ID/background Info
Referral source, reason, chief OT complaint
Hx
precautions, risk factors, meds, contraindications
eval and re-eval
intervention plan
problem list, goals and potential for functional improvement.
GOALS - SMART Specific Measurable Attainable Relevant Time-limited
LTG’s
Activities/interventions
type, amt, frequency/duration, of tx needed
explanation of tx plan
statement of reason for missed tx
AE/instructions
HEP - compliance
D/C plan
Documentation formats
POMR problem oriented medical record based on list of problems SOAP consultation reports critical incident reports
Dx codes`
describe conditions or MEDICAL reason for required services
CPT - Procedure codes
services provided by HC professionals. HCFA or HCPCS used.
Outpt OT under medicare part B
Must report functional data using G codes
G-codes
ID primary issue (goal) being addressed. All codes usable to track pt outcomes over time.
Words that reflect 0 progress
chronic status quo maintain plateau slow progress stable
words that 0 reflect improvement
same as uncooperative/noncompliant dislikes therapy confused/disoriented can't follow directions unmotivated generalized weakness
Federal Legislation
Establishes practice guidelines and reimbursement standards
ACA
10 legislative titles
increase accessibility, fairness, quality, efficiency, accountability, and affordability
HIPAA
HC continuity, privacy and security
written consent - good effort made
exempt if delays timely care
language barriers - consent can be implied
permission to discuss with family 18y/+
any info disclosed must be minimum needed for purpose
Pt right to access records
30-60days to respond. can charge reasonable copy
$
Pt can request info be amended
Can be refused w/ written rationale
Can be approved, but no removal of original doc
No 100% guarantee of confidentiality
research guidelines align with IRB
does not override stricter state laws
Medicare Title 18 - PL 89-97
SSI
Rehab Act 1973
Prohibits discrimination d/t disability w federally funded agencies
Fair Housing Act
Prohibits discrimination based on sex, color, religion, etc
new apartments must meet accessibility standards
requires tenants to make exceptions to policies for individuals with disabilities (s/a allowing seeing eye dog)
OBRA Omnibus Budget Reconciliation Act 1981
Prohibit discrimination in federally funded programs
Medicaid financing for community based services if less expensive than institutional care
ADA 1990
prohibits discrimination against qualified persons with disabilities in transportation, employment, telecom, accommodations, and public services
Criteria for disability = physical/mental impairment limiting 1+ major life activity.
Record of increased impairment
regarded as impaired
NOT - substance abuse, mania’s, or sexual behavior disorders
ADA Title I
Employment
reasonable accommodations - 15+ employees
unless causes undue hardship
US government, Indian tribes, and tax exempt clubs = exempt
ADA Title II
Public Services
no discriminating ppl w disabilities from participation in services, programs, or activities of PUBLIC entities
ADA Title III
Public Accommodations and Services by Public Entities
(schools, hospitals, theatres, stores..) Cant limit participation or benefit from goods/services
ADA Title IV
Telecommunication 1996
all TV’s include closed captions
phone co’s include TRS (telecom relay services) 24/7
TWIAA Ticket to Work & Work Incentives Improvement Program
allows pt to maintain Medicare/Medicaid benefits
CAPTA Child abuse & prev tx act
mandated reporter
mental/physical injury, neglect, maltreatment, or sexual abuse of 18 and under.
Early Intervention and Education Acts
Free and Appropriate Education (FAPE)
3-21y/o
schools provide OT
schools - prim early intervention service
mainstreaming
OT = PRIMARY EI SERVICE/PRIMARY DEVLOPMENTAL SERVICE
$ for family support services
Reauthorization and amendment of IDEA
IEP- address childs unique needs to allow full access to general education curriculum/classes
- include consideration of AT and behavioral interventions
- team planning open to all personnel at request of parent or school
Education to prepare student for Independent living and employment
mandates IFSP
Transition planning
begins at 14y/o or younger
updated annually
Transition Services
begin at 16y/o or younger
IDEA improvement Act
evaluations to include functional performance, developmental performance in addition to academic
RtI - services provided as needs become apparent
Pilots multi-year IEP
allows for flexible attendance of taem members, incl video/conference calls
specialist screenings without IDEA eval
Discipline = case by case. Must continue services and assessments
IDEAIA & KCFSA
requires state procedures for abuse referrals
NCLB
no child left behind
general education
standards based
OT= pupil services personnel - can recommend testing alternatives and accommodations
Age Discrimination Employment Act
Prohibit age 40+ discrimination or mandatory retirement
Can work AND receive SSI
Omnibus Reconciliation Act 1990
Nursing homes receive M Care/Aid
Resident Rights - autonomy, QOC, QOL
RN completes MD resident assessment yearly
** Psychosocial, activity pursuit patterns, physical condition, cognition all to be considered. Enhanced OT ROLE
Eval and Tx follow RAP (resident assessment protocol) guidelines
Individual care plans within specific time frame
RESTRAINT REDUCTION
Medical Model
Individual with disability = decreased functional capacity
tx addresses disorder/dysfunction
FOR address pathology - Biomechanical and Neurodevelopmental
Education Model
Individual with disability = lacks knowledge/skills
Focus on learning and behavior changes
deficits/goals promote learning & performance
obtain skills, knowledge, competency to meet environmental demands
OT FOR - role acquisition, cognitive remediation
Community Model
Individual lacks skills, resources, supplies for community participation
ID & Develop skills needed for environment
external supports
OT FOR - life-style performance, Occupational Adaptation
Telehealth Model
All model features
uses teletechnology
Acute Care Hospital
Eval - quick accurate screen
stabilize, motivate, improve function through purposeful activities
generalist or specialist
Subacute Intermediate Care Facilities
Pt progressed to stable, not ready for Outpt.
Eval more in depth
LTAC - long term acute care hospital
chronic/catastrophic illness/disabilities
extensive medical care… life support/ventilator
2+ dx w complications
palliative
prevent deformities & decubiti
Rehab hospital
medically stable
Extensive OT eval.
Long Term Hospital
months to years
Extensive eval
maintain QOL
D/C to least restrictive environment
SNF
requires skilled care
stable/0 acute symptoms
1mo - life
extensive eval and or palliative care and maintenance of QOL
Forensic settings
jail - less than 1 yr city/county
prison - greater than 1 yr state/fed
Outpt ambulatory care
req OT to improve fxn, without hospital or inpatient necessary.
EI Programs
<3 y/o at risk kids
birth complications, dev delays
failure to thrive maternal substance abuse
kid born to teen mom disability or dx
33% dev delay in 1 area or 25% in 2
IFSP
6mo reviews by all professionals
Strength oriented evals and doc in family friendly terms
Play/ADLs
Transition plan EI to Pre-k
Schools
facil participation in education and fxnl performance
referrals from: prev agency, teacher, school
IEP annual review
education model
AT & Transition service provisions
OT role incl = psychosocial needs and prevention of school violence, behavioral intervention plans including RtI and positive behavioral supports.
Prevocational programs
develop prerequisite skills to get work.
vocational programs
develop specific vocational skills. Already has prerequisite skills. develop strength/endurance
Residential Program Continuum
24 hr support quarter way houses
half-way houses
group homes
supportive apartments with check-in supervision
Partial hospitalization/Day hospital programs
Stable med/psychiatric conditions
symptoms still require active tx
up to 5days/wk
1wk-6mo
Clubhouse Programs
enter/exit at will
OT = generalist
adults/elders with or hx of mental illness
MBO Management by Objective
management based on core goals
measurable objectives and time frame
4 steps in Program Development
needs assessment
program planning
program implementation
program evaluation
Capital Expense
$500.00+ fixed amounts separated from other expenses
Direct Expense
Service Provision. salaries/benefits, office supplies, tx equipment (ADL materials)
Indirect Expense
Costs shared by whole setting: utilities, housekeeping, marketing
Fixed expenses
Expenses that remain the same: rent
Variable expenses
change in proportion of services provided. more splinting req more splinting materials
splinting materials = variable expense
Break even analysis
cost-volume-profit analysis
volume of services to equal cost & profits to equal 0
Accounts Payable
debts within budget
Accounts Receivable
Assets within budget
