Ch.4: Competency and Practice Management Flashcards
1
Q
Beneficence
A
-demonstrating a concern for the SAFETY and WELL-BEING of patients
2
Q
Non-maleficence
A
- DO NO HARM
- intentionally refraining from actions that cause harm
3
Q
Autonomy
A
-respect the right of the pt to self-determination, PRIVACY, CONFIDENTIALITY and CONSENT
4
Q
Justice
A
-promote FAIRNESS and objectivity in the provision of OT services
5
Q
Veracity
A
-provide COMPREHENSIVE, ACCURATE, and OBJECTIVE info when representing the profession
6
Q
Fidelity
A
-treating pts, colleagues, and other professions with RESPECT, FAIRNESS, DISCRETION, and INTEGRITY
7
Q
Ethical Decision Making
A
- ID all of the ethical issues and potential dilemmas
- gather all relevant info
- determine conflicting values and ares of agreement
- ID as many relevant alternative courses of action as possible
- determine all possible positive and negative outcomes for each possible action
- weigh with care, the consequences of each outcome
- seek input from others (i.e. supervisors)
- apply best professional judgement to choose the action(s) to recommend
- contact any and all agencies that have jurisdiction over a practitioner if there are questions about potential ethical violations that COULD CAUSE HARM or have the POTENTIAL TO CAUSE HARM to a person
- determine desired and/or potential outcome of filing an ethical complaint
8
Q
OTAs/COTAs Expanding their Role by Establishing Service Competency
A
- service competency is the ability to complete the specific task in a safe, effective, and reliable manner
- i.e the OTA/COTA and OT can perform the same or equivalent procedure and obtain the same results
- OTAs/COTAs who establish service competency do NOT become independent, they continue to work with OT supervision
- if the exam item does NOT provide info about establishing the OTAs/COTAs service competence, the correct answer cannot have the OTA/COTA performing the task
9
Q
OTAs/COTAs
A
- OTAs/COTAs can be activities directors in SNFs and can supervise OT aides
- AOTA supports independent practice of OTAs/COTAs with adavanced-level skills who work for independence living centers
- state licensure laws and scope of practice legislation may supersede this recommendation
10
Q
Level of Supervision
A
-the supervising OT is the one that determines the appropriate level of supervision
11
Q
Principles of Collaboration: Factors that Influence Effective Team Functioning
A
- member skill and knowledge
- membership stability
- commitment to team goals
- good communication
- membership composition
- a common language
- effective leadership
12
Q
InTRAdisciplinary Team
A
- one or more members of one discipline eval, plan, and implement tx of the pt
- communication is limited
- NO other discipline involved
13
Q
Multidisciplinary Team
A
- a number of professionals from different disciplines conduct assessments and interventions independent from one another
- members’ primary allegiance is to their own discipline
14
Q
InTERprofessional Team
A
- ALL professional disciplines relevant to the case at hand agree to collaborate for decision-making
- eval and intervention conducted independently
- members work towards a COMMON GOAL
15
Q
Transdisciplinary
A
- characteristics of interdisciplinary teams are maintained and expanded upon
- members support and enhance activities and programs of other disciplines
- shared decision-making for pts benefit
- evals and interventions planned cooperatively
16
Q
Team-efficacy
A
-interprofessional and transdiciplinary teams are the MOST COMMON and considered the MOST EFFECTIVE in today’s healthcare system
17
Q
Medicare
A
- the largest single payer for OT services
- administered by CMS
- intermediaries determine if services provided are within Medicare guidelines
18
Q
Persons Eligible for Medicare
A
- over the age of 65 years
- of all ages who have end-stage renal disease/permanent kidney failure that may required dialysis tx or a kidney transplant
- have a long-term disability (i.e. ALS, MS) who have received gov funded disability benefits for 24 months may be eligible
- retired railroad workers
19
Q
Medicare Part A
A
- pays inpt hospital, SNF, home health, rehab facilities, and hospice care
- automatically provided to all who are covered by the social security system that meet qualifications for Medicare
-services in acute care hospitals received a prospective predetermined rate based on DRGs
>the DRG per case reate covers all services including OT
>fixed dollar amount for pt care for each dx regardless of LOS or number of services given
>tx supplies (i.e. splints, adaptive equip) are included in this case rate
>individual hospitals determine the combo of services a pt will get
-Part A covered services have specific time limits and also require deductible and co-insurance payments by the beneficiary
>annual deductible fees must be paid by pt
>20% of home health care must be paid by pt
20
Q
Medicare Part B
A
-pays for hospital outpt physician, and other professional services including OT services provided by independent practitioners
>considered a supplemental medical insurance program and therefore must be purchased by the beneficiary usually as a monthly premium
>Part B services have no specific time limit and require 20% co-pay
21
Q
Primary Difference Between Medicare Part A & B
A
-Medicare Part A
>inpt Part A coverage requires services for a minimum of 5 days per week
-Medicare Part B
>outpt services are covered by Medicare Part B for typically 3 days per week
- primary difference between Part A & B is FREQUENCY in which the individual receives services
- OT in SNFs is covered if the pt requires skilled nursing or skilled rehab (OT, PT, ST)
- NBCOT exam items about reimbursement will likely focus on service QUALITY not service quantity via PDPM payment system
22
Q
OT in home care
A
- is covered if the individual is home bound, needs intermittent skilled nursing care, PT or ST before OT began
- OT services can continue after need for skilled nursing, PT, or ST has ended
- homebound = not able to leave the home (confined), takes considerable time and effort to leave the home (can leave for non-medical short-term appointments and events)
- reimbursement is under a prospective payment system
- initial and comprehensive assessment via OASIS must be done for pt to be eligible for Medicare home health benefits
- OT can complete OASIS, conduct follow-up, transfer, and d/c evals (if need for OT is established)
- initial assessment must be done within 48 hours of referral or within 48 hours of person’s return home
23
Q
Medicare Coverage of Durable Medical Equipment (DME)
A
- DME is covered if it is used in the beneficiary’s home and if necessary and reasonable to tx an illness or injury or to improve functioning
- MD prescription is needed and must include dx, prognosis, and reason for DME need
- repeated use can be withstood
- primarily and customarily used for a medical purpose (i.e. w/c or walker)
- generally not purposeful or useful to a person in the absence of illness or injury
- self-help items, bathtub grab bars, and raised toilet seats are NOT reimbursable DME because other people can used them and they are not considered medically necessary
24
Q
Medicaid
A
- state/federal health insurance program for persons who have an income that is below an established threshold and/or have a disability
- under the ACA, Medicaid has to proved the same minimum essential benefits that are provided in insurance exchanges established by the ACA
25
Purposes of a Program Evaluation
- measures effectiveness of a program (were goals accomplished)
- use of info obtained in the eval to improve services and assure quality
- meet external accreditation standards
- ID program problems/limitations and resolve them
26
Major Types and Terms
- Quality Improvement (QI)
- Total Quality Management (TQM)
- Performance Assessment and Improvement (PAI)
- Goal Attainment Scaling (GAS)
- Utilization Review (UI)
- Statistical Utilization Review
- Peer Review
- Professional Review Organization (PRO)
- Prospective Review
- Concurrent Review
- Retrospective Review
- Risk Management
27
Quality Improvement (QI)
- system oriented approach
- views limitations and problems proactively as chances to increase quality
- prevention emphasized
- problems related to organization improvement needs
28
Total Quality Management (TQM)
- creation of organizational culture
| - enables all employees to contribute to an environment of continuous improvement to meet or exceed consumer needs
29
Performance Assessment and Improvement (PAI)
- systematic method and eval appropriateness and quality of services
- focus on interdisciplinary systems
- client-centered approach
30
Goal Attainment Scaling (GAS)
- eval tool
| - attains pts goals for tx and measures goal attainment and tx outcomes after a specified protocol
31
Utilization Review (UI)
- plan to review the use of resources within a facility
| - determination of medical necessity and cost efficiency
32
Statistical Utilization Review
-reimbursement claims data are analyzed to determine most efficient and cost-effective care
33
Professional Review Organization (PRO)
-groups of peers who evaluate the appropriateness of services and quality of care under reimbursement and/or state licensure requirements
34
Prospective Review
- eval proposed tx plan that specifies how and why care will be given
- used by 3rd party payers to approve OT tx programs
35
Concurrent Review
- eval of ongoing tx program during hospitalization, outpt, or in home care tx
- method to enure appropriate care is given
36
Retrospective Review
- audits of medical records after tx was rendered
- method to ensure appropriate care was given
- a UR tool for 3rd party payers (can be time consuming and costly)
37
Risk Management
-a process that identifies, evaluates, and takes corrective action against risk and plans, organizes, and controls the activities and resources of OT services to decrease actual or potential losses
38
QuANtitative Methodology/Design Types
-True-experimental
-Quasi-experimental
-Nonexperimental/Correlational
(Retrospective, Prospective, Descriptive, Predictive)
39
True-experiemental
| quantitative
- classic two-group design which includes random selection and assignment, into an experimental group that gets tx or a control group that gets no tx
- all other experiences are kept similar
- a cause-and-effect relationship between the independent and dependent variable is examined
40
Quasi-experimental
| quantitative
-an independent variable is manipulated to determine its effect on a dependent variable but there is a lesser degree of researcher control and/or no randomization
41
Nonexperimental/Correlational
| quantitative
- NO manipulation of independent variable
- randomization and research control is not possible
- describes relationships, predicts relationships among variables w/o active manipulation of the variables
42
Retrospective
| quantitative
-investigation of date collected in the past
43
Prospective
| quantitative
-recording and investigation of present data
44
Descriptive
| quantitative
-investigation of several variables at once; determines existing relationships among variables
45
Predictive
| quantitative
-used to develop predictive models
46
QuALitative Methodology/Design Types
- form of descriptive research that studies people, individually or collectively, in their natural social and cultural context
- systematic, subjective approach to describe real-life experiences and give them meaning
- rich in verbal descriptions of people and phenomena based on direct observation in naturalistic settings
- process of study is considered as important as the specific outcome data
- types: Phenomenological, Ethnographic, Heuristic, Case Study
47
Phenomenological
| qualitative
-a study of one or more persons and how they make sense of their experience
48
Ethnographic
| qualitative
-patterns and characteristics of a cultural group, including values, roles, and beliefs, and normative practices are intensely studied
49
Heuristic
| qualitative
-complete involvement of the researcher in the experience of the subject(s) to understand and interpret phenomenon
50
Case Study
| qualitative
-a single subject or a group of subjects is investigated in an in-depth manner
51
QuALitative Methodology Trustworthiness Criteria
- Credibility
- Transferability
- Dependability
- Confirmability
52
Credibility
-the researcher's lvl of confidence that their findings truthfully reflect the reality of a study's participants and the study's contxt
53
Transferability
-how well other researchers can fit a study's findings into similar contxts; the "goodness of fit" btwn the contxts of two studies
54
Dependability
-the inclusion of the full range of data, including outlier or a typical findings
55
Confirmability
-the degree to which a study's conclusions are based on data
