Ch.4: Competency and Practice Management Flashcards
Beneficence
-demonstrating a concern for the SAFETY and WELL-BEING of patients
Non-maleficence
- DO NO HARM
- intentionally refraining from actions that cause harm
Autonomy
-respect the right of the pt to self-determination, PRIVACY, CONFIDENTIALITY and CONSENT
Justice
-promote FAIRNESS and objectivity in the provision of OT services
Veracity
-provide COMPREHENSIVE, ACCURATE, and OBJECTIVE info when representing the profession
Fidelity
-treating pts, colleagues, and other professions with RESPECT, FAIRNESS, DISCRETION, and INTEGRITY
Ethical Decision Making
- 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
OTAs/COTAs Expanding their Role by Establishing Service Competency
- 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
OTAs/COTAs
- 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
Level of Supervision
-the supervising OT is the one that determines the appropriate level of supervision
Principles of Collaboration: Factors that Influence Effective Team Functioning
- member skill and knowledge
- membership stability
- commitment to team goals
- good communication
- membership composition
- a common language
- effective leadership
InTRAdisciplinary Team
- one or more members of one discipline eval, plan, and implement tx of the pt
- communication is limited
- NO other discipline involved
Multidisciplinary Team
- a number of professionals from different disciplines conduct assessments and interventions independent from one another
- members’ primary allegiance is to their own discipline
InTERprofessional Team
- 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
Transdisciplinary
- 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
Team-efficacy
-interprofessional and transdiciplinary teams are the MOST COMMON and considered the MOST EFFECTIVE in today’s healthcare system
Medicare
- the largest single payer for OT services
- administered by CMS
- intermediaries determine if services provided are within Medicare guidelines
Persons Eligible for Medicare
- 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
Medicare Part 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
Medicare Part B
-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
Primary Difference Between Medicare Part A & B
-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
OT in home care
- 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
