exam 1 weeks 1-2 Flashcards
3 main documents of OT
ICD, ICF, OTP4
What does ICF and ICD stand for
(ICD) - international classification of diseases
(ICF) - international classification of functioning, disability, and health
4 guiding principles of ot
CLIENT CENTERED
OCCUPATION CENTERED
EVIDENCE BASED
CULTURALLY RELEVANT
typical OT
38 yr old female from central north usa, works in hospital 72k a year
secondary work settings for OT
1/4 of practitioners work in secondary setting; most common one is SNF
environmental factors
natural environment, products and technology, support and relationships, attitudes, services systems and policies
ot practitioners licensed
OTA : 17%, ot : 83%
OT demographics
mostly white 84%, female 91%, age group- 30 yr and 39 yrd old
OTA primary work setting
SNF, 40% of al OTA’s work in urban areas
OT primary setting
hospitals, 46% work in urban, 39% in suburban, 15% in rural
geographic density of OT
more OT’s live in north central states, fewest live in Mountain states
trends in salary for OT practice area
Academia and Home Health have the highest median salary
HHS
-department of health and human services)- protect health of americans, provide essential health services
Milestones in Early 1800s
Hospitals were physician-owned by those who practiced
within them
milestones in early 1900s
Ownership changed from physicians to church groups,
larger facilities, and the government
* 1973 – first Patient Bill of Rights was established
* 1985 – Emergency Medical Treatment and Active Labor
Act (EMTALA) was enacted
current hospitals systems are
not for profit, for profit, gov’t facilites
Characteristic of Not-for-profit
traditional model, often initally founded for charitable cause, may have religious group involved
tax exempt
For Profit characteristics
new from 1980s
owned buy shareholders
may focus on certain areas of care that are more profitable
-
gov’t hospital agencies
owned by federal, state or local gov’t
- provide care for patients who may have limited access elsewhere
impacted by politics, funding debates
main type of hospital in USA
not for profit 58%
role of congress in health care
write and pass legislation
president role in healthcare
carry out laws that are passed, oversees HHS and CMS, power to issue executive orders
state and local govt role in healthcare
states administers medicaid programs, local health departments
civic- faith based groups
free clinics, civic groups like lions club, shriners
insurance 1940s-1960s
blue cross 1929, 1939 blue shield, retrospective payment, consumers could pick provider easily, IMPACT ON OT- hospital based OT are paid by private insurance
historical 1964-1972
social security act
- health insurance federalized, medicare provided for 65 and older
- medicaid established for low income people
part A medicare in 1965
hospital insurance
medicare part b in 1965
medical insurance
medicaid 1965-1972
medicaid expanded to include families, pregnant women, individuals with disabilites , and individuals needing long term care
medicare 1972
MEDICARE EXPANDED TO INCLUDE PEOPLE YOUNGER THAN 65 WITH LONG TERM DISABLITIES and end stage renal disease
medicare-medicaid impact on OT
ot included in original medicare law, medicare largest payer of OT, mediciad largest payer OT school based. expansion in 72 increased number of clients
health maintenance act of 1973
beginning of managed care, includes health maintanence organizations, HMOs adn PPO- preferred provider organizations
1975 Education of the Handicapped ACT
free and appropraite education for all children
1980 and 1982 medicare expansion
expand into home health services, expand into hospice
shift in 1983 of payment
shift from retrospective payment to prospective payment DRG (diagnostic related group)
1986-1992 EI, IDEA, Fee schedule
1986- handicapped infant and toddle act- ot established EI
1991- IDEA - individuals with disabilities education act, replace education for all children act– requires education in least restrictive environment
1992 fee schedule
medicare physician fee schedule- determines fee for services for pArt B
-OT utilize the fee schedule and CPT codes for Part B payment
1997 BBA
balanced budget act , OT 1500, PT/SLP 1500,
in 2023- cap of $2,230 for OT and $2,230 for PT/SLP
1997 chip
children’s health insurnce program – covers some OT services
2010 ACA
Patient Protection adn Affordable Care Act- health care reform to reduce cost and provide affordable act
insurance marketplace created for uninsured
increase in federal funding to expand to include qualifications and to single childless adults
ACA impact on OT
rehab and habilitation 10 essential benefits, coverage of prexisiting conditions
ACA coverage
health plans can no longer limit or deny benefits to children under 19 due to pre-exisitng conditions
– gurantees right to appeal
distribution of coverage trends
mainly employer coverage, then medicaid, then medicare
Private health insrance
– fee for service
HMO
– HMO with Point of Service (POS)
– HMO PPO (preferred provider organization
– CDHP
– HSA
– HDHP
FEE FOR SERVICE
retroactive payment
managed care
moves towards prospective payment – HMP, PPO, POS
GOVT Insurance types
federal , fed/state, state
federal insurance
medicare (65 older, SSDI, end stage renal disease/ ALS
fed/state insurance
medicaid,
CHIP
IDEA
state programs insurance
workers compensation
medicare part A now
all medicare people are coverd, no monthly premium, pay deductibles,
medicare part B now
covers outpatient services –
paid for by monthly premiums,
20% copay,
payment for OT services under Medicare part B
medicare physician fee schedule
CPT CODES can be untimed or timed, example evaluation codes are untimed
timed codes think 8 minute rule
ICD-11 CODES
8 minute rule
8 to 22 mins 1 unit
23-37 2 units
38 to 52 3 units
53-67 4 units
medicare part C
private part of medicare
medicare advantage (benfits of a, b and d )
not a medicare supplement
Medicaid
funding shared between federal and state
primarily for low-income individuals and families, older adults, children, individuals with documented disabilities
CHIP
states administer programs, covers 1/3 of all us children
costs of OT services
for patients with insurance - copay often from 10-50 dollars
private pay insurance
– evaluation costs 150-200, treatment session 50-400 an hour
value based care
ACO model
IMPACT – improving medicare post-acute act 2014
JCAHO
provides certification for programs
CARF
independent, nonprofit accreditor health and human services providers
