Test 1 Review Flashcards
What is a PAC?
Politician Action Committee:
voluntary, nonprofit, provides funding to individuals that support the needs for
OT and their clients
What is AOTPAC?
American Occupational Therapy Political Action Committee (AOTPAC)
is a voluntary, nonprofit, nonpartisan, unincorporated committee of members of AOTA.
What is the purpose of AOTPAC?
The purpose of AOTPAC is to further the legislative aims of the Association by influencing or attempting to influence the selection, nomination, election, or appointment of any individual to any Federal public office, and of any occupational therapist, occupational therapy assistant, or occupational therapy student member of AOTA seeking election to public office at any level.
AOTPAC was authorized by the Representative Assembly in what year?
1976
When was ACA passed?
March 23, 2010
Feb 2018 - Bipartisan Budget Act: What is it?
- Helped fund the government through March 23rd (gov’t was shut down at the time)
- Lifted previous budget caps
- Expanded children’s health insurance and community health centers, to name a few
-2 things important for OT
1)Continuation of independence at home
Repeal of Medicare Independent Payment
Advisory Board (IPAB)
2) Repeal of the
Therapy Cap Policy - A Permanent Policy!
Define Accessible pertaining to OT (wk 2)
Occupational therapy provides culturally responsive and customized services.
Collaborative pertaining to OT (wk 2)
Occupational therapy excels in working with clients and within systems to produce effective outcomes.
Define Effective pertaining to OT (wk 2)
Occupational therapy is evidence based, client centered, and cost-effective.
Define Leaders pertaining to OT (wk 2)
Occupational therapy is influential in changing policies, environments, and complex systems.
Policy is created by?
1) government (public): Source of Power- government/constitution/financing
Roles- financing/ organization & delivery/regulation
2) private enterprise: free enterprises/ capitalistic market
Roles; financing/ organization & delivery
What’s Dualism?
Both the government and private enterprise are involved in the financing, organization, and delivery of health services, including occupational and physical therapy.
PPACA?
Patient Protection and Affordable Care Act.
3 branches of government
executive, legislative, and judicial.
When is it appropriate for the government to use such power?
1) There is a failure of the private market to work as expected
2) a consensus for government action
Libertarian
Responsibility is on the individual, health care is an earned reward to work, poor best treated by private charity
Egalitarian
Responsibility of society, health care is a prerequisite to be able to work, and poor should be treated using government programs
Utilitarian
the greatest good for the greatest number of people
Libertarian
- Source of responsibility
- Health care
- Treatment of the poor
- Key Characteristics
Individual
Earned reward
(phase out SS)
Private charity
- Liberty
- Make own choices and accept the responsibility (personal liberty)
- Competitive free trade (economic liberty)
- Government sole purpose it to protect individual’s rights
Egalitarian
- Source of responsibility
- Health care
- Treatment of the poor
- Key Characteristics
Society
Prerequisite for work
Government programs
- Equality
- Equality of opportunity
- Equality of income and wealth
- Equal rank and power
- Declaration of Independence = “all men are created equal”
Utilitarian
- Source of responsibility
- Health care
- Treatment of the poor
- Key Characteristics
Morals/Ethics
Maximize welfare
Give when able to
- Greatest good for the greatest number of people
- Morals
- Value theory + theory of right action
- Maximize happiness
Ethics and Values
Aristotle:
- social good should be shared in a community
- treat equals equally and unequals unequally
- distributive justice = requires policy whose outcome is not equivalent for all persons
Ethics and Values
Rawls:
2 principles for creating just social policies and institutions
1) Each person has equal right
2) social and economic inequalities should:
•Be attached to officers and positions opened to all
•greatest benefit to the least advantaged
Ethics and Values
Long: 4 values =
- Freedom: individual decisions, Autonomy ( Medicare therapy cap)
- Equality: Beneficence, disbursement of rewards and responsibilities (uninsured Americans)
- Rewards: universal vs. employment based health care
- Treatment of the poor: care and treatment of all and those disadvantaged groups (Medicaid program changes)
Disability is a
biomedical problem, an economic challenge, and a sociopolitical issue
3 major perspectives of disablement:
Biomedical model, Social Disability Model, & Universalism
Biomedical Model
- Medical doctors determine who is disabled and who can benefit
- Based on science and cellular pathology
- Disablement = problem of medical pathology (cure pathology)
- New models of medical disablement
- Medical necessity = covered by insurance
- OT/PT = improve function, address pain, weakness, contractions…….. recovery/rehab/ medically necessary
Social disability model
- Social disability is dynamic: Cultural norms, socioeconomic status, and individual’s physical conditions
- Social Disability theorists believe that the Medical models reinforced
3 stereotypes:
•1) Health care provider is a solution to disablement
•2) Assume the “sick role” in order to receive services
•3) ignores powerful social influences
Universalism
2 separate systems:
1) medical rehabilitation system
2) Human services system
Disablement is a situation to be recognized by all society at risk of disablement
Policies to include all and educate all
The International classification of functioning, disability, and health (ICF)
ICF
(International classification of functioning)
- Define: Describes how people live with their health condition
- Assesses: Body structure/function, activities and participation, contextual factors, and personal factors
Practice Frameworks
Define: presents a summary of interrelated constructs that describe OT practice; purpose is to facilitate communication within the OT profession.
•Assesses: areas of areas of occupation, environmental /personal/client factors, ADLs, education, rest, sleep.
Access to Health Care Services
Factors of Access are…
5 A’s
Availability
Amount and type of services provided by workers and the amount and type
needed by the population
Accessibility
Geographic features
Location of services and location and access to transportation for the population
Accommodation
1) The manner in which health care providers, services, and facilities are organized
2) The population’s ability to use these providers, service, and facilities
3) The population’s opinion of the appropriateness of the providers, services, and
Acceptability
Attitudes between providers and populations
Cultural differences, language barriers, values, customs,
beliefs…
Affordability
Price and ability to pay Predisposing Factors
Method NQF (National Quality Forum) uses to choose a quality measure
- Importance to measure and report
- Scientific acceptability of measure properties
- Feasibility
- Usability and Use
- Assess related and competing measures
3 types of outcome measures
Generic health status assessments
Disease outcome measure
Improve function and decrease need for assistance
Awareness of quality of healthcare
- Interested consumers
- Understandable
- Focus on outcomes and high priority quality areas
- Utilization of accurate measures
- A reward system for provider accountability
Purposes for professional regulations
- Protect clients from unethical provider activities
- Public assured of basic level of competence from practitioner
- Have a procedure for unethical or incompetent acts
5 Core Patient Rights
- Right to information
- Right to privacy
- Right to refuse treatment
- Right to dignity
- Right to an advocate
Medical Negligence
-Failed to perform duties of that profession
=Cause harm or damage
Crossing the Quality Chasm- 6 Areas that need improvement
- Safety
- Effectiveness
- Patient- centered
- Timeliness
- Efficiency
- Equitability
How to Improve Health Care ?
- Increase accountability and transparency in health care
- Promote evidence-based practice
- Increase use of information technology
- Align payment policies with quality initiatives
Americans with Disabilities Act (ADA)
major civil rights act that provides protection not only in employment, but in transportation and public accommodations, in telecommunications, and with state and local governments, for people with disabilities. Expanded coverage to areas not previously covered by other federal disability acts.
Assistive Technology Act (ATA)
Supports state programs for public-awareness programming to increase access to technology.
Developmental Disability Act (DDA)
Services those with intellectual impairments and other developmental disabilities. Provides protection and advocacy. Promotes “independence, productivity, integration, and inclusion into the community.”
Fair Housing Act (FHA)
Federal act that prohibits housing discrimination, includes discrimination against people with disabilities.
Older Americans Act (OAA)
Federal, state, tribal, and local collaboration for “organizing, coordinating, and providing community-based services and opportunities for older Americans and their families.”
Rehabilitation Act (RA)
Helps people with disabilities maximize their employment abilities and independent living abilities, and supports inclusion in society.
Work Investment Act (WIA)
Supports federal job training for many populations. Addresses “employment services, adult education, and literacy programs, welfare-to-work, vocational education, and vocational rehabilitation”
Individuals with Disabilities Education Improvement Act (IDEA)
supports the education of children and youth with disabilities
Social Disability Model
disablement as sociopolitical experience resulting from the marginalization of people with disabling conditions by policies, social structures, attitudes, and (barriers) of the nondisabled population. The source of the disablement experience is not in the individual by rather in the community.
Medical model
people with disabilities were perceived as “sick” or “impaired” needing a cure.
Inclusion model
incorporates people with disabilities into a community-based model emphasizing inclusion and empowerment.
Disability movement
considered the civil rights movement of the “minority” group of people with disabilities
Independent-living philosophy
based on self-rule and self-help, and political and economic rights.
Advocacy =
“a client-centered strategy involving a variety of actions taken by the client and the therapists, directed to the client’s environment to enact change for the client such that engagement in occupation is enhanced through meeting basic human rights or improving quality of life”
OT Code of Ethics Principle
- Beneficence : beneficence is when one is concerned for the well-being and safety for those receiving services.
- Nonmaleficence: one should do no harm.
- Autonomy and Confidentiality: client has the right to self-determine, privacy, confidentiality and consent.
- Social Justice:one should advocate for fairness, equitable and appropriate treatment
- Procedural Justice: fairness
- Veracity: OT/OTA shall be truthful, honest and provide accurate information.
- Fidelity: clients/colleagues/and other professionals should be given respect, fairness, discretion and integrity
DESC communication model
Description of the circumstance
Expression of feelings
Specification of the change
Consequences identified
AOTA Public Affairs Division: Includes 3 groups
- State Affairs Group
- Federal Affairs Groups
- Reimbursement and Regulatory Affairs Group
“[Y]ou have a direct and powerful influence on how AOTA response to …changes that are occurring around us by proposing a motion to the Representative Assembly” (Hinerfeld, 2016, p.16).
Article: “One RA Motion at a time” (Hinerfeld, 2016)
- 2025 Vision and Priorities
- The RA provides leadership and direction for the profession
How to submit a motion?
Contact State Representative
Collaborate with RA representative
Complete the Motion Submission Form
Rationale: Why the motion is important and how the motion addresses the strategic priorities and the vision
Sequence for Advocacy
Step 1: Knowledge
Step 2: Research
Step 3: Implementing Political Action
•Step 4: Critical Thinking/Reflection
ACA directs the HHS to “…ensure that the scope of the essential health benefits…. Is equal to the scope of benefits provided under a typical employer plan”.
Article: Habilitative Services (Brown, 2014)
Insurance Basics
▪Individuals pay a fee (premium) to create a pool of resources that will provide income or service benefits to holders (beneficiaries) of an insurance contract (policy).
Purpose of Insurance
▪Performs the social purpose of protecting individuals and organizations against unforeseen financial loss
Two contracts for insurance?
▪1) Between insurance company and contract holder (patient)
▪2) Between insurance company and the provider of health care services.
The Consolidated Omnibus Reconciliation Act (COBRA)
Why was COBRA developed?
developed to deal with the problem of loss of health care insurance
▪Loss insurance for other reasons other than gross misconduct are eligible to continue coverage for 18 months at full cost to themselves
▪If spouse dies, spouse can purchase for up to 3 years if they were on family coverage
HIPAA
1996 Health Insurance Portability and Accountability Act
Favorable selection
preferentially identifies people with anticipated low health care costs
Adverse selection
a pool of individuals with higher health care costs who may not be able to obtain affordable insurance
Triple Aim of the ACA
we need to improve outcomes by linking payment to performance with three goals in mind:
1 - improve population health outcomes
2 - enhance consumer satisfaction
3 - reduce healthcare costs
Pneumonic for this - TIER (Triple, Improve, Enhance, Reduce)
Article: Advancing OT in health service Delivery
- shift from volume-based reimbursement to one based on quality, evidence based, patient-centered care
- Define high quality care and develop quality indicators
- Improving outcomes: Use quality measures in practice
- Need to translate evidence/research into practice, use standardized quality measure, documentation to capture the quality of OT care, evaluate care provided
Triple aim
4 Major Payment Mechanisms
fee-for-service: charging the patient a separate fee
case-based: enacted by Medicare in 1983- provider pays for each episode of care
capitation: flat fee per patient per month
global budgeting: all-inclusive budget given to a hospital to cover all of its operational expenses.
Crossing the Quality Chasm:
released by the institute of Medicine in 2001 – report that advocates a redesign of the health care system to bolster the clinical information infrastructure, encourages the use of EBP by clinicians
what are moral hazards?
moral hazards are insurance problems that can be caused by both the beneficiary and the insurer. It is financially irresponsible behavior regarding insurance. This tends to make insurance expensive since more health care results in higher plan costs.
