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Health Care Reform Impacts Occupational Therapy
Jill Claytonon 25 October 2012
Transcript of Health Care Reform Impacts Occupational Therapy
Impacts the Occupational Therapy (OT) Profession The Patient Protection and Affordable Health Care Act (PPACA) was passed on March 23, 2010. The law will increase coverage by controlling costs, subsidies, and mandates (Braveman & Metzier, 2012). Changes in the health care system will occur between now and 2014
Required to have insurance or pay a yearly penalty per person.
May be penalties for employers who do not offer insurance. Health Insurance Exchanges: -Created at state level to provide health plans to individuals
-Place approved plans in one place to increase accessibility and decision making Changes to Insurance Regulations Medicaid is expanded to families
with lower incomes. Medicare changing the delivery and payment of care: Post-acute care bundling
Accountable care organizations
Medical home models Single payment for services related to one condition that leads to hospitalization (hospitalization, re- hospitalization, post-acute care, physicians, and OT services) Decrease costs, focus responsibility, prevent complications, and improve care coordination to decrease readmissions.
This includes the group of providers such as physicians, primary care providers, specialists, and other health care professionals. The group of providers will work together to provide appropriate care, meet outcome goals, and decrease costs. The health care team is lead by a physician and focuses on the patient throughout their life span. How will this impact the occupational therapy profession? More Changes There will be no higher premiums based
on health and gender. No ineligibility from making simple mistakes when applying. Covers pre-existing conditions There will be no lifetime limits on coverage. Individuals are covered on parent's health insurance until age 26. Post-Acute Care Bundling Accountable Care Organizations Medical Home Models Opportunities for Occupational Therapy Advocate for OT's role in the primary care team, medical homes, and accountable care organizations.
OT can promote role in wellness and prevention programs. Prevention programs may help save money, so emphasize the importance of these programs.
PPACA will require annual wellness checkups for Medicare patients.
A personal risk assessment and mental health check up that focuses on one's ability to function, safety, cognition, and depression.
OT can address these issues.
For example, an OT can evaluate these components and provide ways to improve safety to eliminate risk of injuries. The Affordable Care Act will cover services in the essential health benefits categories. Ambulatory patient services
Mental health and substance services
Rehabilitative, habilitative services, and devices
Preventative, wellness services, and chronic disease management
Pediatric services (oral and vision care) OT fits under these essential health benefits categories: OT can play a vital role in chronic disease management.
Manage diabetic foot
Recommendations for diet (meal preparation, grocery shopping)
Self-monitor weight, blood pressure, blood glucose
ADLs and IADLs: References OT's Role in Rehabilitation, Habituation, and Devices
Therapy Cap Advocate for OT's role in community health and mental health services
Overcome the problem areas: Habilitation Services: Services that focus on maintaining, remediating or learning abilities for activities of daily living.
Rehabilitation Services: Services that focus on remediating, enhancing, or maintaining abilities for activities of daily living due to illness or injuries.
Services include OT and occurs in outpatient and inpatient Medicare Outpatient Part B
-Patients may receive services
past the $1,860 cap. How does OT fit into the prevention role?
Injury prevention training
Training on body mechanics OTs should advocate for role because there is an increase in insured patients, which means an increase in patients required to be covered for mental health services.
Advocate: Other disciplines are in same settings, so advocate for OT to be included in the team approach.
Decreased direct reimbursement when payment occurs in one bundle.
Answer questions such as how OT provides quality care and what are the costs
Establish self with medical homes and educate others on OT services
American Occupational Therapy Association. (n.d). Health care reform implementation: What are we doing to protect your future [PowerPoint slides]. Retrieved from www.aota.org
American Occupational Therapy Association. (2010). Health care reform: An OT perspective. Retrieved from http://www.aota.org/Practitioners/Advocacy/Health-Care-Reform/Overview/Reform.aspx?FT=.pdf
Braveman, B., & Metzler, C. A. (2012). Health care reform implementation and occupational therapy. American Journal of Occupational Therapy, 66, 11-14.