Special Presentation to Yamagata University of Health

Sciences – March 2007

OT in the US: Directions

David Greene, PhD, OTR

OT in the US: Directions

Population trends

Reimbursement

Emerging areas of practice and popular areas of practice

Problems – Medicare abuses

10% 14%

9% 5%

75% 54%

(U.S. Census Bureau, 2002)

Under 15

15–34 35–44 45–54 55–64 65+

Total U.S. Population Growth:18%

Change in US Population2000–2020

Age (years)

Percent of Individuals Percent of Individuals Limited in Activities Because of Limited in Activities Because of

Chronic Conditions (By Age)Chronic Conditions (By Age)

0

5

10

15

20

25

30

35

40

45

%

< 18 18Ğ44 45Ğ64 65Ğ74 75 +

Age(Robert Wood Johnson

Foundation, 1996)

U.S. Health Care Costs Medical care at end of life consumes 10%–12% of total health care budget and 27% of Medicare budget.

At least one third of all Medicare expenditures provide care for eventually fatal illnesses.

About 27%–30% of the total Medicare budget is spent in the final year of life.

Of total amount spent in final year of life, nearly 40% is spent in the last 30 days.

Hospice care can save 25%–40% of health care costs during the last month of life.

(Trupin, Rice, & Max, 1995)

Number of Medicare Beneficiaries

25.5 31.0 34.1 38.652.2

68.2

20.4

8.6

8.7

7.35.4

3.33.0

0

10

20

30

40

50

60

70

80

1970 1980 1990 2000 2010 2020 2030

Calendar Year

Disabled & ESRD

Elderly

* Estimated. Numbers may not sum due to rounding.

Source: CMS, 2004.

The number of people Medicare serves will nearly double by 2030.

20.4

28.4

34.3

39.6

45.9*

61.0*

76.8*

Me

dic

are

En

roll

me

nt

(mil

lio

ns

)

Today’s Emerging Areas of Occupational Therapy PracticeErgonomics consulting Design and accessibility consulting and home modification Older driver assessment and training Consulting to assisted-living facilities Technology and assistive-device development and consulting Health and wellness consulting Low vision rehabilitation Addressing Alzheimer's disease and caregiver training Addressing the needs of children and youth Community services

Practice Settings

Hospital13%

College/ Academics

10%

Rehab6%

Other10%

Skilled /Nursing

ResidentialCare13%

School System31% Outpatient

6% Private Practice5%

-CommunityBased

6%

(AOTA, 2005)

Source: AOTA Member Survey, Final Report October 2003; AOTA 2005 - Centennial Vision

Trends in Practice Areas

0

5

10

15

20

25

30

35

40

Pe

rce

nta

ge

2001

2003

2005

Connecting the DotsCurrent

State

Future

Scenario

Possible

ImplicationsFewer than1% of OTs workin mental health.

Mental illness is becoming a major health burden.

Continuing education, education, licensure

Much content ineducational programs is aboutbody structure and function.

Developments in stem cells, assistive technologies, etc.,may restore functional ability.

Educational programs may need to shift focus to lifestyle and QOL strategies.

AOTA Centennial Vision

The eight elements viewed as relevant to a shared vision included the following: 1. Expanded collaboration for success 2. Power to influence 3. Membership equals professional responsibility 4. Well-prepared, diverse workforce 5. Clear, compelling public image 6. Customers demand occupational therapy 7. Evidence-based decision making 8. Science-fostered innovation in occupational therapy

practice

AOTA Centennial Vision

Six barriers were identified: 1. Rigid adherence to the status quo

2. Misalignment between the current OT priorities and the external environment

3. Limited appeal of membership in AOTA

4. Inconsistent competencies for education and practice

5. Overemphasis on a “helping culture” in the OT workforce

6. Unclear professional language and terminology

AOTA Centennial Vision

Four strategic directions emerged after a careful analysis of barriers and opportunities: 1. Building the capacity to fulfill the profession’s

potential and mission. – This includes:

• Ensuring an adequate and diverse workforce for multiple roles

• Preparing OTs and OTAs for the 21st century

• Increasing research capacity and productivity

• Strengthening our capacity to influence and lead

AOTA Centennial Vision

2. Demonstrating and articulating our value to individuals, organizations and

communities.

This includes: • Meeting societal needs for health and well-being

• People understanding who we are and what we do

3. Building an inclusive community of members

4. Linking education, research, and practice

ACCREDITATION STANDARDS FOR A MASTER’S-DEGREE-LEVEL

EDUCATIONAL PROGRAM FOR THE OCCUPATIONAL THERAPIST

(Effective 1/1/08, ACOTE)

B.1.0. FOUNDATIONAL CONTENT REQUIREMENTS

Program content must be based on a broad foundation in the liberal arts and sciences.

A strong foundation in the biological, physical, social, and behavioral sciences supports an understanding of occupation across the life span.

Coursework in these areas may be prerequisite to or concurrent with professional education.

B.2.0. BASIC TENETS OF OCCUPATIONAL THERAPY

Coursework must facilitate development of the performance criteria including:

Articulate importance of the history and philosophical base of the profession

Explain interaction of areas of occupation, skills, patterns, activity demands, etc.

Ability to analyze tasks

Clinical reasoning

B.3.0. OCCUPATIONAL THERAPY THEORETICAL PERSPECTIVES

The program must facilitate the development of the performance criteria listed below:

Describe theories and models

Explain how used in evaluation and intervention

B.4.0. SCREENING, EVALUATION, AND REFERRAL

The process of screening, evaluation, and referral as related to occupational performance and participation must be:

Culturally relevant

Based on theoretical perspectives, models of practice, frames of reference, and

available evidence

B.5.0. INTERVENTION PLAN: FORMULATION AND IMPLEMENTATION

The process of formulation and implementation of the therapeutic intervention plan to facilitate occupational performance and

participation must be:

Culturally relevant

Reflective of current occupational therapy practice

Based on available evidence

Based on theoretical perspectives, models of practice, and frames of reference

B.6.0. CONTEXT OF SERVICE DELIVERY

Context of service delivery includes the knowledge and understanding of the various contexts in which occupational therapy

services are provided.

B.7.0. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES

Management of occupational therapy services includes the application of principles of management and systems in the provision of occupational therapy services to

individuals and organizations.

B.8.0. RESEARCH

Application of research includes the ability to read and understand current research that affects practice and the provision

of occupational therapy services.

B.9.0. PROFESSIONAL ETHICS, VALUES, AND RESPONSIBILITIES

Professional ethics, values, and responsibilities include an understanding and appreciation of ethics and values of the

profession of occupational therapy.

The Real World

In spite of best intentions of educational programs, graduates and the institutions they work for make mistakes in billing Medicare!

Problems with Payment System

Major payer for OT is Medicare – the US version of socialized medicine – only for 65+ and individuals with disabilities

Private health insurance often follows Medicare guidelines for paying OT/PT

Medicare Does Not Pay When:

Therapy is repetitive – provided only to maintain function – not improve

Person’s restoration potential is poor

Goals cannot be reached

Therapy considered general exercise program

Medicare “going broke” and one reason is inappropriate charges from OT and PT:

Not Medically necessary - Medicare paid nursing homes $1 billion for OT and PT for services judged as not medically necessary or delivered by unqualified staff

Poor documentation – Medicare paid $331 million for time billed that did not match time charted by OT/PT

Medicare paid nursing homes $342 million more than OT/PT contractors charged nursing homes

Medicare Going Broke!

Cost of Unnecessary Units Billed

0

50

100

150

200

250

300

350

400

450

500

PT OT

Mill

ion

s o

f $

MedicallyUnnecessary

Provided byInadequately SkilledStaff

Copyright 2005 American Occupational Therapy

Association, Inc.

AcknowledgmentsSlides on trends and Centennial Vision

were developed by the AOTA Vice-President pursuant to his responsibilities

for Strategic Planning. Appreciation is extended to Carolyn Baum, PhD, Leti Ford, Judy Wolf, Maureen Peterson,

Cynthia Johansson, and Barbara Dickson for their assistance in its preparation.

© 2005 by the American Occupational Therapy Association, Inc. All rights reserved.