Today’s blog post comes from Veda Collmer, OTR, WebPT’s in-house counsel and compliance officer. Veda is a licensed occupational therapist and attorney—quite the combo!


The theme of Occupational Therapy Month—“Transforming lives, building independence”—has inspired me to write about the transformation of occupational therapy itself. In the years following the 2010 passage of the Patient Protection and Affordable Care Act (ACA), I’ve been studying up on how the new law will change the face of health care in the United States—particularly, how it will affect occupational therapy. Policymakers and politicians have realized that the “old” model of healthcare delivery is expensive and ineffective. If healthcare reform plays out the way our leaders in Washington envision, the cost of health care will be lower, and the quality will be higher—leading to more positive patient experiences. Healthy routines and prevention—which form the foundation of the OT profession—are crucial to the achievement of that vision. Thus, occupational therapy— with its unique framework of “therapy by doing” and its holistic approach to addressing the social, cultural, physical, and emotional dimensions of an individual—complements this new model perfectly.

Here are four ways the ACA will positively transform OT:

The PT’s Guide to Billing - Regular BannerThe PT’s Guide to Billing - Small Banner

1. More people will be able to access OT services.

The ACA expands access to health care in general, and as part of that expansion, insurances must cover a wider variety of services. A qualified health insurance plan—that is, a plan certified to be sold on the Health Insurance Marketplace—must cover ten essential benefits. These benefits include mental health care and substance abuse treatment as well as rehabilitation and habilitation services.

OT once had solid roots in mental health rehabilitation. In the past, OTs provided services in psychiatric hospitals, community settings, and residential facilities, teaching skills to equip patients with the tools necessary to enhance their lives. However, over the last several years, the availability of OT in mental health settings has slowly eroded. Before the ACA, insurance didn’t cover mental health treatment—or, in some cases, such treatment was inaccessible due to cost-sharing requirements and treatment limitations. The result: OTs interested in mental health specialties could not find fieldwork opportunities or jobs.

Fortunately, the ACA emphasizes the importance of mental health and substance abuse treatment by requiring qualified insurance plans to cover those services. The ACA also expands on the Mental Health Parity and Addiction Equity Act of 2008  (MHPEA) by requiring insurance plans to cover mental health and substance abuse services in the same manner as medical and surgical care. This means insurance plans cannot impose different requirements—like increased cost-sharing and treatment limitations—for mental health services. Additionally, the ACA extends the MHPEA to individual and small group markets. More access, better coverage, and increased recognition of the importance of mental health treatment all will help reinvigorate the OT’s role in health care.

As a form of habilitation, OT has proven highly effective in early intervention treatment. Historically, though, access has been a problem. Before the ACA, private plans excluded habilitation services. Furthermore, families couldn’t access habilitation services if their state didn’t provide them or if their children didn’t qualify for Medicaid. The scope of coverage still varies considerably from one region to another, and the differences aren’t always clear—which means there’s still plenty of work to do on that front. The good news is that the AOTA is advocating for a clearer definition of habilitation. I believe that in time, habilitation services—including OT—will be available for more children.

2. We’ll see new models of OT delivery.

In the future, OT delivery will be more efficient and effective than it is under the traditional direct (i.e., one-to-one) model. The ACA promotes more team-based, collaborative care. Enter: accountable care organizations and medical homes, which are designed to reduce costs and improve care coordination. Because primary care providers and OTs share similar treatment approaches, pilot programs for these models have placed OTs in primary care physicians' offices. To serve in these roles, some OTs will become generalists. In line with the rollout of these types of care delivery models, coaching and educational strategies for improving patient health literacy will become crucial, and OTs are well positioned to fulfill that need.

In addition to promoting new models of care delivery, the ACA will encourage OT delivery in a natural environment. The ACA-created Center for Medicare and Medicaid Innovation (CMMI) is piloting the Independence at Home project and lauding the importance of the once-popular house call. As part of those efforts, primary care teams are seeing people with chronic conditions in their homes as well as making early referrals to OT. The CMMI also is transitioning people from nursing homes and hospitals to home-based care. OTs will play a critical role in helping more people achieve independence at home.

Finally, telehealth (i.e., remote delivery of healthcare via communication and information technologies that allow the provider and the patient to be in different physical locations) will allow for OT delivery to patients in rural and underserved areas of the country. Evidence shows that telehealth is effective in improving patient outcomes and health literacy. While the federal government still needs to hash out all of the licensure requirements around telehealth, many states are changing their laws to support this low-cost, highly effective model of service delivery.  

3. OTs will deliver better care with better outcomes.

The current fee-for-service payment model is inefficient and expensive. In fact, research shows that fee-for-service reimbursement produces uncoordinated care as well as sloppy care transitions—both of which lead to unnecessary hospital readmissions and wasteful spending. With healthcare reform comes things like quality measures (i.e., Physician Quality Reporting System) and a stronger emphasis on evidence-based practice as the foundation of clinical decision-making. To that end, the AOTA has made evidentiary resources—such as practice guidelines and open access articles—available to empower OTs to use evidence-based practice.

4. OTs will join the public health movement.

Because most of the diseases plaguing the US are preventable (e.g., diabetes, obesity, and heart disease), the overall approach to health care is shifting toward prevention and population health improvement. Public health initiatives incorporate a broad view on what makes a population healthy. OT fits nicely into this framework, as it promotes healthy routines, prevention, and safety. Thus, OTs will play a key role in public health initiatives such as:

  • Fall prevention
  • Heart disease and stroke prevention
  • Nutrition and physical activity education aimed at obesity reduction
  • Workplace wellness programs

 

As you can tell, the ACA will transform the future of OT—and I’m not the only one who’s making that prediction. In fact, OT leaders have been thinking about the changing role of OT for a long time. If you have a moment, take a look at this inspiring article, which was written long before the ACA was a glimmer in Congress’s eye.

How do you envision OT evolving in the years to come? What changes have you witnessed already? Share your thoughts in the comment section below.

  • Cloudy with a Chance of Reform: 5 Key Healthcare Forecasts for 2017 Image

    webinarJan 5, 2017

    Cloudy with a Chance of Reform: 5 Key Healthcare Forecasts for 2017

    Predicting the weather is tough—just ask any meteorologist who has called for sun on the day of a major downpour. Well, predicting the fate of the US healthcare system isn’t much easier—there’s a lot up in the air, after all. But, even without a healthcare equivalent of Doppler Radar, there are a few key trends that are sure to have a major impact on PTs, OTs, and SLPs in 2017 and beyond. And to keep your practice …

  • Common Questions from our Cloudy with a Chance of Reform Webinar Image

    articleFeb 13, 2017 | 13 min. read

    Common Questions from our Cloudy with a Chance of Reform Webinar

    In our first webinar of 2017 , WebPT’s co-founder and president, Heidi Jannenga, teamed up with CEO Nancy Ham to discuss the current and future healthcare trends that will impact PTs, OTs, and SLPs. (Missed it? No worries; you can view the complete recording here .) As always, we received quite a few questions during the presentation—way more than we could address live. So, we’ve put them all here, in one handy Q&A doc. Scroll through and …

  • This Week in PT News, May 2 Image

    articleMay 1, 2014 | 2 min. read

    This Week in PT News, May 2

    CMS Hints at ICD-10 Transition Date Last night, during the release of 2015 IPPS Proposed Rule , CMS referenced October 1, 2015, as the new implementation date for ICD-10. In fact, according to the AAPC , CMS referenced that date three separate times within the proposed rule. Not prepared for the transition? Well, we have you covered. You can reference our previous blog posts about ICD-10 here or you can head over to our ICD-10 blog . …

  • What the New HCAHPS Proposal Means for the Future of Hospital-Based PT  Image

    articleAug 11, 2016 | 3 min. read

    What the New HCAHPS Proposal Means for the Future of Hospital-Based PT

    When a patient is in pain, that patient wants relief—fast. And even if the patient knows medication is only a temporary fix—and a potentially dangerous one, at that—he or she will probably still choose drugs over longer-lasting, less-instant treatment options like physical therapy. For healthcare providers beholden to payment structures that incentivize patient satisfaction, that preference presents a real pickle: give the patient what he or she wants—long-term consequences be damned—or risk lower satisfaction scores (and potentially …

  • Putting the PT in Hospital: Direct Access in Acute Care Image

    articleNov 2, 2017 | 8 min. read

    Putting the PT in Hospital: Direct Access in Acute Care

    Physical therapy is a relatively new profession—although its origins can be traced back to Hippocrates in 460 BC . And it has quite the interesting history. In the US, many healthcare practitioners used physical therapy techniques to help patients during the polio epidemic of 1916. Then, according to this US Army Medical Department page and this slide deck by Aaron Keil, PT, DPT, OCS, it was World War I—which the US entered in 1917—that really propelled the …

  • How the Affordable Care Act Impacts Patient Payment Collection Image

    articleMay 16, 2016 | 5 min. read

    How the Affordable Care Act Impacts Patient Payment Collection

    You take the good; you take the bad. You take ’em both, and you have healthcare reform. Like most government-led initiatives, healthcare reform in general—and the Affordable Care Act (ACA) in particular—has inspired a lot of passionate debate. And that’s because, while it has expanded health coverage to millions of previously uninsured people (woo-hoo!), it also has given way to some less-than-positive consequences. One such effect: the trend toward increased patient financial responsibility (whomp, whomp). Out-of-Pocket Overload …

  • Think Big, Think Differently: 6 Bits of Inspiration from Ascend 2017 Image

    articleOct 5, 2017 | 11 min. read

    Think Big, Think Differently: 6 Bits of Inspiration from Ascend 2017

    The overarching theme of Ascend 2017 —the fourth-annual installment of rehab therapy’s premier business summit—was, quite simply, “Think big.” But, based on what we learned from our esteemed group of speakers over the course of two inspiration-filled days in Washington, DC, a more accurate tagline for this year’s conference might have been, “Think differently.” After all, in a field as complex as health care, grand aspirations are not enough. To solve the problems plaguing this industry, we …

  • Live from CSM: Leading the Way in Healthcare Reform and Women’s Empowerment Image

    articleFeb 6, 2015 | 15 min. read

    Live from CSM: Leading the Way in Healthcare Reform and Women’s Empowerment

    Temperatures here in Indianapolis have finally broken the freezing mark, with today’s predicted high at a balmy 40 degrees. But that warming trend isn’t limited to the brisk Midwest air. Things also are heating up inside of the Indiana Convention Center, where thousands of physical therapy professionals and students have converged for the APTA’s 2015 Combined Sections Meeting (CSM). There’s no shortage of hot issues on the radar for the physical therapy industry this year—and CSM’s jam-packed …

  • The PT Patient's Guide to Understanding Insurance Image

    downloadApr 3, 2017

    The PT Patient's Guide to Understanding Insurance

    Patients are shouldering a greater portion of their healthcare costs than ever before. But when they don’t know the specifics of their coverage, they can end up with much bigger bills than they bargained for—and that often leads to unpaid balances and unfinished treatment plans. Bring them up to speed—and improve your practice’s collections and patient retention—with this guide. Patients will learn: What it means for a service to be “covered.” How to define common insurance terms. …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.