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OTs: How preventive therapy can beef up reimbursement

Rehab Regs, April 8, 2004

Source: Briefings on Outpatient Rehab: Reimbursement and Regulations, November 2002

For OTs looking to expand their practice and create a new revenue stream, work with senior citizens: The sessions can be very rewarding, and profitable.

A recent study published in the August issue of theJournal of the American Geriatrics Society measured how preventive OT affected the "well elderly." Study participants say they felt better both physically and emotionally.

"Occupational therapy is a highly cost-effective and much better use of scarce health care resources than many other interventions routinely prescribed for elderly patients," says Joel Hay, PhD, a health care economist at the University of Southern California School of Pharmacy, and lead author of the study.

Home visits: Payment and reimbursement

For visits to a patient's home, you can bill insurance or have the patient pay an out-of-pocket fee, says Frank Gainer, MHS, OTRL, education program manager for the American Occupational Therapy Association. There are pros and cons to both forms of reimbursement: Medicare, for example, will only pay for a home health visit if it considers the therapy a skilled service. However, to be eligible for Medicare reimbursement, a physician must order the service.

Medicare bases skilled services on the diagnosis and whether the patient can make an actual change in physical function. OTs must highlight these changes in the documentation they submit to the insurance payers.

Include the following three items in your documentation:

Treatment goals
Treatment results
Amount of time spent at the patient's home

The additional reimbursement plus the amount of time involved in your visits makes this a perfect addition to your practice. "There are a number of OTs that do home health on the side," Gainer says.

Private pay

You do not have to contact physicians for the private pay option; payment comes from the patient. An OT can expect to earn between $50 and $150 per visit. The number of visits an OT will make to each patient's home will vary, Gainer says, noting that some complete the therapy in one session, while others need six or more. Base the number of visits on the level of the patient's disability.

Getting started

1. Provide an initial assessment of the patient's home. "You want to look at their entire support system-not just the physical home," says Gainer.

"Does [the patient] have someone coming in to help with the laundry and the house cleaning? What's the family support system like? Do they have a significant other?"

2. Identify the safety hazards of the home. Here are some common, troubling objects you should be aware of when looking over a home for the first time:

Throw rugs
Telephones with long cords.
Alternatives: Gainer suggests fastening the rugs to the floor with strong, double-sided tape. And instead of corded phones, suggest a portable, hand-held option.

3. Don't be afraid to suggest changes to the household layout. "Some patients haven't moved anything in their home for the last 30 years," Gainer says. "As a fresh set of eyes, I ask to move objects, such as a hallway bookcase, out of the way so they can have more room to walk down the hall."

But Gainer urges discretion. Don't rearrange a home during the first visit. Establish trust and work with the patient to let him or her know that you know your craft.

Danger in rubber ducky land

When it comes to elderly injuries, the bathroom remains a slippery house of horrors.

"Some older people enjoy taking baths and want to continue this," Gainer says, "it can be very dangerous for them to get in and out of the tub."

Consider these tips to make tubs safer for seniors:

Suggest a shower chair.
Install a shower bench.
Affix shower grab bars to the sides of the bathtub walls. Take into consideration the measurement of the bars during installation, as well as how the patient gets in and out of the tub, and which way the faucet faces.
Purchase bath mats, with rubber grippers on the bottom
Not all bathroom accidents happen in the tub. If the toilet is too low, seniors often struggle to get up-especially people with arthritis.
Install a raised commode seat or one with arms that fits over a "regular" seat.
When older people have difficulty getting off the toilet, many grab the sink or toilet paper dispenser. This is very dangerous, says Gainer, because the person's hands can slip off the sink or the dispenser can break.

Tell your patients to purchase these bathroom safety items at any medical supply store or their local pharmacy. Medicare and private insurers reimburse patients for many of these items. The patient often pays just 20% of the cost. The one caveat: A physician must recommend these tools.

When a patient shows cognitive changes, consider the range of options

Falls aren't the only things that can disrupt the home life of an elderly person; cognitive changes such as dementia and Alzheimer's disease raise safety issues, too.

OTs: When doing your evaluation, check to see whether symptoms of these maladies are creeping into your patient's lives. If you do suspect dementia, here is one precautionary suggestion: Instruct the patient not to cook on a stove.

"By the time you are called in, a family member probably has a sense of what is going on," says Frank Gainer, MHS, OTRL, education program manager for the American Occupational Therapy Association. "Make sure that the spouse or family member is involved in your evaluation process. They can give you feedback on what is going on in the home."

Stove restrictions or not, people have to eat. Gainer lists the following ways to prepare meals without using a stove: