Thursday, March 17, 2016

Update on occupational therapy and case management

One year ago I posted about the American Occupational Therapy Association process of an Ad Hoc committee to delineate the role in case management for occupational therapy in primary care and mental health.

My concern at that time centered around two primary points:

1. Case management is not a recognized domain of concern of occupational therapy practice.

2. There is a difference between 'things that can be done with OT skills' vs. 'what constitutes OT practice.'  I believe that occupational therapists should be delimiting practice and clarifying professional roles, not blurring them.

My objections have nothing at all to do with case management, which I consider a worthwhile and valuable endeavor.  It is my opinion that these are worthwhile and valuable endeavors for others and should not be something that OTs concern themselves with excessively.  The concern has a lot to do with resource allocation.

Despite this type of feedback that was given to the RA, the Ad Hoc Committee was created anyway.  Today I was given a copy of the committee's report to the RA by some colleagues who were aware that I had concerns about this issue last year.  Getting this report also coincides with my reading of the lead article in the March/April 2016 American Journal of Occupational Therapy entitled: Role of occupational therapy in case management and care coordination for clients with complex conditions.

I don't expect that it is any coincidence that such an article would be published just as the RA is considering the report about the topic and new motions on case management.  Clearly there are forces at work to push the case management agenda for the profession.

Unfortunately for the cause, the report to the RA reveals major problems for those who would like to think that OTs can act in a case management capacity.  Here are some rather stunning details in the report:

1. Of employers surveyed 98% LIMITED the case management role to nurses and social workers.  The vast majority of primary and medical employers required that the position be filled by a nurse only.

2. Of insurance plans surveyed in 14 states, 98% DID NOT allow occupational therapists to fulfill the role of a case manager.  Again, the majority stated that a nursing degree was required.

3. The committee survey attempted to find OT practitioners working as case managers only FOUR could be located in the entire United States.  Adding to the SEVEN members of the Ad Hoc Committee that is only ELEVEN OTs in the United States working in this capacity.

4. Not all state license and practice acts identify case management as a legitimate role for occupational therapists.

Despite the overwhelming lack of justification for any consideration whatsoever, the Ad Hoc group proposes several motions including AOTA lobbying license boards to recognize case management courses for OT continuing education credit, for AOTA to develop an official document on the role of OT in case management, and the creation of an online special interest section for professional networking of OTs working in this area.

The lead paper in the AJOT this month presents a similarly surprising argument given the overwhelming lack of supporting evidence.  Claiming that the Affordable Care Act is a "game changer both for the insurance industry and for health care providers" the authors state that "one group of providers that can be more than they are now is occupational therapy practitioners." (Robinson, Fisher, & Broussard, 2016).  It is very unclear why these authors think that OTs need to be more than what they are now, or what evidence exists outside of their own perceptions that such changes are needed.  They seem to lean heavily on the premise that occupational therapists should (for some inexplicable reason) be responsible for contributing to the highly partisan and controversial Triple Aim philosophy, which has been discussed here previously.

Why would a lead article in AJOT that offers nothing but the opinion of the authors as evidence be accepted as a legitimate argument to change the role and scope of the occupational therapy profession?  And why would such a paper be published just as some Ad Hoc committee makes recommendations to pour scarce resources into a project that benefits ELEVEN occupational therapists in the entire United States?

To be fair, not a lot of resources would be required to enact these proposals, but what justification exists for allocating any at all?

Isn't an Ad Hoc committee and a lead article in the professional journal and the volunteer efforts of RA members who are now forced to spend time on this issue enough to meet the needs of eleven occupational therapists in the United States?  Or do we really need to now spend money on more meetings and more papers and more conversation?

Spending time on case management roles for OT is wasteful.  These efforts have no practical relevance to the profession. There are certainly more pressing issues for members of the association to attend to.

References:

AOTA Representative Assembly (2016, January 8). Report of the Ad Hoc Committee on the Role of OT as Case Managers, Bethesda, MD: Author.

Robinson, M., Fisher, T.F., & Broussard, K. (2016). Role of occupational therapy in case management and care coordination for clients with complex conditions. American Journal of Occupational Therapy, 70, 7002090010.



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