Occupational Therapy Can Be One of the Great Ideas of Myopic 21st Century Health Policy Experts

(with deep apologies to the memory of Mary Reilly)

Social media has been one long party this week in the occupational therapy world with therapists and membership associations popping champagne corks over the recent article that appeared in Medical Care Research and Review entitled "Higher hospital spending on occupational therapy is associated with lower readmission rates."  Click here for the abstract, but please go read the whole thing.

Once you get beyond the abstract you get straight to the nut of the problem where the authors admit right in the introduction that "the relationship between hospital spending and quality...is poorly understood in the literature..."

For background reading on this precise issue and concerns about how people are defining 'quality' in health care outcomes click here and here .

There is unquestionably some 'value' (however one may choose to define that term) in decreasing hospital readmission rates.  People who are NOT in the hospital are almost certainly better off than those who are in the hospital, even if we reduce our operational definition of 'better off' to some biomedical metric of their health status.  So to be clear it is important to note that some 'value' is achieved in decreasing readmission to hospitals.

That point being stipulated, we must return to the larger concern for the profession of occupational therapy:

Is it the intention of the profession of occupational therapy to serve the myopic perspectives of 21st century health policy experts?

Is this what Mary Reilly intended in her Slagle lecture?

There is no blame directed at the administrators and Boards of Trustees of hospitals - it is their jobs to make sure that the hospital is able to financially function and in fact prosper.  This is not an either/or situation either, because by extension any employee of any hospital also has some responsibility for contributing to that financial health of an institution.

But where does the profession draw the line between meeting employment obligations to their worksites and becoming willing stooges to make sure that the myopic perspectives of cost control are realized?

When we define our profession is it our hope to serve the greater needs of Man and his need for competence and achievement and participation in the world, or do we reduce ourselves to a metric of being a band-aid that serves to cover the immediate problem of hospital readmission rates?

Perhaps avoiding hospital readmission is the first step to achieving a more broad vision and purpose, but I warn you all not to allow the financial interests of an institution to define the type of practice that is delivered by this profession.  Read deeply into the article and you will already see the scheming machination of the authors to determine exactly what kind of intervention will be best for the occupational therapists to provide.

Be careful, occupational therapy.  You might just become exactly what a hospital administrator or health policy expert wants you to be. 

Is that your big purpose?

References:

Rogers, A., Bai, G., Lavin, R.A., and Anderson, G.F. (2016). Higher hospital spending on occupational thearpy is associated with lower readmission rates. Medical Care Research and Review, 1-19.

Comments

Scott Harmon said…
Good point Chris. I recently attended the WebPT Ascend conference for practice owners and a therapist in the audience asked what we can do to stop bowing to the demands of insurance companies. He likened it to battered wife syndrome which I thought was a great analogy. No matter how hard we try to please these paying sources it's never enough.

If our main goal is to decrease hospital readmission rates we may not be fulfilling our function as an OT. I think decreased hospital readmission could certainly be the result of good OT but if that is our main goal we will never be a good enough wife to our overlord husband whose name is insurance.

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