Showing posts from July, 2009

Recurring philosophical questions

I have had a recurring question in my mind since the beginning of my occupational therapy career. At that time I was working in an urban acute care psychiatric facility and I was fresh out of college with my head full of lofty ideas about occupational behavior, occupational role, and the potential of occupational therapy to solve societal problems. I read every word that Mary Reilly ever wrote, and listened as they were explained to me in the classroom by proxy of Phil Shannon and watched in amazement as they were practiced in a hospice home care setting while being mentored by Kent Tigges. Still, after work each day I took the Metro North to the safety of suburban living and I kept rolling over the question: "How can I remember NOT to transpose my values and my concept of Quality when working as an occupational therapist??" My training told me that I wanted my patients to develop options, decision-making, problem solving, and agency relating to some return to occupati

Fun-filled game of the day: Guess the CSE chairperson's intent!

Why would a CSE chairperson who has worked in the field for over 20 years suddenly want more information on the Beery VMI?? This chairperson has seen this assessment used hundreds of other times... so why more information now?? Inquiring therapists want to know. re: Johnny XXX To Whom it May Concern: At the request of the district CSE Chairperson, here is additional information regarding Johnny's performance on the Beery VMI. Quite honestly this is an unusual request as this test is perhaps the most commonly used assessment in school-based occupational therapy and I do not understand why special explanations are required for this child. I am hopeful that this information will help to get an appropriate plan for this child into place. The Beery Developmental Test of Visual Motor Integration 5th Edition is a widely respected assessment tool that is backed by decades of research and clinical use. The Beery VMI screens for visual-motor deficits that can lead to learning, neuropsyc

We need consumer education and tort reform before handing over health care to our government

There are many conversations swirling about regarding health care reform, proposed 'public options,' and tax/penalty methodology to pay for the programs. The more that gets said the less specificity seems to be revealed. Instead I am hearing a lot of lofty and non-specific theory that the system will pay for itself by 'inherent efficiencies' which I have concern may be code for rationing. When pressed for these kinds of details all I am hearing is a full-frontal assault on 'insurance companies' but occasionally there is a jab slipped in at providers who are accused of making decisions based on reimbursement structure and not on clinical necessity. There is no doubt that a reimbursement system obviously creates incentives and disincentives to how care is delivered - but to accuse providers of driving decisions solely on financial incentive is a little much. The added insult is to trumpet the 'endorsement' of prominent organizations - like the AMA - w

The impact of proposed new federal regulation on health care delivery

Proposed new health care regulations may have an extraordinarily negative impact on the way consumers access their health care. The following information is from a September 2005 report from the Small Business Association entitled The Impact of Regulatory Costs on Small Firms. "The annual cost of federal regulations in the United States increased to more than $1.1 trillion in 2004. Had every household received a bill for an equal share, each would have owed $10,172, an amount that exceeds what the average American household spent on health care in 2004 (slightly under $9,000). While all citizens and businesses of course pay some portion of these costs, the distribution of the burden of regulations is quite uneven. The portion of regulatory costs that falls initially on businesses was $5,633 per employee in 2004, a 4.1 percent cost increase since 2000 after adjusting for inflation. Small businesses, defined as firms employing fewer than 20 employees, bear the largest burden of fed