Friday, May 12, 2017

Wait...You Can Pull Off Over 90% Productivity??

If this is you and you are an Occupational Therapist, please speak now or forever hold your peace in this mastery of an unheard skill.

New value-based OT evaluation codes were released in January and some occupational therapists claim they are able to meet 90% productivity ( and higher) when being asked to accomplish this at some settings! Can you believe it?

I am scratching my head at the confusion...this is so 2016 shenanigans.

We have been reminded that we get the permission to go back to our roots of what occupational therapy truly is, as well as being able to have the say of:

HOW LONG we spend with clients for evaluation sessions

AT WHAT COMPLEXITY LEVEL we evaluate them at (based on the complexity of their case) and....

no other non-OT person has the right to make this decision.

I was curious about the claims I read in social forums related to pulling off 90% + I explored the break down (seen below) for the time allotted in a typical day to do evaluations and/or treatments for clients in a post acute setting:

8 hours in a shift (480 minutes)

90% productivity met would be 432 minutes in a shift which would equal 7.2 hours

For California therapists: add on two mandatory 10 minute breaks to that - now we are hitting 452/480 minutes in the shift leaving us with 28 minutes to do a few un-billable things:


1. SELF CARE: water and pee ( or #2) breaks

2. EDUCATION and information gathering where the client is unable to be present:

This could be discussing education or occupational performance with:

The client's nurse who is running around the floor getting medication for their other patients

The doctor who is not in the building

Other disciplines working directly with this client who is not immediately present in the room at exactly the time you are having your session or caregiver/family involved.


am I missing any scenarios?


4. DOCUMENTATION and INTERPRETATION OF ASSESSMENTS that cannot be completed when you have your hands on treatment with your client

If you are able to physically master documentation on an IPAD while doing ADL treatment in a bathroom... or in the patient room while treating them, you MUST share your secrets for others to read because that is an impressive talent.

...I wonder this when the patient requires contact guard assist for standing balance while at the sink side for grooming

...or needs MAX redirection cues for safe participation in lower body dressing at the edge of the bed

...or needing to monitor their vitals while the client takes that rest break.

...or is impulsive in their movements during a cooking activity at stove top/ meal prep and needs the therapist to have two hands ready at any moment

...or that hands on assist for that safe shower transfer training

...or they have an aspiration risk that needs our eyes on them for the whole meal they are being trained to feed themselves with.

...or it's their first time handling that razor to shave themselves for grooming and their cognitive awareness isn't quite up to independent standards.

Other additional things like transporting a patient to and from our evaluation/treatment space of choice when this is not conducted in the client's room, clean up of materials and etc can likely be delegated right?....hmmm not sure if there is a designated rehab aide in all settings yet, having an assistant is helpful when we cannot do it all.

Here's the flip side...

(I am all about seeing each side of the coin and I do forewarn you on the real talk):

1. SELF CARE: I see the burnout and lack of self compassion for my occupational therapists who are my students, colleagues and clients of mine.

They are conforming to a non-OT rule to the way of evaluation, practice and treatment. Sure there is business to be done and I am not even talking about this being about having "no other choice." It is to point out that some disregard themselves as even being human, imperfect and doing their best...and that human I speak of must come first; to truly serve their clients.

2. CARE FOR COLLEAGUES: we want them to be their most successful in assisting their client and decrease their burnout as well. They flourish from our guidance and training to facilitate our client's access to their life occupations. Take that time to say "how are you?" "How can I help?" Connect with their human self.

3. CARE FOR CLIENTS/PATIENTS: Their occupations are at the center of our practice ...

and yet, are they getting their value's worth for the evaluation, practice and treatment we provide them?

Is it truly client-centered....a life occupation based practice...

...or is it a day at the rehab gym?

(is it me or have many client's taken up the hobby of cone stacking, arm biking and T-band pulling?)

What do they (your client) want to get back to? Do they want to:

Care for their dog?

Spend social time with their grandchild?

Get back into their golf swing?

Write that letter to their best friend on the other side of the coast?

Put on their make up every morning?

Pull the weeds from their garden?

Wipe their tuchus on their own despite being incontinent so they can live with their children at home and not worry about them cleaning up after themselves?

Play their favorite instrument again?

This is why I love and live off my copy of the Occupational Therapy Framework because I know if I get lost, there will always be it's guidance in getting back to my client's occupations.

I am also super grateful for my California State and National occupational therapy associations because they not only advocate on behalf of me to do be able to do my job...

They keep me in the loop about resources to use to defend my intention in everyday practice, as well as provide the up-to-date info impacting our profession AND when I need to step up and act to protect it

(and, and... let me tell you this much):

we need to protect our profession even when - and especially - things are going right.

So here is some real talk ;) :

1. Go easy on are productive when you are with your clients working toward their occupation based goals

AOTA provides you with a copy of an occupational profile template to use with your clients to accomplish this.

2. Stay true to your value-based evaluations in choosing accurate codes to best serve your client

Didn't get formal training at your site for this?!

Here is the OT evaluation worksheet I compiled to help you figure out the formula of what code to choose for which patient (not every client or diagnosis fits all).

3. Ask yourself when your gut instinct cries and screams at you:

"what other resources are out there that can help me shift from defeat of ethical dilemmas to champion mode?"

Here is an additional document to use in defending your case to administrators of facilities/ parties that say you should do it differently than you have decided clinically (when you in fact, are in the right):

Consensus Statement on Clinical Judgment in Health Care SettingsAOTA, APTA, ASHA

My closing thoughts about this high productivity? I go for the goal of being 100% productive:

 when in an actual session...

From the time I enter a client's presence, to the end of that session, I am accomplishing one goal: 

understanding their occupations to their fullest, jam packing my assessment and intervention with therapeutic use of self and seeing them flourish on their own to access what is meaningful to them.

Two things I kindly ask of you:

1. Leave your comments below on ways you feel productive in a one-on-one session by answering this question:

When it comes to OT, what makes your heart sing?

2. Share this with your fellow OT colleagues as we don't know what we don't know and sharing the resources is mandatory so they too can do what they do best in practice.

Thank you for stopping by,


Tuesday, December 27, 2016


HUGE ANNOUNCEMENT for my fellow Occupational Therapists! 

If you have yet to hear the news, the evaluation codes we choose to initiate our plan of care in serving our patients (in the realm of physical medicine and rehabilitation) is changing and fast! January 1st, 2017 to be exact.

Here is what you need to know before plugging in any evaluation code and how to decide on the right code to choose:

1.    It is a formula!
o   You plug the measures into each equation and come out with a result or answer. This answer indicates a level of complexity. That level of complexity determined by you is reflected as your OT evaluation code.
o   The worksheet included helps you decipher what measurement to plug in and where to get your answer to the equation. It is super simple if you go through the process in using the formula, for each and every patient. 


2.     DO NOT pay attention to the time indicated beside the code, it is irrelevant. Here’s why:
o   The code (for evaluation only not a standard visit with treatment only) is chosen based on a formula, not how long a therapist conducted an evaluation for.
o   The time is a projected or an educated guess of how long it may take to complete the level of complexity for an OT evaluation. THIS IS NOT utilized to formulate the data needed to decide on which code to choose.
o   At this time, each choice in code reflects the combined level of complexity in three categories (it is like a math problem based on three variables…consider it algebra)
o   The code is not reflective of the time spent doing any of the evaluation specifications but the “how” of deciding on which code to choose; this is determined with the step by step completion of the formula in the worksheet
o   The code costs may or may not be the same (depends on payer as time goes on and this may change in the future)
o   Each code is 1 unit; however, this does not mean choosing any code blindly or impulsively will suffice. You really have to ask yourself: how complex is this case? We will explore more why it is important to choose the right code in the next section!

3.    The codes directly reflect how valuable the OT profession is to our clients:
o   It indicates how complex our assessments are for individual patient cases; the higher level of complexity involved in each of the three criteria levels, the greater the combined level of complexity, resulting in a determined code.
o   The code reflects that our time is valued for the level of complexity in evaluation and developing a plan of care; this means quality of care is important and highlighted in the process.
o   It encourages and allows us to remain consistent with our OT framework
o   It is a tool to communicate our distinct value
o   It directly reflects how holistic we are
o   It helps us to remain ethical in clinical decision making
o   It helps us provide evidence as to why we choose the code we decide upon
o   It helps us advocate as individual practitioners; no other individual is allowed to decide a code for us.
o   When conducting an evaluation and formulation of a plan of care for our clients, only the OT practitioner may do so, reflected in their choosing of the code for that evaluation.
4.    The new OT evaluation codes are a collection of data.
o   This data collection reflects a skilled OT need in variety of MD referrals for a patient to receive consultation.
o   Why is this important? It appears to determine where OT is needed, where OT should be continued and where services in the community are lacking (all under the umbrella of physical medicine and rehabilitation).
o   It appears it will likely be greatly utilized in the future of other OT settings (mental health perhaps? Primary care? Community based private clinics?)
o   This data collection will also likely influence payer sources in the future to determine what payment is allotted for patient therapy costs, starting right at the beginning at evaluation.
o   As time goes on, our data input (aka OT evaluation code selection) may reflect what is covered in the future; therefore, we must be accurate in selection to continue to serve patients.

5.    Code selection is (and always will be) determined by the therapist, not administrators.
o   ethical and legal standards practiced strictly by the therapist conducting the evaluation is reflective of how we serve our clients and whether we get to continue to do so
o   Our unique role and professional, skilled expertise as occupational therapists allows us to make a decision or conclusion of which code to choose.
o   Code selection is based on four components completed in the evaluation process. This can only be done by the skilled therapist, therefore, no other discipline or individual can reflect which code is chosen for evaluation. 
6.    OT evaluations remain the same; they are just broken down into levels reflected in the code we choose
o   There is specific and stated criteria to determine which is an appropriate OT evaluation code to choose (listed in the worksheet).
o   Evaluation has four components; three of which when combined and formulated effectively, determine the code we choose.
o   We normally gather data to form an:
                                               i.     occupational history, as well as medical history, to determine a patient’s prior level of function
                                             ii.     whether the client has a change in functional performance and how we are utilizing our assessments
                                            iii.     clinical reasoning/decision making ability to determine an appropriate plan of care.
o   These codes directly reflect that we are clearly doing our job in the evaluation process. Consider them check boxes to mark off your evaluation checklist; use it as you complete your formal evaluation.
o   It ensures all aspects of an evaluation are covered and it will be individualized for each patient served. How complex is our case and how complex is the process to get a thorough assessment and implement a plan?

7.    Three of four components of the evaluation determine the code you choose
o   1. Occupational profile, client history (medical and therapy) 2. Assessment of occupational performance 3. Clinical decision making
o   once the level of complexity is chosen for each of these components, a overall, comprehensive level of complexity is decided (they are plugged into the formula, which is reflected as the OT evaluation code chosen).
o   The fourth component completed in the evaluation is developing the plan of care. This is directly reflected in the holistic assessment of the three component formula.

Now it is time to conduct your OT evaluation! The worksheet formula breaks down and guides you through how to choose the accurate code for each and every individual patient you evaluate. 
Deciding which OT evaluation code to use starting Jan 1st 2017 is a several step process! 
Decipher how to rank the level of complexity in the OT evaluation code you choose! This worksheet is designed to make it simple for the therapist to breakdown. In a step by step format, you will know how to choose the code to use for evaluation. 
This will decrease some of the confusion and bring our OT evaluation process back to serving the client. Stay ethical and legal with the need to know information. 

Here is the FREE formula worksheet to determine which OT evaluation code you need to use:

References for this information are included in the worksheet