AOTA

Jennifer DeRosa, OTR/L

Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour)

 Abstract

Chronic conditions such as heart disease, stroke, diabetes, and arthritis are some of the most common, costly, and preventable health issues ailing Americans today (Centers for Disease Control and Prevention, n.d.). Americans are experiencing a shift in their need for health care services—from acute, episodic health care to care for chronic conditions—and this change poses a unique challenge for our health care delivery system as it currently exists. As the federal agency charged with administering Medicare and collaborating with states regarding Medicaid and children’s insurance programs, the Centers for Medicare & Medicaid Services (CMS) sets a standard for reimbursement that others follow. Current reimbursement models are beginning to change to pay-for-performance programs, whereby agencies are incentivized and rewarded to coordinate care and improve quality measures, notably client satisfaction and reduction in use of health care services, specifically re-hospitalizations. As payment models evolve and the delivery of health care in America is restructured, it is imperative that occupational therapy practitioners have the tools to communicate and deliver value. Providers deemed valuable by the health care systems in which they work will be those who are adept at collaborating with clients to achieve realistic goals that result in high client satisfaction and positive, health-related behavior change. Providing evidence-based interventions that include using self-management support is the key to improving clients’ satisfaction with managing their chronic health conditions, thus improving outcomes overall. This article explores the current climate of our health care system and highlights the pivotal role occupational therapy practitioners can play in improving performance outcomes with their clients through the therapeutic use of self and engaging our clients in productive conversations about behavior change.

Learning Objectives

1. Identify three factors contributing to the need for health care delivery and reimbursement reform.

2. Identify aspects of the Patient Protection and Affordable Care Act of 2010 and reimbursement changes relative to health care delivery in America.

3. Recognize the necessary principles of internal motivation and the importance of fostering this in clients.

4. Identify the five self-management support techniques used to guide care and frame therapy sessions.

Content Focus: Category 3: Professional Issues: Legal, Legislative, Regulatory, & Reimbursement Issues