Why You Should Be a Lifelong Member of AOTA and NMOTA

 

health

In 1917 a forward-thinking group of people created a professional association of occupational therapists (AOTA) in order to promote the use of occupation as a powerful healing modality, including supporting research and advocacy for the fledgling group. This founding also set in motion a 100 year (and counting) project of work by a dedicated association staff and volunteer occupational therapy professionals to ensure occupational therapy has defined and observable worth to law and policy makers, medical system administrators, insurers, health organizations, and people who benefit from OT services. The New Mexico Occupational Therapy Association (NMOTA) was established in order to protect and support the concept of occupation as health on a local and statewide basis.

It would be a grave error to suppose that occupational therapists can practice and be paid for their services only because one has education, training, competence examination, and licensing to practice. To the point: AOTA made this possible for you.

Occupational therapists are only able to practice because professional membership associations like AOTA and NMOTA exist to provide evidence and persuade decision-makers to include occupational therapy as a paid benefit in federal, public, and private realms. From the inclusion of occupational therapy in veteran’s rehabilitation during World War I and II, to the present Essential Health Benefits inclusion of occupational therapy as a mandated service, and now, the recognition of OT as mental health providers: your privilege to practice and draw top wages is predicated on the work of others who believed firmly and durably in the work you do.

The work of 100 years is not done, it is ongoing. New threats and present dangers threaten to un-ravel the goal of healthcare for all people, and will certainly jeopardize the careers of those who work within health systems (it has happened before). It requires funding, strategic action, and the power of membership to respond effectively.

The only question is, are you willing to support the associations that enable you to work, get paid, and serve others? The answer should be an unequivocal YES.

Membership for is affordable. Membership is certainly worth giving up something of lesser value in the short-term in order to secure the greater value of your future in the long term.

Be a Member.

UPDATED NEWS ON SCHOOL OT

Representatives for ancillary providers met with state directors for special education at the New Mexico Public Education Department on Tuesday, June 7. NMOTA President Carla Wilhite was present at the meeting, and has this report for school-based occupational therapists:

Special Education Director Mike Lovato, and Assistant Director Mark Mutz stated that NMPED supports the use of assistants in providing related services in schools. Both recognize that in many of New Mexico's rural and frontier communities that assistants are essential to enabling schools to serve the needs of children with an Individualized Education Plan (IEP). Director Lovato said, "We can't do without them".

However, it is important for the Local Educational Agencies to appropriately document and report the need for personnel based on the service needs of the children, which in turn, justifies the amount of full time equivalency (FTE) is needed by related service providers like OT, PT, SLP, and MSW.

In order to utilze assistants, the OT supervisor is assigned the FTE workload for the number of OTAs, in addition to the FTE they will be fulfilling to provide related services. NMPED requires that any position carrying FTE over 1.1 requires NMPED approval. The approval is contingent on justifying the need for the FTE. For example, if a LEA determines they require 5.0 FTE of OT to provide related services for children on an IEP, the supervising OT or contracting OT would carry the 5.0 FTE (1.0 FTE for the OT, and 4.0 FTE of OTA, or 0.5 FTE for the OT, and 4.5 FTE of OTA).

Regarding "direct service", Directors Lovato and Mutz concur that all of the components such as collaboration, training of teachers, evaluation, re-evaluation, preparation time, home visits, preparation of equipment- are recognized as being directly related to serving the child on IEP. However, Director Lovato wanted to emphasize that face to face time, in his opinion, is the most crucial service provided to children.

Moving forward, NMPED will be looking for anomalies in the STARS data: wrong codes, zero direct service situations, double-dipping (ex. drawing down FTE from pre-school AND K-21), etc.; and, only one formula for calculating the FTE will be used (LEA's can no longer calculate based on the average teachers contact hours).

If anomalies are found, NMPED will be checking with the LEAs to provide justification through documentation. Ancillary providers should be keeping service logs accounting for what they are doing in terms of related services. Director Lovato said he has heard some school districts are having ancillaries to document up to minute increments about their activities. This is probably overkill, says Lovato. Half hour, or even hourly reporting is probably sufficient. In addition, NMPED recognizes that the allocation of time during a week can shift, especially for social workers who may be involved in crisis or suicide interventions. So, some weeks may vary in terms of services: one week has more hours, one week has less;  but they average out. The NMPED is also supportive of LEA's identifying creative and innovative ways to address service logs; for example: time studies that assist LEA's in developing multipliers to estimate the annual FTE in order to decrease the time burden of constantly documenting the weekly schedule. If it is reasonable, NMPED is open and responsive to that.

Director Lovato and Mutz acknowledge they have heard that positions are being terminated around the state, but were emphatic this is a local issue that NMPED has no control over. Important points to consider they say are:

1. The legislature allocated approximately $450 million dollars to special education in New Mexico. According to Director Lovato, this should be more than sufficient. However, there is a caveat:

2. The LEA's receive all monies to support public education as an entire "pot" (indluding the special ed money). These funds are non-categorical, meaning the superintendents of schools make the choice of how much funding will go into Special Education, and can do whatever they want with the money left.

3. NMPED assumes the superintendents are doing the right thing: that all the funding allocated for special education will support special education.

4. LEA's receive approximately $106,000 per ancillary service provider FTE. NMPED assumes that after salary and benefits, any of the residual funding will support special education.

5. NMPED's takeaway message is: the mission of Special Education is to assist students have access to general education, and make it to graduation. There is sufficient money for the mission. Over-utilizing funding reduces the unit value available to support students. LEAs have the responsibility to do the right thing with the funding.

Carla's takeaway impression from the meeting: I am hearing that "on the ground" positions are being cut around the state, with the brunt of those cuts being borne by social workers. The NMPED is intent on enforcing the "rules", but some LEAs have developed considerable bad habits (underallocating the money "pot" to special education, converting that money to other purposes not related to special education, over-utilzing FTE, and double-dipping funding streams. NMOTA will be writing letters to superintendents and LEAs urging them to follow best practices in receiving and utilzing state funding for special education, as well as providing a caution against inflating workload onto fewer ancillaries. "Loading up" on the FTE will only lead to an inability to deliver appropriate services to children on IEP and reduce the ability of the LEA to meet assurances for maintenance of effort.

Please email Carla about questions and concerns at: This email address is being protected from spambots. You need JavaScript enabled to view it.

 


 

The Design Mind in Occupational Therapy

The theme of the 2016 NMOTA Conference is "Creativity Intersections in Occupational Therapy: Occupational Therapists Co-Constructing the Bright Future of Practice, Education, and Health Through Occupation". This is the beginning of a series on the subject, beginning with occupational therapy education.

One of the strategic initiatives of the American Occupational Therapy Association is to seek increasing "educators' understanding of the need to accelerate content development in curricula for changing workforce opportunities in areas such as wellness, prevention, primary care, wounded warriors, mental health, and work and industry....and support the preparation of existing occupational therapy practitioners for traditional and changing roles, environments, and patient demographics through continuing education, conference sessions, books, and their preferred communication vehicles". 

As an educator and practitioner, I see this as a complex challenge. STUFFING more content into the brains of learners does not necessarily lead to filling all of the practice niches and opportunities that will evolve now and in the future. Rather, we must evolve as a professon to recognize occupation where it is occuring in native contexts of work, home, community, or school AND be able to nimbly respond when we see individuals, families, and groups challenged in performing desired and healthful occupations. This requires a DESIGN MIND. 

What is a design mind? Certainly it is a habit of mind for thinking creatively, flexibly, and moving adaptively to changing phenomena. According to the blog at Design Mind (post from April 26, 2014 http://designmind.frogdesign.com/blog), DESIGNERS must be:

1. SYSTEMS THINKERS: Designing for the inter-relationship of ideas, not just a single aspect of a problem. 

An example of teaching occupational therapy's version of design mind might incorporate having students examine ohow facilitating an individual's use of a dressing stick leads not only to the independence of dressing oneself, but also to the relationshps and connections dressing has to a person's identity through fashion and participation in work and community; and how inclusion of all people into the fullness of society expands our social and cultural competence in the world (i.e. occupational justice).

2. UNIFYING DESIGN WITH TECHNOLOGY: Today's designers must be capable: not only with creative materials and methods, but also be capable in the realm of technology.

Many examples of design mind are occuring in many colleges and universities, and in private practice, where occupational therapists are designing apps and using iPads to enable activities of daily living. The new "shop" course in OT education programs should be replete with 3D Printers, small robotics, and creative software like Adobe Slate, Google Sketch, and more. Students and practitioners must become engaged in creating the products, services, and designs that nurture people occupying spaces that permit maximum inclusion and use of space for all. Space includes virtuality.

3. ENTREPREUNEURIAL: According to Design Mind, people burgioning with ideas go to the FRONT OF THE PACK.

Occupational therapists, occupational therapy educators, and occupational therapy students brimming with ideas and solutions for addressing society's occupational problems will be reimbursed FIRST and recruited into positions of leadership and policy making at the highest levels of creative thinking and doing.

4. THINK WITH OUR HANDS: Creating things help bring design skills to life.

In occupational therapy education this might look like giving students assignments requiring the critical thinking of design, as well as the tool of TIME to incubate and marinate in ideas, learning to shape those ideas, turn them over, visualize them inside/out, and practice performing them in contexts where occupation needs to unfold. Such a learning culture allows (even perpetuates) failure, pushing the envelope, risk-taking, and reaping the reward when prototypical ideas can  be launched robustly into places of practice.

5. EMPHASIZES EXPERIENCE, NOT THINGS. Good design is about relationships.

Design creates change, and so does therapeutic use of self...the mindful design of using one's personality in helping another person visualize and engage in a healthful lifeway. 

6. CONNECT BY SHARING: The 21st Century is about open-source, sharing, and collaboration.

In occupational therapy education and practice, this is the encouragement of the community of OTs to "steal" and appropriate ideas like artists do. Reserving and meting out intellectual effort within the academy does little to ensure our profession is wedely recognized and globablly connected. Educators with design mind will push to share in open journals, on blogs, in the Creative Commons, and other connecting sources. It's about publishing to flourish versus publishing to "not perish". 

In summary, the 21st century is ours to claim as the premier health discipline, but it will require creating new habits of mind in learners accustomed to passively recieving information and becoming technically proficient in traditional service delivery. To survive as a health profession, we must CREATE!                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

President's Corner: Insurers Diluting Affordable Care Act

 

Setting the Scene: A speaker at a continuing education event mentions "down in Arizona the insurers are only paying for physical therapy. They can do that now under the Affordable Care Act". A participant asks, "Are the OT's having PT's just sign off?" Speaker states, "No, they tried that, but they [insurers] caught on, and it doesn't work now".

Scene II: A Wyoming OT says, "The insurer will only pay for OT for stroke and tramautic brain injury now. So we have to bill under physical therapy codes".

Scene III: A Minnesota OT says, "My facilikty no longer wants us to run occupational therapy groups. They want us to just do activities. Can we sign off as OT's on these groups without doing an occupational therapy evaluation and intervention plan?"

What is disturbing about these scenarios is that the distinct value of occupational therapy is being eroded by larger economic forces. Although OTs are being intrepid in working around the system realities in which they are caught, in the long term, they wind up contributing to the erosion of occupational therapy practice.

The Affordable Care Act states "Rehabilitative/Rehabilitation Services Health care are services that help you keep, get back, or improve skills and functioning for daily living that have been lost or impaired  because you were sick, hurt, or disabled. These services MAY [my emphasis] include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.

We rightly interpret the AOC wording to mean insurers should cover ALL the necessary rehabiiltation services indicated. However, we would be wrong to assume insurers interpret this in the same way. It is obvious in the examples above that insurers are perverting the wrap around of services necessary to get people back to functioning. They are partitioning occupational therapy OUT of rehabilitation services through that ONE little word: MAY. The rationale would be "Why pay for OT and PT, when we can just pay for PT and call it good".

Face it. The profession of PT has greater name recognition and three times the lobbying ware chest than OT does. Of course insurers are going to omit the "weaker" profession, and save a dollar doing it. Out of 90,000 OT practitioners, only 2000 of them gave to the AOTA Political Action Committee last year (2015).

Intead of accepting temporary work-a-rounds, occupational therapists need to get aggressive. We need to be assertive in distinguishing our services from that of other health disciplines. We have to stand united nationally, regionally, and locally in staking our claim on function through performing occupations or preparing people to perform occupations.

If you are dealing with a "work-a-round" situation like the one above, that threatens to erode the profession: let your association know. We can all link to AOTA for advice, we can take action, we can perturb systems like insurers that want to give sub-minimal effort in caring for people just to save a few bucks. Don't wait and hope it just works out.

A final caution: Health care reform is NOT over. We CAN directly influence the process of reform. Or, we can let the insurers do it all. If you are not inclined to DIRECT action, at least give what you can regularly to AOTAPAC at:

http://www.aota.org/advocacy-policy/aotpac.aspx

 


 

 

 

Do You Have the OTA Supervision Log Blues?

A little over a month to go to renew licensure, and the emails are rolling into NMOTA about what to do to renew this year regarding supervision logs. We sought some clarification and guidance from the Board of Examiner's for OT.

First, if you received your renewal notice and it says you are being audited, you must turn in your supervision logs/contacts for the past year in order to renew your license.

Second, if you did NOT have an audit message on your renewal notice, you do not have to turn in the supervision logs.


NMOTA Says:


Third, whether you are audited or not, you should keep your supervision log records. Why? Because if someone makes a complaint against your license and the Board of Examiners for OT investigates you...they will want those records available for review. No doubt in my mind.


Fourth, the worst case scenario...you haven't been keeping up your supervision logs. DO NOT fabricate information for the supervision logs. Accurately piecing together a supervision log from data, notes, or calendar entries between the OTA and OT may be possible for a few weeks, and a month or so is a stretch. But seriously- several months or a year is just not believable.

If you fall into the latter camp (months and months of no log), friend, you need to make some changes in your priorities going forward.
NMOTA Says:

1.    Create a supervision plan for every OTA and provisional practitioner right NOW. Carla emailed out one very simple version as a PDF document a few weeks ago to every member, as well as a sample for contact notes. All the required elements are on these forms. One caveat: we have not asked the Board of Examiners for OT to review it, but are planning on doing so soon.
2.    Be creative. Multiple solutions are available that can be customized to your setting. Supervision is a real and dynamic process that is intended to improve client outcomes, clinical efficiency, and communication.
3.    If you have to do it, make it count for something. AOTA has numerous resources to help your clinical environment integrate supervision into the familiar and everday activities of OTs and OTAs at work.
4.    Check the supervision discussion on the NMOTA website. Ask questions, give answers, share information. We need to help one another make regulatory and licensing compliance an easy option for all and part of our professional culture. OT Managers, please weigh in with your best tips and advice.

Regulation of Health Professions in the Time of Creative Entrepreneurism

Photo of trophys in a line

 

In U.S. healthcare these days, people are in the driver’s seat of how to spend their discretionary
healthcare dollars. We are literally health consumers as we seek remedies, cures, and products to speed
healing, prevent aging, and soothe the aches and pains of daily living. And obviously, there are no
shortage of businesses willing to ply and purvey every manner of cream, salve, splint, machine,
touch therapy, service, and device to satisfy our health cravings. We are probably the most health
information inundated nation in the world, but are we savvy consumers? Are we health literate
enough to decide which health services and products we want to purchase, or will we just become the
willing victims of 21st century snake-oil hucksterism? Shouldn’t someone be watching our backs to
make sure we are getting what we pay for?


State regulatory and licensing boards have typically been the entities watching our backs to ensure
unscrupulous and unskilled people do not perform skilled health services or sell harmful products
to unsuspecting consumers. The virtue of Health is a commodity of priceless value that we cannot
put at risk to illusory claims. Do we really want someone who is not a licensed dental professional
to perform tooth extractions, like El Dentista in Santa Fe? The guy wasn’t even that cheap.


On the other hand, we are a nation of entrepreneurism, and if a competitor can offer a service or
product superior to ours, shouldn’t they have the right to get it into the hands of consumers who
stand to benefit? In this example, most of us don’t like unnecessary regulation or limitations on
getting the bigger, better, and economical products into our hands. And as a nation we don’t like
monopolies either, who have had a tendency to greedily hike up prices or create artificial
scarcities.But where is the tipping point? How much regulation for our well-being vs. how much freedom for enterprise and competition?

Well, the U.S. Supreme Court has definitely made it harder for states to figure that out when it comes to protection of health. In a recent 2015 Supreme Court decision North Carolina Board of Dental Examiners v. Federal Trade Commission, the justices decided that state licensing boards composed of market participants do not enjoy automatic immunity from antitrust laws, (i.e. a licensing board comprised of a majority of occupational therapists, for example, can be held liable for damages if they are found to be too “anti-competition”). In the facts of the case: the dental board tried to keep non-dentists from providing teeth-whitening services, and especially at prices undercutting the same teeth whitening services of their own profession: dentists. The board sent threatening letters to non-dentists who offered teeth-whitening services and then encouraged “mall operators to kick out kiosks used for teeth whitening”, according to Eric Fraser, an analyst on the case. The self-interested protectionism of the dentist’s board is unmistakable in hindsight.


In New Mexico, we have yet to see the state completely tip its hand on what it will do to protect
itself from future litigation stemming from the decision. An attempt might be made to create a Super Board
or boards comprised of only non-market participants/citizens. The legislature has already created a
mechanism to handle new scope of practice changes during the 2015 session, and the governor signed
House Bill 122. House Bill 122 states that any licensee can request scope of practice changes, but
that changes must be evidenced and investigated by a legislative committee which will issue a
recommendation to the entire legislature on whether to approve the scope of practice change or not.

What’s the problem? The problem is: those high on the food chain of influence, like physicians,
will probably navigate the new system without problems in changing scope; while smaller and
substantially less influential professions will have to endure street-fight level struggles for the
leftovers. I’m not “mad” at physicians for having such positionality, I’m just that envious for my
beloved profession to have that kind of credibility and influence.


Occupational therapists need a strong regulatory and licensing board to oversee the practice of
occupational therapy in New Mexico, to clarify our scope of practice, AND to keep unskilled
providers from causing harm to our prospective clients. It is, without doubt, a position for
multiple Salomon’s. As occupational therapists, we also need to clearly and distinctly articulate
who we are, what we do, and how we do it. After all, who can do what we do?? On the other hand, who can't?


Citation: Eric M. Fraser, Opinion analysis: No antitrust immunity for professional licensing
boards, SCOTUSblog (Feb. 25, 2015, 3:56 PM), http://www.scotusblog.com/2015/02/opinion-analysis-no-
antitrust-immunity-for-professional-licensing-boards/

OT Certification Made Easy!
Join and Support OT in New Mexico!
Join and Support Your National Organization
Tuesday the 25th. Copyright © NMOTA.ORG 2017 - All Rights Reserved