Healthcare Management in Occupational Therapy

Question 1: Legal Documentation Skills/Billing Codes Assignment

Question 2: Effective Supervision

Issues that may arise with Alice (OT) supervising Mike (OTA) will be about the level of supervision that Alice would have over Mike. It is important that they both sit down and clearly set up a plan for supervision that creates a safe and effective work environment and promotes professional competence and development. They will both have to work together to develop the best and most effective treatment plan/implementation for their clients. Alice will need to be able to contact Mike concerning patients who have recently been evaluated and need to be scheduled for therapy sessions. Alice holds responsibility for Mike and needs to have confidence that Mike will perform competently with her clients. Alice will need to discuss this fact with Mike and make sure they will be able to perform at the same level for each patient. They can also discuss other modes of communication for effective supervision that will make it easier for them to provide the best patient care if Alice is unable to be directly present during Mike’s implementation of services, such as through telehealth services. Telehealth methods of communication include email, text message, phone calls, etc. They will need to communicate on issues related to appropriate and timely documentation, such as completing progress notes before the scheduled due dates and making sure each note has been co-signed according to corporate policy and state and national supervision requirements (Jacobs, 2016).

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Alice’s role in the supervision of Mike is to provide direct supervision in the beginning stages of providing patient care. This way Alice will be able to make sure the Mike is able to develop service competency before she can feel comfortable about Mike providing patient care without this level of supervision. They will need to collaborate and implement effective communication in order to move forward into other levels of supervision such as routine supervision or general supervision that will allow for Mike to have more responsibilities in patient care. Mike will have the role to collaborate with Alice to communicate patient progress and important information about patient care. Mike can provide input for discharge recommendations (AE/AD recommendations, home evaluation, and transition services) to Alice, even though Alice has the main responsibility in discharge planning. Mike’s main responsibility is to implement Alice’s (OT) plan of care and complete daily documentation as well as progress notes.

Mike’s role in the healthcare environment as an OTA will be to collaborate with Alice (OT) on patient intervention plans and communicate with Alice all things patient care and provide recommendations on AD/AE the patient may need in order to participate in functional tasks as well as discharge planning. Mike will provide the implementation of the OTs plan of care. Mike will collaborate with Alice throughout the entire OT process and will contribute to the intervention plan and implementation of the plan as well as documenting the patient’s progress through progress notes. Mike can also provide home assessments, transitioning services, and discharge planning in collaboration with Alice or if service competency has been established. Mike will also need to communicate and develop effective and successful interprofessional relationships with the nursing staff, PTAs/PTs, other OTAs/OTs, CNAs, the facility administrator/manager, directors of rehab, the cooking staff, etc. Mike will need to be able to operate as a team member in order to acquire pertinent patient information regarding when/if the patient has taken their medication that day, if they were able to finish their meal during lunchtime, information about a new patient he’ll be seeing from another OTA or PTA who has worked with the patient before, and asking the CNA staff about if the patient is up and ready to participate in therapy that day or if they can help with a Hoyer lift to get patient up and transferred into their chairs for transportation to the therapy gym.

The first OTA educational requirements include obtaining a high school diploma or a GED. The individual will then need to complete the required prerequisite classes (such as A&P, psychology, etc.) before applying to an accredited OTA program, which is typically 2-3 years long. After being accepted into the OTA program, you will need to complete the required course specific classes along with completion of required fieldwork and observation hours. Following the completion of the OTA program, the NBCOT exam will need to be scheduled and passed to become an official OTA. In addition, the occupational therapy jurisprudence exam for the state you wish to practice will need to be completed and passed in order to obtain a license and begin working in the field. In comparison, an OT has similar steps to take in the educational process; however, they will acquire a four-year bachelor's degree instead of a two-year associate's degree. Once a bachelor's degree is obtained, the individual will continue school for two more years to acquire their master’s degree, or complete their associate degree and apply to a bridge program to achieve their master’s degree. Like an OTA, they will also be required to take and pass the NBCOT and jurisprudence exam to obtain their state license to practice in the field as an OTR.

There are six levels of supervision. The highest level of supervision is direct supervision, where a supervising OTR is readily available at the facility to help and provide assistance/supervision for service implementation alongside the COTA. Mike (OTA) can directly contact Alice (OT) via telecommunication if he has a question about a certain technique or needs to reschedule a client’s appointment. This level of supervision will impact Alice’s role as a supervising OTR by increasing her responsibilities to directly be available to Mike and uphold more responsibilities in patient care implementation. Mike’s role in this level of supervision will be decreased as he will be leaning more on the guidance of Alice as he develops more leadership skills and service competency in service delivery. The next level of supervision is immediate supervision, where there is face-to-face interaction between the OTR and COTA and the OTR is within close proximity of the OTA. This level will involve Alice being at the facility with Mike and Alice being available for face-to-face communication with Mike during the treatment implementation. The next level of supervision is close supervision. This level of supervision involves daily, direct communication but not as readily available as direct supervision such as through phone calls or daily check-ins. This level of supervision gives Mike a sense of more responsibilities in providing treatment implementation as Alice will not be as readily available as she was in the previous levels of supervision. This will also decrease Alice’s responsibilities and provide her more freedom to supervise other COTAs as well as conducting more patient evaluations. Routine supervision involves the supervising OTR giving instruction and guidance initially to the COTA at the facility and then providing review of the COTAs therapy implementation periodically (about every 2 weeks) and using telecommunication services for interim supervision. General supervision begins with initial instruction provided to the COTA by the supervising OTR and the OTR providing review of services approximately every 30 days along with telecommunication supervision. This level continues to allow for Mike to gain more independence and Alice will be able to step back and allow for him to provide treatment implementation and collaborate with her on patient care and discharge planning. The last level of supervision is minimal supervision, involving the supervising OTR providing supervision and guidance on an as-needed basis. This level of supervision requires Mike to have developed adequate service competency and this will impact Alice’s role as a supervising OTR as the level of supervision decreases Mike will be able to take on more responsibilities and free her up to take on other COTAs to supervise and conduct more patient evaluations for different facilities. They will still need to continue effective and efficient communication throughout each level of supervision through face-to-face contact or by telecommunication services.

A helpful strategy that Mike and Alice could imply to ensure that Mike is adequately supervised is through telecommunication. This could implement telecommunication strategies for continued supervision if they are unable to meet in person for face-to-face contact. This method of communication allows them to communicate directly without requiring them to be in the same place at the same time. This approach will allow Mike to quickly ask Alice a question and receive a quick message back without Alice or Mike having to meet at the same location. Examples of telecommunication include email, facetime, text messaging, phone calls, Skype, etc. Another strategy Mike and Alice could employ to ensure that Mike is adequately supervised is having monthly meetings at a coffee shop or restaurant that will allow them to be in a relaxed environment in order to discuss the pros and cons of their current level of supervision. During these monthly meetings they can discuss what is working out and change or improve things as needed. Such meetings will allow for them to identify the appropriate level of supervision to employ and communicate important information to each other. As a result of this communication, their relationship will become stronger due to increasing competence as well as giving Mike the confidence to provide treatment implementation. The key is for Mike to develop service competency and feel comfortable communicating with Alice about everything related to patient care and service delivery. This is a simple way they can each come together and develop an appropriate, successful relationship.

Question 3: Practice Responsibilities

The type of relationship the OT practitioner has with a company or facility determines the steps and actions taken for who is held liable for a therapist’s negligence. However, it is important to note that the OT practitioner is overall responsible for his or her actions in a liability case. An OT practitioner working as a full-time employee for a company has been employed by the company to provide services on the company’s behalf. In this case, the company or employer is usually held liable for the negligence of its employee (Ranke & Moriatry, 1997). This is based on the theory that an employer acts through its employee and therefore, should be held responsible for the employees actions (Ranke & Moriatry, 1997). The client can file a malpractice action against the employer without even naming the employee in the lawsuit (Ranke & Moriatry, 1997). The company can sue the OT practitioner and hold them liable for the incident, however, this rarely occurs and if the company chose to take this action, it would be a nightmare to carry out. 

For an OT practitioner practicing under a contract for a company, the person held liable for malpractice is the OT practitioner themselves and not the company or employer they are providing services for. However, liability can be extended to the employer in this case in two different ways. One way is if the OT practitioner is really an employee and conducts services as a provider of care under the employer, in this case the employer is held liable (Ranke & Moriatry, 1997). Another way, in which the employer is held liable for the OT practitioner’s negligence, is through the doctrine of agency by estoppel (Ranke & Moriatry, 1997). This doctrine applies when the client looks to the company or employer rather than the individual OT practitioner as being held liable for negligence or other forms of malpractice (Ranke & Moriatry, 1997).

The OT practitioner that is working for a company on a contract basis will provide services using equipment that will be purchased independently as an independent contractor doesn’t typically use the equipment of the facility that would be provided for full-time employees. The OT practitioner working as an independent contractor has more flexibility in their job and they will be able to choose what facility they would like to work for and the type of patient they will work with. The type of facility the OT practitioner chooses to work in will impact the types of services that will be able to be provided and the equipment they have available to them to use in service delivery. The full-time OT practitioner has access to all of the equipment and supplies that are provided at the facility and will be able to use the equipment to provide a variety of services to patients. The full-time employee will be able to develop a stronger and more successful relationship with the patient’s at the facility and with the other professionals working at the facility compared to the independent contractor that will not be treating the same patient’s consecutively leading to a better relationship built with them. Due to this fact employers who are familiar with their full-time employees will give them more responsibilities and opportunities for service delivery compared to an independent contractor. There is less availability of service delivery options and extra responsibilities given from an employer to an independent contractor compared to the higher priority of an employer giving full-time employees these opportunities. 

Question 4: Principles of Teaching and Learning

To enhance learning about the different levels of supervision for students in the OTA program, I will use the teaching principle of goal-directed practice incorporated with targeted feedback to enhance the quality and understanding of the student’s learning. For my learning activity I would have the students get into teams of 2 or 4 and give each group or pair a health professional role such as a PT, PTA, OT, COTA, RN, LVN, etc. and give them each a case study about an example of an intervention for a patient who is receiving services from each profession in the group. Each student will use their learning of effective and ethical supervision and roles in the collaborative process for each professional they were assigned. After they have developed their interprofessional/collaborative plan, I will have them participate in a role-play of them engaging in effective and ethical collaboration using the appropriate type of supervision for the patient in their case study. This activity involves relaying important information to each team member for them to know about the type of supervision needed in the setting and for the patient’s needs. Following the completion of the role play learning activity, I will give each group and each student targeted feedback on how they performed and things they can improve upon. This activity targets the students learning of the roles in supervision and the scopes of practice of OTAs and non-OT personnel.

The learning principle of self-directed learning will be incorporated for the students to learn how to monitor and adjust their approaches to learning (Principles of Teaching and Learning, 2018). The role play assignment taught the students about supervision roles and effective and efficient communication for OTAS and OTRs and non-OT personnel supervisory roles. The constructive and direct feedback I will provide after each role play assignment will allow for each student to use this learning principle to refine their approaches to learning and help them adjust how they study and understand the course curriculum in order to apply it to real-life circumstances. The next time the students participate in a role play assignment, they will be able to have learned from the feedback given and hopefully have adjusted their learning approach in order to be successful. “The instructor will act as an advisor rather than a formal instructor to provide helpful feedback for the student to apply to their learning process in order to improve and make adjustments to be successful with their learning in the future” (Self-Directed Learning: A Four-Step Process, 2019).

The learning activity I have chosen to incorporate into my curriculum for OTA students learning about effective and efficient supervision for OTAS and non-OT personnel fit into the third level of Bloom's Taxonomy. The third level of Bloom’s Taxonomy is “applying”, this activity allows the students to be able to take their knowledge from books, worksheets, and other in-class or online assignments, and apply them to real-life situations (Shabatu, 2018). The students will demonstrate their learning and understanding of the coursework and apply it.

References

• Jacobs, K. (Ed.). (2016). Management and administration for the OTA: Leadership and application skills. Thorofare, NJ: SLACK Incorporated.
• Principles of Teaching and Learning. (2018). Retrieved from https://screencast-omatic.com/watch/cFXXD7rcXv            
• Self-Directed Learning: A Four-Step Process. (2019). Retrieved from https://uwaterloo.ca/centre-for-teachin-gexcellence/teaching-resources/teachingtips/tipsstudents/self-directed-learning/self-directed-learning-four-step-process
• Shabatu, J. (2018). Using bloom’s taxonomy to write effective learning objectives. Tips Center.Retrieved from https://tips.uark.edu/using-blooms-taxonomy/