Our Gear's Don't Mesh: Why OT Struggles in American Health Care!
Does the practice of occupation-based therapy fit in today's American health care system? While I have previously written about the merits of occupation [see links to the right], experience leads me to believe that occupation may not be a good fit in today's health care system. This is not to say that OT has no place in medicine, it's to say that our place is limited, not by our abilities, but by the system in which we operate. In an effort to better understand this limitation, a over-simplified mechanical model of American health care will be used.
Think of U.S. health care as a three dimensional mechanical machine, made of many different inter-meshing gears. The myriad of professions, organizations and concerned parties each represent different gears of this machine. As with any machine, lubrication between moving parts is essential. In this hypothetical model, two things serve this lubrication function:
1. An entity's product/service is perceived as being needed by interested parties, namely: payers, referring organizations and patients.
2. The product/service is effectively delivered to those entities that perceive a need.
For example, a patient seeks a physician because of illness. Because the patient and doctor perceive a need for each other and services are effectively delivered, these two gears are well-lubricated and freely turn. Another example of well-lubricated interaction can be seen in the interaction between insurance companies and therapy providers. A therapy company perceives a need for a specific insurance company's reimbursement and that insurance company perceive a need for the services of the therapy company. As long at there is a perceived need and each entity effectively delivers its product/service, these entities' gears will freely turn. American health care consists of many, many such interactions and while American health care at times seems anything but smooth, overall, the system works.
In this model, the primary product/service offered by OT is occupation! For the OT gear to effectively mesh, other gears must perceive a need for the OT product/service. My experience is that that neither doctors, nurses, or insurance companies often value or even recognize a need for our product/service. While there are explainations as to why there is a lack of perceived need, these will not be discussed in this newsletter. Because there is little perceived need between OT and other entities, the gears of the profession are not well greased and do not easily turn.
Another entity concerned with OT's product is the patient. My experience is that clients perceive "problems" to be a medical condition rather than occupational dysfunction. Often it is only after medical treatments are exhausted and the client has long come to grips with their infirmity that they are ready to look at learning "skills for the job of living". Of course, by this time, insurance companies typically do not reimburse for this type of therapy because it is deemed 'not medically necessary'. Clearly then, our OT gear does not mesh well.
The other component needed for a smooth running machine is effective delivery of a product. While occupation has existed since the beginning of time, the use of occupation as therapy and especially the research of occupation are relatively new! Compared to other modalities, little evidence exists to support the use of occupation as therapy. Again, comparatively speaking, there is little research on the phenomenon called occupation. Without evidence supporting occupation, it is difficult to accurately assess whether occupation is being effectively delivered. In fact, it's difficult to know if occupation is even being delivered at all. To this day, there exists a lack of consensus defining occupation and therapist use a myriad of colloquial definitions for the term. Again, the lack of effective delivery of our product inhibits effective meshing of our gears.
So here we are, a professional organization, providing services whose need may not be well-perceived and which may not be effectively delivered. Undoubtedly, OT exists despite these limitations. However, just existing may not be adequate in today's aggressive health care market. Understanding our limitations may provide opportunity to enhance our product delivery and perceived need, allowing OT to become the preeminent leader in therapy services .
