Why Bother?
Recently on the OTlist, I shared that some friends of mine had negative experiences and perceptions of OT. An OTlist reader asked the following question:
"... If people are having such negative OT experiences in rehab, [why do] they bother to come for more OT once discharged?"What follows is a response from Terrianne Jones MA, OTR/L
Jeanne, you pose an interesting question, and one that is pretty easily answered. For the population covered by Medicare A , which is the main payer for physical rehabilitation for the largest portion of the population receiving OT services, it is ignorance plain and simple. Most of these clients have no idea what the MD's order; many a time I go to do a home care OT eval and my clients will balk that they didn't know the doctor ordered home care let alone OT. So in a sense they are somewhat a captive audience. And since under the part A benefit they cannot be balanced billed, they see no direct out of pocket cost associated with OT.
So, although they may hate or love their OT, until our clients have more connection to the investment versus outcome associated with OT, we will continue to offer in some circumstances, a mediocre product with not much accountability, because the market will bear it. I am surprised quite frankly that Medicare hasn't demanded more from the profession.
When I teach OT students, my mantra is always "would YOU pay out of pocket for your service? Would others see the value in what you are doing with their loved one? Would there be enough face validity to your interventions that you could feel good about what you are doing and what you charge for the skilled service? " If you can't answer yes to these questions, then in all likelihood you are not offering a skilled intervention and will burn out in this field"
After 15 years in this profession, I have really come to the conclusion that many OT's in adult and geriatric rehab are not that invested in truly operating as professionals. They want the paycheck and some sort of prestige, but they don't hold up their end of the equation by continuing their educations, using the best evidence and offering their clients a truly unique and skilled service. And they can get away with it because the patients/clients don't know any better and don't have to, yet.
If there were even a $5 co-pay under part A for every therapy visit/session, this situation would change in a heartbeat, because the clients would demand better from us, and we would have to deliver to remain viable as a profession. The real question is: do we continue to "feast" on a sinking ship or do we abandon sloppy practice and hold ourselves accountable before we are forced to do so? In my mind that is what makes a real professional.
Terrianne Jones MA, OTR/L