How High Do We Jump? The Effect of Reimbursement on Occupational Therapy

Abstract

This paper explores the extent to which third-party reimbursement dictates occupational therapy practice. A literature review was used to examine the history and meaning of reimbursement in regard to occupational therapy. It was found that the profession has altered its definition, practice, management, ethics, and professional response as a result of changes in reimbursement. Reimbursement policies reflect societal influences and are shaping occupational therapy in several ways. Control has shifted to third-party payers, allowing them to define occupational therapy; use of the medical model is being rewarded by reimbursement; the language used to discuss the profession has changed to accommodate the insurance and other industries; and values that dominate society are being reinforced. Conflict between the values of society and the values of the occupational therapy profession is a source of struggle for many clinicians. If the causes of the reimbursement-imposed constraints on practice are understood, occupational therapists will be free to be proactive in issues of health care policy.

Treatment Activity Preferences of Occupational Therapists in Adult Physical Dysfunction Settings

“…This difference might simply be a reflection of the different settings and sample sizes surveyed by these three studies The lack of clear dominance of remedial over functional activity use in this study might also indicate that occupational therapy practice is shifting back toward functional treatment aCtiVities, after a peak of remedial activities in the late 1980s. This change could be a response to the increasing demands of third-pany payers' for functional outcomes in rehabilitation (Fisher & The American Journal of Occupational Therap\' Short-DeGraff, 1993;Howard, 1991). Both the present study and Pendleton's (1989) indicate thal this movement toward functional activities does not yet embrace community-living skills activities.…”

The Impact of Reimbursement Systems on Occupational Therapy Practice in Canada and the United States of America

“…Framing occupational therapy goals and outcomes in a particular language makes it reimbursable (Howard, 1991). Framing occupational therapy goals and outcomes in a particular language makes it reimbursable (Howard, 1991).…”

Workers’ compensation insurance agents’ satisfaction with occupational therapy activities of daily living assessments

“…Howard (1991) and Posatery Burke and Cassidy (1991) have examined this confusion. They suggested that when occupational therapists try to meet both the needs of the customer and the client, as well as their own professional philosophy of health care, they might experience conflict about whose needs are most important.…”