Implications of the Affordable Care Act for Occupational Therapy Practitioners Providing Services to Medicare Recipients

Abstract

The passage of the Patient Protection and Affordable Care Act of 2010 (ACA; Pub. L. 111-148) represents the largest expansion in government funding of health care since Medicare and Medicaid were established in 1965 (Curfman, Abel, & Landers, 2012). Although the health insurance mandate and Medicaid expansion have received the most attention as a result of legal challenges and the July 2012 Supreme Court ruling on the legality of the ACA (Henry J. Kaiser Family Foundation, 2012), other ACA initiatives may have even greater implications for occupational therapy. The ACA includes sections on improving quality and health systems performance for Medicare recipients, with some sections also applying to Medicaid recipients. Insurance companies commonly follow Medicare rules; therefore, the Medicare reforms are likely to spread across all payers, health care settings, and care recipients.

Toward a Broader Role for Occupational Therapy in Supportive Oncology Care

“…Unfortunately, what is deemed necessary does not necessarily encompass psychosocial or wellness-based practice. Nonetheless, Medicare does have a history of designating necessary care as encompassing that which increases function (Fisher & Friesema, 2013), and recent scholarship indicates not only that increased function decreases the economic burden of cancer survivorship but also that occupational therapy is an essential part of any multidisciplinary effort to improve function in cancer survivors (Silver, Baima, Newman, et al, 2013). Ultimately, although ACA may complicate efforts to provide holistic, wellness-oriented care, its focus on function also suggests the potential for increased coverage of functionbased occupational therapy services.…”

Policy and Payment Changes Create New Opportunities for Occupational Therapy in Acute Care

“…As a result of the CMS payment and other policies described earlier, we believe that the acute care setting will continue to see an increase in patients being discharged home in lieu of typical PAC settings, creating opportunities for acute care occupational therapy practitioners to provide increasing proportions of a patient's rehabilitation throughout a care episode. Acute care occupational therapy practitioners can ensure a safe discharge home through emphasizing evaluation within 24 hr of admission, caregiver education, and wellness initiatives in addition to discharge planning recommendations and caregiver training (Fisher & Friesema, 2013;Rogers et al, 2017). In addition, the best opportunity to reduce readmissions and drive down expenses is with adults who have four or more medical comorbidities, because they have longer LOS and occupational therapy has unique perspectives on these patients (Steiner & Friedman, 2013).…”

Population Health and Occupational Therapy

“…Population health spans both occupational therapy's traditional and its emerging practices. It encompasses the work practitioners do when they identify the health needs of populations such as people with autism, diabetes, falls, limited mobility, or cancer and address those needs through integration with clinical care providers in schools, hospitals, private businesses, and community-based organizations (Roberts & Robinson, 2014;Fisher & Friesema, 2013). It will also encompass expanded roles practitioners could adopt in the policy arena, in nonprofit organizational leadership in organizations such as the American Cancer Society or the Brain Injury Association of America, or in federal health agencies such as the Centers for Disease Control and Prevention or the National Institutes of Health.…”