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What does it mean to be a professional

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One of a group of persons who jointly and individually assume responsibility for: Defining the nature of the service provided Defining minimum base of knowledge needed for the service Defining the code of ethics to be used in the service Policing self regarding provision of service Living up to established code of conduct Maintaining membership in professional group Being responsible to maintain advancing professional knowledge, ideals, and practice

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AOTA governed by OT or nah?

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Nah, not usually

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AOTPAC

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The AOTA Political Action Committee: Voluntary, nonprofit, unincorporated committee of members of AOTA. Used to further legislative aims of the APTA by influencing or attempting to influence the selection, nomination, election or appointment of any individual to any federal public office. Can raise money and make donations to support political campaigns in line with AOTA's agenda (1976)

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AOTF

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The American Occupational Therapy Foundation: Created to advance the science of OT and to increase public understanding of its value. Has three centers for scholarships and research (including competitive grants). Publishes a research journal (OTJR: Occupation, Participation, and Health) (1965)

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Fund to Promote Awareness of OT

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a separate non-profit with the mission of promoting awareness on the part of the general public of OT. Runs promotional campaigns that educate the public in different areas of practice, range from public to social issues. http://www.promoteOT.org/ (2002) they did like TV adds and ads in regular magazines teaching people what OT was

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Normative approach to ethics

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Asks the question if something is moral/ethical

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Non-normative approach to ethics

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Tries to establish what factually is ethical/moral (Code of Ethics)

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Advance Directive

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living will

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autonomy

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respecting the decision making capabilities of a self governing person

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bias

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a preference that interferes with impartial judgement

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conscientiousness

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trying with due dilligence to do what is right

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compassion

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active regard for another's welfare combined with sympathy/discomfort at another's misfortune

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competence

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cognitive/psychological ability to make decisions to be judged as rational. the person must be able to communicate these decisions

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confidentiality

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keeping privileged info within the proper bounds always involves a realtionship

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confidentiality vs privacy

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confidentiality always involves a relationship and privacy doesn't

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conflict of interest

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conflict of private interest and public obligation in an official position

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discernment

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Make decisions without being influenced by personal attachments, outside influences, etc.

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duty

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a course of action required by law

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ethical dilemma

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A conflict between ethical beliefs and involving choices between alternatives that are equally acceptable

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LIfe sustaining treatment

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interventions to save/restore bodily functions

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informed consent

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Consent containing information, voluntariness, and competence

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nonmaleficence

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do no harm

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paternalism

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The intentional overriding of one person's known preferences; the person who overrides the decision justifies it by the goal of benefiting the person

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privacy - physical

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restriction on the ability of others to experience a person through the five senses;

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privacy - informational

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restriction on facts about the person

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privacy - decisional

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exclusion of others from involvement in decisions made by the person

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Rights

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Justified claims that individuals and groups can make upon other individuals or upon society

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Rules

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General norms that guide actions

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Shared DEcision making

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A process by which clinical decisions are made through shared discussion of information between the client and the care team.

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Substituted judgement

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Requires the surrogate decision maker to make the decision the incompetent patient would have made if competent

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fraud

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"Making false statements or representations of material facts in order to obtain some benefit or payment for which no entitlement would otherwise exist"

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abuse

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Practices that either, directly or indirectly, result in unnecessary costs to the Medicare program"

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fraud vs. abuse

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fraud is intentional and abuse is not necessarily intentional

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Example: billing for a non-covered service - fraud vs. abuse

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Fraud: provider knows it isn't covered, so changed the ICD-10 primary dx to obtain coverage Abuse: provider suspects service might not be covered, but figured she would "test" and submit a claim anyway

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Common types of medicare fraud

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Billing for services not furnished Altering claim forms to receive a higher payment Duplicate billing to the beneficiary, a private insurer, or Medicare Falsely representing the nature of services provided Soliciting, offering, or receiving a kickback Billing a person who has Medicare for services provided to someone who does not have Medicare Using another person's Medicare card for services Provider waivers of beneficiary payment of deductible

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common types of Medicare abuse

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Overcharging for service and supplies Providing medically unnecessary services that do not meet professional standards Billing Medicare on a higher fee schedule than that for non-Medicare patients Submitting bills to Medicare that are the responsibility of another insurer

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how much $ lost to health care fraud each year?

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The US Dept of Health and Human Services-Office of Inspector General (HHS-OIG) conservatively estimates that $100 Billion is lost to health care fraud each year

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Fraud and Abuse Utilization Reviews: how many levels?

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3

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Level I

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Reviews the utilization pattern against an "edit" Looks at a defined number of visits as appropriate for certain diagnoses May result in a referral to Level II

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Level II

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A focused review by a health professional Reviews documentation to determine whether the care meets Medicare guidelines for appropriateness May result in a denial or a referral to Level III

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Level III

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An onsite review of patient-care documentation and Medicare billing records

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Conviction of abuse

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Will result in denial of payment for the claim, and may result in a fraud investigation

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Conviction of fraud

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Can result in expulsion from participation in the program, financial penalties, and/or prison time

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AOTA Code of Ethics 7 Principles

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BENEFICENCE NONMALEFICENCE AUTONOMY AND CONFIDENTIALITY SOCIAL JUSTICE PROCEDURAL JUSTICE VERACITY FIDELITY

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Beneficence

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Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. Complete evals/re-evals, in a timely manner Use EBP/avoid outdated evals whenever possible Provide services within your scope of practice D/C/refer to other services, PRN Follow the code of ethics/report unethical behavior to the proper authorities

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Nonmaleficence

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Principle 2. Occupational therapy personnel shall intentionally refrain from actions that cause harm. Avoid inflicting harm on patients, students, etc Avoid abandoning the service recipient Avoid sexual relationships with pts, students, etc Avoid alcohol or drugs during work includes research participants and employees any sort of non-working relationship is discouraged

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Autonomy and confidentiality

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Principle 3. Occupational therapy personnel shall respect the right of the individual to self-determination. Establish a collaborative relationship Obtain consent Respect right to refuse Maintain confidentiality (HIPAA) Relationship includes families, caregivers, etc If person cannot give consent, must get it from legally responsible person-POA Right to refuse treatment, back out of research project, etc

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Social Justice

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Principle 4. Occupational therapy personnel shall provide services in a fair and equitable manner. Ensure the common good Educate the public about OT Advocate for fair & just treatment for everyone Understand that services can be affected by multiple outside situations Consider doing work pro bono or for reduced fees when possible Our profession is altruistic-unselfish concern for the welfare of others How we can promote health and wellness and reduce the impact of disease Patients, clients, employees, and colleagues Can be affected by economic status, age, ethnicity, race, geography, disability, marital status, sexual orientation, gender, religion, culture, and political affiliation

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Procedural Justice

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Principle 5. Occupational therapy personnel shall comply with institutional rules, local, state, federal, and international laws and AOTA documents applicable to the profession of occupational therapy Know and apply Code of Ethics, rules, and laws Have proper licensing/maintain it properly Complete research according to rules Collect fees legally Laws/rules include everything: supervision rules, licensing rules, labor practices, etc

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veracity

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Principle 6. Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession. Represent yourself completely but not falsely Record/report in an accurate and timely manner Give credit and recognition when using other's work/don't plagiarize In what you are able to do as a therapist, in any marketing, etc Record/report: Including evals, treatments, etc

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Fidelity

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Principle 7. Occupational therapy personnel shall treat colleagues and other professionals with respect, fairness, discretion, and integrity. Respect traditions, practices, etc of OT and other professions Attempt to prevent or correct any breaches of the Code of Ethics, but use internal resources to resolve issues first Avoid conflicts of interest/use conflict resolution

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Basic Elements for making reliable moral judgements

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Identify ethical issue Gather relevant information/facts Describe values at stake Identify a range of options Make a choice Give reasons to support choice Evaluate how the dilemma could have been prevented

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NBCOT code of conduct

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Intended to encourage therapists and therapy students to adhere to highs personal and professional standards in their conduct and to take responsibility for their actions Encourages enhancement of the profession, fair practice, and following all laws and regulations Where the term "certificant" is used, the term "applicant or candidate" is included in its scope

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NBCOT principle 1

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Certificants shall provide accurate and truthful representations to NBCOT concerning all information related to aspects of the Certification Program, including, but not limited to, the submission of information: On the examination and certification renewal applications, and renewal audit form; Requested by NBCOT for a disciplinary action situation or Requested by NBCOT concerning allegations related to: Test security violations and/or disclosure of confidential examination material content to unauthorized parties; Misrepresentations by a certificant regarding his/her credential(s) and/or education; The unauthorized use of NBCOT's intellectual property, certification marks, and other copyrighted materials

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NBCOT principle 1 summary

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give accurate information about your education qualifications take your own test actually go to CEUs don't use NBCOT's intellectual property without permission

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NBCOT principle 2

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Certificants who are the subject of a complaint shall cooperate with NBCOT concerning investigations of violations of the Candidate/Certificant Code of Conduct, including the collection of relevant information.

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NBCOT principle 2 summary

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if there is a complaint against you, you will comply with all needs to conduct investigation

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NBCOT principle 3

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Certificants shall be accurate, truthful, and complete in any and all communications, direct or indirect, with any client, employer, regulatory agency, or other parties as relates to their professional work, education, professional credentials, research and contributions to the field of O.T.

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NBCOT principle 3 summary

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tell the truth about yourself, if you have been convicted of a crime check the box on your application

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NBCOT principle 4

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Certificants shall comply with laws, regulations, and statutes governing the practice of occupational therapy.

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NBCOT principle 5

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Certificants shall not have been convicted of a crime, the circumstances of which substantially relate to the practice of occupational therapy or indicate an inability to engage in the practice of occupational therapy safely, and/or competently.

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NBCOT principle 5 summary

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you can't be convicted of a crime that shows you would not be a good OT if you are a sex offender you can't do peds if you have a DUI or lost your license for wreckless driving you can't do home health or driving rehab

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NBCOT principle 6

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Certificants shall not engage in behavior or conduct, lawful or otherwise that causes them to be, or reasonably perceived to be, a threat or potential threat to the health, well-being, or safety of recipients or potential recipients of occupational therapy services.

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NBCOT principle 6 summary

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don't do anything to put client in danger you ccan't leave demented pt. in a room with safety risks

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NBCOT principle 7

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Certificants shall not engage in the practice of occupational therapy while one's ability to practice is impaired due to chemical (i.e., legal and/or illegal) drug or alcohol abuse.

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NBCOT principle 7 summary

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don't try to treat pt. while you're on drugs

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Accreditation

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Accreditation is awarded to organizations who comply with standards established by the accrediting body. Most accrediting bodies require maintaining ethical behavior Examples: State Licensure JCAHO

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JCAHO

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require institutions to have a process to examine ethical issues in marketing, admissions, discharges, billing, relationships with third-party payers, and managed care organizations

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state regulatory boards

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Usually have the authority to discipline practitioners who violate the state's code of ethics SRB Discipline can range from censure (formal expression of disapproval that is publicly announced) to temporary suspension of practice privileges to permanent prohibition from practice in the state

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NBCOT regulation of OT practice

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Overseen by the Qualifications and Compliance Review Committee Oversees the Code of Conduct Has jurisdiction over OTs certified by it as well as those applying to take the exam Notifies SRBs when any complaint is filed or any disciplinary action has been taken

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NBCOT discipline can include

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reprimand, ineligibility for certification, censure, probation, suspension, and revocation of certification

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AOTA and ethics

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AOTA Commission on Standards and Ethics (SEC) recommends the development of standards and ethics Is responsible for enforcing the Code of Ethics Has many documents relating to standards, ethics, code of conduct; can answer many FAQ relating to these topics

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malpractice

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The improper or unethical conduct or unreasonable lack of skill by a... professional...negligent or unskillful performance of duties when professional skills are obligatory

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what must a patient show to claim malpractice?

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A patient has to show that the OT's action (or inaction) fell below the professional standard of care and injured the patient

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Malpractice

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Improper transfers resulting in a fall Forgetting to tell a nurse about a pt's c/o chest pain, resulting in a heart attack Causing a burn from a hot/ice pack Sexual misconduct with a patient Improper instruction of a splint or other device Failing to refer the pt. to another therapist more competent to treat the pt.

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Ways to prevent malpractice

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Chart clearly & consistently, not re-writing an entry if a problem arises. Keep up to date. Know current literature, recommended guidelines, evidence support for practice. Use approved abbreviations only & write legibly. Have malpractice insurance to be prepared in case of litigation (?) Follow the communication system between providers to track sent & received messages. Read information from licensing board, professional publications & malpractice carriers. Have good policies & follow them. Document decisions varying from policy. Demonstrate good customer service & communications with clients. Engage in risk management

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Risk management

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The identification, analysis, assessment, control, and avoidance, minimization, or elimination of unacceptable risks. Research new areas of practice, providing a professional service in the area Be aware of state practice acts, which vary Check other guidelines you may be working under Maintain a safe environment

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Complaints against you license

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Generally, attacks against your credentials come from the following sources: Disgruntled patients or clients State Agencies Criminal Activity Substance Abuse

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