Coverage of Rec. Therapy -- Book Review.

I recently read Tim Passmore’s “Coverage of Recreational Therapy: Rules and Regulations” (2nd ed.). This book is published by the American Therapeutic Recreation Association (ATRA). All profits from this book to to ATRA. Passmore does not receive any.

I admire Tim Passmore and what he is doing to advocate for the profession. Recreational therapists need to know what the requirements are to assure coverage of services.

Here is an example:

I work in an inpatient psychiatric hospital setting. Passmore points out the requirements for “active treatment” that are outlined in the Medicare Benefit Policy Manual. One requirement is a physician’s order for treatment.

I first learned of this requirement when I had attended a session "on coverage" by Passmore at the 2009 ATRA conference in Minneapolis, Minnesota. I immediately went back to work and checked into this. I discovered we do have a standard order for all admissions (where I work at -- in one of the two Virginias).

Basically, our order is a checklist of therapies to be provided such as: individual therapy, Therapeutic Recreation/ Education (TR/Ed), and others. It is checked off (usually by an admission nurse) and the physician signs it. Of course, the physician can always write an order for other interventions when needed, too, such as: Community Re-entry outing.

Many of the requirements for “active treatment” are the same as the standards of practice for our profession, including: conduct assessment, work with patient/ client to develop an individualized treatment plan, provide interventions to assist the patient in meeting her (or his goals), evaluate outcomes, and form a discharge summary at the time of discharge.

Naturally, active treatment requires the goals to address areas of functional improvement. Here is an important concept: Simply providing recreation activities in a clinical or hospital setting does not constitute as “therapy” or in this case “active treatment.”

Don’t get me wrong. I think recreation is great! My undergraduate degree is in Park Resources and Leisure Services. Of course, I have an emphasis in Therapeutic Recreation. I think recreation activities are great! I also realize that simply providing an activity like “Bingo” or “DVD Movie” in a hospital setting isn’t Recreational Therapy. It is just divisional activities.

I think activities for diversion is great! However, these activities wouldn’t be covered under “active treatment” in the Medicare policies manual.

Be sure to get a copy of this book to make sure you’re in alignment with requirements for coverage for your setting. Passmore covers the required steps for inpatient physical rehabilitation and inpatient psychiatric hospital facilities.

Here is the link for the book: http://www.atra.affiniscape.com/storelistitem.cfm?itemnumber=1

Advocate for CMS Coverage of Services!

I recently read Jim Sabin's Health Care Ethics Blog. He posted an interesting comment on advocating CMS coverage of services.

I wasn't able to comment on his blog. I kept being dis-connected from the internet when I attempted, so I posted my thoughts here:


Jim Sabin's comment about the man who wished for money to be spent on younger people reminded me of a sad story when I was younger, which I think was fiction. It may have been part of a school assignment in middle school. It consisted of a group of diverse people who were stuck on a submarine. There were only enough resources to save 50% of the people on the submarine. The question or problem was to decide who’d be saved.

I can’t remember all of the facts from this story. It may have been a movie I saw when I was younger. I do recall a person who was elderly willingly sacrificing himself. He had the same “internal moral” argument that a younger person who had much more life ahead of him should be selected first.
I wouldn’t want to be the person to make a decision for other people. I’m fairly healthy and happy 30-year-old man. I’d want a younger person to make it over myself. And I don’t think I could live with myself if I left anyone behind. What if the people who were elderly were someone I knew and loved like my own parents?
I’m not very keen on politics and funding.

I do my best to keep up on updates from the Centers for Medicare and Medicaid (CMS) because I’m a Recreational Therapist and patient advocate. I advocate that patients receive Recreational Therapy (RT) services when medically necessary, evidenced-based to be beneficial, and ordered by a physician. RT is most often provided in three in-patient settings: skilled nursing, rehabilitation, and psychiatric.
My big point is: There has to be an ethical and cost-effective way to assure all people have access to services (including the person you commented on with the lung issues). It reminds me of a neighbor friend who is retired. She has little income and no insurance. She could purchase insurance, but it would take all of her income because she has a pre-existing condition (a leg problem). She can’t go back to work for long periods of time or for many jobs because the pain from the leg would be too much to handle.

There must be a solution for people in this group. There are many more people who are retired, without insurance, and with little income. There must be a way to assure that people in this group get coverage and services, too.
I hope you’ll post more thoughts and ideas on this topic in the future.

Your friend,

Medicare Makes Cut into Rehab Services

My cousin Tracy is a Physical Therapist.

She was the person who introduced me to Recreational Therapy back in 1999.

She posted an interesting link from the American Physical Therapy Association (APTA) about Medicare making cut into Rehab Services. One focus is on outpatient services.

I think Recreational Therapsits need to be aware of these new policies, too. There aren't many RTs working in outpatient services.

My thoughts:

It is so vital that RT services have measurable outcomes that are related to the patient's treatment needs. Evidenced-based practice is a must for Recreational Therapy.

Getting any type of treatment is expensive. Medicare and 3rd-party payers are already wanting to cut back on expense. Plus, they're not going to pay for services that are "not needed" or "don't focus on outcomes related to the patient needs."

Be sure to read the link here:


http://www.apta.org//AM/Template.cfm?Section=Media&Template=/CM/ContentDisplay.cfm&ContentID=77213

CMS and RT

I follow Jim Sabin’s National Healthcare Organizational Ethics blog. Sabin has been in health care for 40 years. He’s worked as a psychiatrist, medical director, teacher/ researcher, consultant, and he is a leader of the ethics program for a health insurer.

Other recreational therapists may be interested in following his blog, too.

Today (7/7/10) Sabin posted this following comment:

“CMS [Centers for Medicare and Medicaid] is the closest we come to a national voice. It's the crucial player in the health reform process.”

CMS sets the standard.

It reminds me of the process in which the American Therapeutic Recreation Association (ATRA) had worked to get CMS to explicitly list Recreational Therapy as a covered service in the manual. [which, CMS has done. Thanks to the great effort of ATRA advocacy.] R.T. has always been a covered service for three in-patient settings, skilled nursing, rehabilitation, and psychiatric. Some people were not getting services because of agencies were not certain RT services were covered since it wasn’t written in the manual.

What CMS does, others often follow because, as Sabin said, “they are the national voice.”


http://healthcareorganizationalethics.blogspot.com/2010/07/don-berwick-medicare-and-congress.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+blogspot%2FfpPe+%28Health+Care+Organizational+Ethics%29