INTERVENTIONS TO REDUCE CLAIMS INTENSITY

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INTERVENTIONS TO REDUCE CLAIMS INTENSITY

• Session 18 February 27, 2006
• Session Producer
• Stephen LaPierre
• Senior Vice President
• Penn Treaty Network America

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PANEL

• Sharon Kurfuerst, OTR/L
• Dawn Clayton Bieber, OTR/L

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In the next hour we will . . .

• Review the trigger language for the ADL
• Benefit trigger NTQ policies
• Take a peek at ADL plans of care
• Components
• Effective functional assessments
• Examine interventions to independence
• Show Tell
• Q A

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LTCI Triggers

• Medical Necessity
• Cognitive Impairment
• Activities of Daily Living ADL

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Activities of Daily Living
Ambulation /Transfer
Toileting
Eating
Bathing
Dressing
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ADL Defined

• Bathing
• The ability to wash yourself in a tub or
  shower, or to give yourself a sponge bath,
  without the assistance of another person.

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ADL Defined

• Dressing
• The ability to dress without the physical
  assistance of another person.

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ADL Defined

• Ambulation/Transferring
• The ability to move from place to place,
  including getting in and out of bed or a chair,
  without the physical assistance from another
  person.

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ADL Defined

• Eating
• The ability to get nourishment into your body
  by any means once it has been prepared and made
  available to you, without physical assistance
  from another person.

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ADL Defined

• Toileting
• The ability to get on and off the toilet and
  to maintain a reasonable level of personal
  hygiene.

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ADL Plan of Care The Theory

• Early intervention
• means
• A greater opportunity to ensure the most
• effective treatment at best pricing is
• delivered to the client
• resulting in
• A shorter duration/least costly claim
• Client gets better-quicker-cheaper

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ADL Plan of Care

• Need to consider
• Services provided
• Whos providing
• Are deficiencies being addressed
• Expected duration of services
• Prognosis for independence
• Maximizing opportunities for reaching the highest
  level of independence

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ADL Plan of Care

• Starts with an effective assessment
• RN or OTR
• Effective assessment includes
• Interview of past performance
• Review of medical history
• Observation and evaluation of current performance
  and the skills that may impact this performance
  including

• Range of Motion
• Balance
• Coordination

• Strength
• Cognitive abilities
• Pain
• Activity Tolerance

• Results in a client centered approach with
  collaboration to
• determine goals and treatment interventions

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Next step

• Identify opportunities to restore or improve
  independence
• Dont just document deficiency and not comment on
  possible interventions

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Unique Contribution of Occupational Therapy

• Brings holistic training and well-rounded
  approach to care
• Facilitates client engagement in occupation to
  achieve goals
• Provides activity analysis and adaptation to
  maximize success
• Encourages health promotion
• Supports lifestyle re-design

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Unique Contribution of Occupational Therapy

• Activity analysis and adaptation to maximize
  patient success
• Breaks an activity down into component parts
• Chooses and modifies activities to provide the
  appropriate level of challenge
• Develops activity plans that promote wellness and
  minimize excess disability

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Unique Contribution of Occupational Therapy

• Lifestyle Re-design
• Examines clients routines, habits, roles
• Incorporates activities into a clients overall
  life plan that meets their occupational needs and
  desires given current abilities
• Analyzes and adapts behavioral and environmental
  factors to promote health and functional
  performance
• Prepares client for independent living explores
  access to community resources, adaptive
  equipment, etc.

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Unique Contribution of Occupational Therapy

• Encourages Health Promotion
• Helps client engage in and access activities that
  are supportive of well being and health
• Focuses on specific behaviors and activities that
  support healthy living
• Uses education as a vehicle to promote continued
  health and wellness

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Interventions to Independence
Why bother?

• Eliminate Dependency / Eliminate Trigger
• Win / Win
• If Unable to Eliminate Trigger
• Reduce dependency resulting in . . .
• Reduced intensity of services resulting in
• Reduced Cost ?

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Interventions to Independence

• Health and Well Being
• Exercise
• Education
• Lifestyle re-design/activity adaptation
• Adapted Technique
• Restore function
• Compensate for lost function
• Modify environment
• Adaptive equipment
• Identify most appropriate equipment
• Teach and train in use of equipment

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Interventions to Independence

• Exercise
• Education
• Energy Conservation/Work Simplification
• Adapted Techniques
• Environmental Modification

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Adaptive EquipmentShow Tell
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Bathing

• Tub safety rail
• Tub transfer bench shower hose
• Long handle sponge
• Dressing stick
• Hand Held Shower Hose
• Grab bars

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Bathing

• Bathtub Safety Rail

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Bathing

• Tub transfer bench
• Shower hose

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Bathing

• Long handle sponge
• Dressing stick

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Dressing

• Velcro on shirts or pants behind buttons and on
  shoes
• Elastic Shoe Laces
• Button hook / Zipper pull
• Reacher
• Sock aide
• Dressing Stick
• Long shoe horn

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Ambulation/Transferring/Mobility

• Walkers
• Canes
• Transfer Board
• Transfer Pole/ Transfer Disc
• Trapeze
• Bed hoist
• Bed Bar/Rail

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Ambulation/Transferring/Mobility

• Walker

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Ambulation/Transferring/Mobility

• Canes

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Ambulation/Transferring/Mobility

• Mobile Transfer Pole

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Ambulation/Transferring/Mobility

• Trapeze Bed Hoist

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Eating

• Large handled utensils
• Adjustable angle utensils
• Weighted utensils
• Plate guard
• Scoop bowl

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Toileting

• Safety frame Raised Seat
• Bedside Commode
• Toileting paper aide demo
• Hygiene Mirror

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Toileting

• Raised Seat Safety Frame

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Toileting

• Toilet Paper Tongs

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Toileting

• Hygiene Mirror

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Questions????