Abstract
There is a need for immediate focus on options for OT utilization and practice patterns in home healthcare. New payment models have agencies looking at alternative ways to manage costs efficiently without sacrificing care. Telehealth is not a new concept, but the use in traditional home care is emerging. This study explored the combination of on-site and telehealth visits on the participants’ overall perception of and satisfaction with improvement in occupational performance.
Primary Author and Speaker: Missi Zahoransky
The utilization of therapy in home health care has been growing in the last decade. The Medicare Payment Advisory Commission (2018) has recommended the elimination of therapy usage as part of the payment model since 2011 and in 2018 the Centers for Medicare and Medicaid services (CMS) announced the final rule eliminating the therapy usage part of the payment to home care agencies. AOTA has identified the importance of telehealth in the field of occupational therapy. The purpose of this study was to examine the combination of on-site and telehealth visits for the homebound participant and the impact on satisfaction and perception of improvement in occupational performance areas. A quasi-experimental pre-test post-test design was used. There were no restrictions on diagnoses and participants ranged in age from 61-90 years old. Three outcome measurement tools were utilized to collect data. The Canadian Occupational Performance Measure (COPM) was administered before and after intervention to measure improvement in client self-reported performance problem areas. The home care industry mandated data collection tool the Outcome and Assessment Information Set (OASIS) was completed before and after occupational therapy intervention to measure clinical outcomes of occupational performance areas, specifically activities of daily living (ADLs) and functional mobility. A post-intervention survey was completed after the occupational therapy intervention to measure the participants overall perception of the telehealth experience including technology and perception of the use of a combination of service delivery styles of both on-site and telehealth visits to address participant home care occupational therapy goals. Both quantitative and qualitative data was collected. The results of this study demonstrated that all participants improved in both participant-reported and clinician-driven occupational performance areas with the combination of on-site and telehealth visits as a service delivery model. The COPM analysis yielded highly significant increases in both performance and satisfaction (p=<.001) and the OASIS analysis resulted in a similar finding of highly significant increases in both GG0130 (self-care) and GG0170 (functional mobility) (p=<.001 for both measures). The results found that all but one participant felt the combination of on-site visits and telehealth visits for occupational therapy intervention met their needs, they would do again, and they would recommend to others. Age and diagnosis did not impact ability to utilize telehealth services and prior use or knowledge of technology did not impact success in telehealth use. Telehealth has been identified as a future service delivery model in home care (CMS, 2018) as well as supported as an appropriate intervention mode for occupational therapy practitioners (AOTA, 2018; Cason, 2015). The findings add to the evidence proving occupational therapy’s distinct value to all home care stakeholders while decreasing number of visits, increasing efficiency, and maintaining patient satisfaction. This study is important to practice as it successfully demonstrated the feasibility of telehealth visits in conjunction with on-site visits to explore an alternate service delivery model for home care occupational therapy interventions and supports Vision 2025 as an effective solution transcending practice area and payment systems.
Medicare Payment Advisory Commission. [MedPAC]. (2018). Report to Congress: Medicare and health care delivery system. Chapter 9: Home health care services. Retrieved from http://www.medpac.gov/docs/default-source/reports/mar17_medpac_ch9.pdf
Centers for Medicare & Medicaid Services. [CMS]. (2018). The final ruling for prospective payment system 2019. (Federal Register, Vol. 83, No. 219). Retrieved from https://www.govinfo.gov/content/pkg/FR-2018-11-13/pdf/2018-24145.pdf
American Occupational Therapy Association. [AOTA]. (2018). AOTA Position paper: Telehealth in occupational therapy. Retrieved from https://www.aota.org/∼/media/corporate/files/secure/practice/officialdocs/position/telehealth-interim-20181113.pdf
Cason, J. (2015). Health Policy Perspectives- Telehealth and occupational therapy: Integral to the Triple Aim of health care reform. American Journal of Occupational Therapy, 69(2), 6902090010. http://dx.doi:10.5014/ajot.2015.692003