How Healthcare Policy Affects Your Future Career As An OT

Last Updated on January 8, 2019 by

Change in the world of healthcare is not uncommon. From new treatment methods and devices to assist with therapy to groundbreaking medical procedures, there is always something new to learn about. This does not end with the principles of therapy, as change is also a fixture in healthcare policy. Policy affects insurance regulations, documentation systems, and billing methods which change frequently and can vary significantly between settings. Therapists and therapy students must practice being flexible and adaptive in the ever-evolving healthcare realm.

Following politics can be daunting, especially when trying to determine what parts of policy are relevant to your life and career. As a student, it is clear there are changes coming down the line; however, it may be unclear what exactly those changes entail. Thankfully, you came to the right place to learn of the most recent healthcare policy changes and what they means for your future career as an occupational therapist (OT).

Pre-Existing Condition Coverage is Changing

One of the most important and controversial changes to healthcare policy in recent times is the coverage, or lack thereof, for pre-existing conditions. A pre-existing condition is defined as any disease or injury, whether physical or emotional, that existed at the time or prior to application [for insurance] (Healthinsurance.org, 2018). New insurance regulations allow for plans that don’t provide coverage for pre-existing conditions.

What Does This Mean For OT Services?

Doctors often refer patients with chronic conditions to therapy for development of maintenance programs to slow the progression of illnesses and keep them functioning at their current level. For patients insured through Medicaid, such services will not be covered, which may cause a decrease in the amount of referrals received for this purpose. Coverage changes may also shorten the plan of care for referred patients due to an increase in costs for each visit. Maintenance programs currently serve as a large part of an OT’s role and—without billable time to educate caregivers, fellow staff, or facility administrators—it will make the importance of OT’s services for active and acute conditions even more important.

While the lack of coverage for some patients with pre-existing chronic conditions does not impact OT’s services directly, it could predict a shift of healthcare’s focus away from maintenance toward addressing disease progression. OTs typically address common chronic conditions affecting older adults, for example, in the form of programs developed by senior centers or assisted living facilities. Coverage changes could result in a future loss of facility funding for such purposes.

What Can New OTs Do To Maintain Their Standard of Care?

OTs should use their time wisely to educate those around them about the course of certain diseases, protective mechanisms, and maintenance principles and programs. This intentionality will serve to prevent acute medical problems from arising, while simultaneously slow ing the course of the condition. Shorter plans of care require creativity to get as much as possible accomplished within the allotted visits. The wealth of fresh information from students have from OT school is useful when educating others about OT, both during and outside of traditional sessions.

The Cost of Prescription Medications Is Changing

The costs of prescription medications will be lowered, allowing more affordable rates for those patients with regular prescriptions from their providers (Eisenberg, 2018).

What Does This Mean For OT Services?

Patients with access to prescribed drugs may show improved medication compliance, as the barrier of cost will be lessened or eliminated for some. This will aid the therapy process for some patients, as prescribed medications can decrease pain levels, raise energy levels, improve motivation for therapy, elevate mood and affect, and increase circulation. Conversely, inexpensive prescriptions could have the opposite effect for patients who are prescribed pain medications, either due to a chronic or acute illness, increasing the risk for misuse. 

What Can New OTs Do To Maintain Their Standard Of Care?

It will be important to keep a watchful eye on your patients’ progress, affect, and habits in order to pinpoint early signs of prescription misuse. For example, a patient may verbalize pain, but complete activities with no apparent limitations or discomfort. This action is called malingering and is one of the most common medication-seeking behaviors. As with all documentation, it will be important for therapy notes detail the signs and symptoms demonstrated by patients to ensure doctors know when prescriptions such as opioids are no longer necessary. 

The Health Insurance Mandate Is Changing

In past years, individuals who did not register for any health insurance were taxed in order to incentivize everyone to obtain health coverage. The mandate of the Affordable Care Act (ACA) is now being removed, and regulations for short-term health insurance policies are becoming more lenient. (Mukherjee, 2017).

What Does This Mean For OT Services?

Both new changes are predicted to cause a decrease in healthier individuals obtaining insurance, increasing the proportion of higher-need individuals purchasing policies.  With fewer healthy individuals in the pool of consumers to balance out costs, healthcare premiums will rise for the general population. Rising costs may entirely deter healthy individuals from securing insurance, and may deter some chronically ill individuals due to high costs already associated with having a medical condition.

What Can New OTs Do To Maintain Their Standard Of Care?

With the potential for more upcoming healthcare changes, the field of OT has a large opportunity to fill a gap and continue providing services to the populations who need it most. My prediction is there will be more non-standard opportunities for OTs in light of these changes. For example, more facilities may hire therapists on a consultative basis to improve existing programs and/or develop new programs. Therapists may be sought out to provide lectures to employees on general wellness, preventive techniques, and ways to maintain while living with chronic conditions. Therapists may also speak at conferences, enter teaching roles, and advocate for improved access to OT services.

In summary, healthcare will cost significantly more than it has during the last presidential administration. Those with chronic illnesses will pay more to access their standard services. Under the Affordable Care Act, healthcare costs were more consistent, rising approximately 5 percent each year since its adoption. The Affordable Care Act focused on just what its name suggested: economical preventive care for all individuals, which aimed to reduce the frequency of high cost care prior to individuals developing certain conditions.

It is important to note that with more access to medications and less access to medical services such as therapies, our skills are more central than ever. More focus on medication will make it even more vital for therapists to increase the use of their diverse and holistic backgrounds when treating patients. This will help to keep the focus of treatment on occupation-based methodologies, rather than once again giving precedence to a medical model of healthcare focused on procedures and medications. Often times this medical model is favored in lieu of considering contextual factors, skill-based training, real-life motor learning principles, and true root-cause analyses to eliminate pain, overuse syndromes, inactivity, and overall dysfunction.

Though such changes will make the daily tasks of a therapist a bit different, they are inconsequential compared to the opportunity provided to healthcare workers as a whole. The only portion of healthcare that can provide such diverse, yet specialized services is rehabilitation, making our field more important than ever. Dedicated and skilled therapy professionals are what will continue moving the healthcare realm forward and keeping the altruistic nature of therapy alive.

References:

Amadeo, K. (2018). Donald Trump on healthcare. Retrieved from How Trump’s Health Care Policies Will Raise Premium Prices for You

Armour, S., & Burton, T. M. (2018, August). Cheaper health plans with less coverage move forward. Retrieved from Cheaper Health Plans With Less Coverage Move Forward

Eisenberg, R. (2018). Prescription drug prices: A bitter pill in the midterm elections. Retrieved from Prescription Drug Prices: A Bitter Pill In The Midterm Elections

Healthinsurance.org. (2018, June). Glossary: Pre-existing condition. Retrieved from pre-existing condition definition

Mukherjee, S. (2017). The GOP tax bill repeals Obamacare’s individual mandate. Retrieved from The GOP Tax Bill Repeals Obamacare’s Individual Mandate. Here’s What That Means for You