1. Special Presentation to Yamagata University of Health Sciences – March 2007 OT in the US: Directions David Greene, PhD, OTR

2. OT in the US: Directions Population trends Reimbursement Emerging areas of practice and popular areas of practice Problems – Medicare abuses

3. 10% 14% 9% 5% 75% 54% (U.S. Census Bureau, 2002) Under 15 15 – 3435 – 4445 – 54 55 – 64 65+ Total U.S. Population Growth: 18% Change in US Population 2000 – 2020 Age (years)

4. Percent of Individuals Limited in Activities Because of Chronic Conditions (By Age) (Robert Wood Johnson Foundation, 1996)

5. U.S. Health Care Costs Medical care at end of life consumes 10%–12% of total health care budget and 27% of Medicare budget. At least one third of all Medicare expenditures provide care for eventually fatal illnesses. About 27%–30% of the total Medicare budget is spent in the final year of life. Of total amount spent in final year of life, nearly 40% is spent in the last 30 days. Hospice care can save 25%–40% of health care costs during the last month of life. (Trupin, Rice, & Max, 1995)

6. Number of Medicare Beneficiaries * Estimated. Numbers may not sum due to rounding. Source: CMS, 2004. The number of people Medicare serves will nearly double by 2030. 20.4 28.4 34.3 39.6 45.9* 61.0* 76.8* Medicare Enrollment (millions)

7. Today’s Emerging Areas of Occupational Therapy Practice Ergonomics consulting Design and accessibility consulting and home modification Older driver assessment and training Consulting to assisted-living facilities Technology and assistive-device development and consulting Health and wellness consulting Low vision rehabilitation Addressing Alzheimer's disease and caregiver training Addressing the needs of children and youth Community services

8. Practice Settings (AOTA, 2005)

9. Source: AOTA Member Survey, Final Report October 2003; AOTA 2005 - Centennial Vision

10. Connecting the Dots Current State Future Scenario Possible Implications Fewer than 1% of OTs work in mental health. Mental illness is becoming a major health burden. Continuing education, education, licensure Much content in educational programs is about body structure and function. Developments in stem cells, assistive technologies, etc., may restore functional ability. Educational programs may need to shift focus to lifestyle and QOL strategies.

11. AOTA Centennial Vision The eight elements viewed as relevant to a shared vision included the following: 1. Expanded collaboration for success 2. Power to influence 3. Membership equals professional responsibility 4. Well-prepared, diverse workforce 5. Clear, compelling public image 6. Customers demand occupational therapy 7. Evidence-based decision making 8. Science-fostered innovation in occupational therapy practice

12. AOTA Centennial Vision Six barriers were identified: 1. Rigid adherence to the status quo 2. Misalignment between the current OT priorities and the external environment 3. Limited appeal of membership in AOTA 4. Inconsistent competencies for education and practice 5. Overemphasis on a “helping culture” in the OT workforce 6. Unclear professional language and terminology

13. AOTA Centennial Vision Four strategic directions emerged after a careful analysis of barriers and opportunities: 1. Building the capacity to fulfill the profession’s potential and mission. –This includes: Ensuring an adequate and diverse workforce for multiple roles Preparing OTs and OTAs for the 21st century Increasing research capacity and productivity Strengthening our capacity to influence and lead

14. AOTA Centennial Vision 2. Demonstrating and articulating our value to individuals, organizations and communities. This includes: Meeting societal needs for health and well-being People understanding who we are and what we do 3. Building an inclusive community of members 4. Linking education, research, and practice

15. ACCREDITATION STANDARDS FOR A MASTER’S-DEGREE-LEVEL EDUCATIONAL PROGRAM FOR THE OCCUPATIONAL THERAPIST (Effective 1/1/08, ACOTE)

16. B.1.0. FOUNDATIONAL CONTENT REQUIREMENTS Program content must be based on a broad foundation in the liberal arts and sciences. A strong foundation in the biological, physical, social, and behavioral sciences supports an understanding of occupation across the life span. Coursework in these areas may be prerequisite to or concurrent with professional education.

17. B.2.0. BASIC TENETS OF OCCUPATIONAL THERAPY Coursework must facilitate development of the performance criteria including: Articulate importance of the history and philosophical base of the profession Explain interaction of areas of occupation, skills, patterns, activity demands, etc. Ability to analyze tasks Clinical reasoning

18. B.3.0. OCCUPATIONAL THERAPY THEORETICAL PERSPECTIVES The program must facilitate the development of the performance criteria listed below: Describe theories and models Explain how used in evaluation and intervention

19. B.4.0. SCREENING, EVALUATION, AND REFERRAL The process of screening, evaluation, and referral as related to occupational performance and participation must be: Culturally relevant Based on theoretical perspectives, models of practice, frames of reference, and available evidence

20. B.5.0. INTERVENTION PLAN: FORMULATION AND IMPLEMENTATION The process of formulation and implementation of the therapeutic intervention plan to facilitate occupational performance and participation must be: Culturally relevant Reflective of current occupational therapy practice Based on available evidence Based on theoretical perspectives, models of practice, and frames of reference

21. B.6.0. CONTEXT OF SERVICE DELIVERY Context of service delivery includes the knowledge and understanding of the various contexts in which occupational therapy services are provided.

22. B.7.0. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES Management of occupational therapy services includes the application of principles of management and systems in the provision of occupational therapy services to individuals and organizations.

23. B.8.0. RESEARCH Application of research includes the ability to read and understand current research that affects practice and the provision of occupational therapy services.

24. B.9.0. PROFESSIONAL ETHICS, VALUES, AND RESPONSIBILITIES Professional ethics, values, and responsibilities include an understanding and appreciation of ethics and values of the profession of occupational therapy.

25. The Real World In spite of best intentions of educational programs, graduates and the institutions they work for make mistakes in billing Medicare!

26. Problems with Payment System Major payer for OT is Medicare – the US version of socialized medicine – only for 65+ and individuals with disabilities Private health insurance often follows Medicare guidelines for paying OT/PT

27. Medicare Does Not Pay When: Therapy is repetitive – provided only to maintain function – not improve Person’s restoration potential is poor Goals cannot be reached Therapy considered general exercise program

29. Medicare “going broke” and one reason is inappropriate charges from OT and PT: Not Medically necessary - Medicare paid nursing homes $1 billion for OT and PT for services judged as not medically necessary or delivered by unqualified staff Poor documentation – Medicare paid $331 million for time billed that did not match time charted by OT/PT Medicare paid nursing homes $342 million more than OT/PT contractors charged nursing homes Medicare Going Broke!

33. Copyright 2005 American Occupational Therapy Association, Inc. Acknowledgments Slides on trends and Centennial Vision were developed by the AOTA Vice- President pursuant to his responsibilities for Strategic Planning. Appreciation is extended to Carolyn Baum, PhD, Leti Ford, Judy Wolf, Maureen Peterson, Cynthia Johansson, and Barbara Dickson for their assistance in its preparation. © 2005 by the American Occupational Therapy Association, Inc. All rights reserved.