Will COTAs become Extinct?
As I continue to search the internet, read blogs and forums related to our profession, and study changes that are occurring with pending legislation, I begin to wonder if the COTA occupation will soon disappear.
Many COTAs are not happy with all the changes since PPS came on to the scene. Being pushed for more and more productivity has caused many to leave the field. There are many more that are considering a career change, or currently attending classes to prepare to enter another field. Some COTAs are leaving the market just a few short years after graduating, claiming the job is just too demanding and stressful.
Prior to PPS, the nursing homes were paid an hourly stipend for every hour a therapist was in the building. These fees were set by location and type of therapist. At that time, it was assumed that the therapists in the building were involved with meetings, screening residents, completing notes, and attending to other departmental duties such as cleaning and organizing. All important tasks that are needed to maintain a therapy department. Something I did a lot of, and saw happening in many other clinics.
I know that there were many who abused the system prior to PPS. Stories I've heard such as the 103 bed SNF that employed 16 therapists is just one example of how the system was overburdened. Another story is the therapy company that set up contracts to pay them per treatment. This allowed them to come into a facility and treat as many as 14 patients at the same time with just two or three staff. Working this way allowed them to cover three or four SNF's, and generate 40-60 hours of treatment time daily.
Around the same time PPS came into effect there was a doctor who was caught billing Medicare for services on patients that had passed away. To me, this was a similar abuse of the system, but guess what happened to him? He was fined and had his license suspended for 60 days! The fine levied was about 1/8 of the total amount he had wrongfully collected. All doctors were not affected by this action though, just the one. I've always wondered why this same action was not carried out on those who were guilty in the therapy field. Single out and fine/suspend the unethical ones, and leave the rest alone.
But because of the few who did abuse the system, Congress called for changes to stop the drain on Medicare funds. Their answer affected the entire therapy world, in the form of PPS. To me, this is similar to the whole class getting detention because a few students acted up.
But these changes are all history now. I'm sure there have been many COTAs that have since entered and left the field, blaming PPS. Current job descriptions for a COTA include the ability to lift 50+ pounds routinely and stand for several hours at a time. No, the job is not an easy one, but I've never heard of anyone dying from a little hard work. PPS has made our daily job a bit tougher, but what I think we need to remember is why PPS was created in the first place; unethical therapists and companies looking for an easy way to make money. If the almighty dollar is your only motivation, being a COTA is not for you.
If you came into the field and left due to the physical demands, maybe you've gained some respect for those of us who continue to work as a COTA. I hope this field never dies as there will always be people who need our service. However if people continue to enter thinking they can cheat the system, history may repeat itself with further regulations on therapy.
Until next time, hope all your thoughts are good,
Tim