I have worked for a corporate SNU for roughly 6 years of my career. During that time, I have seen my clinical judgement as a therapist and my practice ethics being slowly plucked away from me. Anymore, Medicare RUG levels seem no longer determined based on the therapists initial evaluation and patient's medical status, but on the corporate "push" for 60% + ultra high RUG catagories, as well as a certain Part B percentage, in order "to help determine the rehab departments annual budget."

Now it's-"ultra high" -unless you can prove otherwise. Then when you do, it becomes, "OK-but can you wait to bump them down after we get them through their next assessment period?" It's just never-ending! I find myself dreading our weekly Medicare meetings-where I get to hear about how we need to "bump up " RUG catagories and "pick up" more part B's because the facility census is low, and how we need to move from 5-day a week treatments to 6, and how we need to stay and do evals on our late admits, etc, etc, etc.

At times, I've wanted to just drop my clipboard & just walk away. I no longer feel like a valued or respected professional, but like a child being told what to do and how often and how long to do it. What I would really like to say is, "I don't care what corporate wants! The last time I checked, I am the skilled professional; I follow my profession,s own code of ethics, the State Board of Healing Arts issues my license, and furthermore, overtime is optional, not mandatory".

The sad thing, is that this scenario exists is most corporate run SNU's- because they are "businesses", so it is not isolated to the facility where I am employed.

I have determined that if I am to continue working in my area of choice, I will need to make a move to be a contract provider, who may be able to eliminate some of the corporate BS mentioned. I would greatly appreciate any assistance from those OT's who are contract providers who would be willing to assist me in making this transistion.

I have been in the same situation.  It is very frustrating and you feel unvalued as a professional.  I actually blew the whistle on my company and little was done by corporate.  However, feeling sure of what is right and what is wrong I gave my notice immediately and started traveling.  To my great delight I was hired by another SNF that was nothing like the previous.  I think that as ethical practitioners, we have to stand up for ourselves and our profession.  Those that treat inappropriately harm our profession and make billing more complex and difficult.  I won't be suprised if something drastic, like PPS, doesn't occur again in the SNF environment and we see a drop in jobs again.

 Although I can't help you with your next step, I wish you much luck.  Keep your chin high, because I'm sure you're doing an outstanding job and never getting praised for it.

Thanks Michelle, I appreciate your feedback. I would not be surprised by the return of PPS either; something has to change for the good of our profession.

 I too, feel your angst. As of the past months I have personally encountered several instances of organizations , agencies & individuals engaged in unethical , abusive & perhaps fraudulent behavior that negatively impact not only my work as an OT but our entire field of rehabilitation. I have had discussions with several OT's &PT's describing to me similar occurances, as well as,  blogs & forums posted on this site.

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Mr. Gagliano - Thanks for your reply and support. I appreciate the invite to attend the forum you will be hosting, but unfortunately I live and work in the Midwest. I too would like to see positive changes for delivery of OT services in the areas I spoke of. In addition to gathering information on the appropriate steps for opening a private practice or providing contracted services, I do intend to write our state legislators & legal representatives of the profession regarding these concerns.

Good luck with the forum, and please feel free to contact me at xbatt@swbell.net to let me know how it goes.

Hi Michelle and Mr. Gagliano,

    I am very interested in the forum and ethical issues that OTs face. I teach ethics at a master's OT program and would like to have students know and perhaps help problem-solve with possible actions. If anyone wants to give me ethical cases (we can change names involved) to have the students study and respond with suggestions, please contact me at slin@su.edu. Mr. Gagliano, I laud your efforts to approach ethical problems head on, with a forum at a university, and I wonder if there is any way you could record the forum digitally, so that others who are far away could listen to the discussion. I have used the free audio recording software, Audacity, and find it very useful (to save as audio files). I'd also like to remind everyone that if you're an AOTA member, you can contact the Ethics Commission for info and guidance.

    - Susan
 

Kudos to you for standing up to corporate push!! I have also been in a similar situation at my previous job. However as the OTR, I would document why a particular patient was not able to meet the predicted category minutes. Such as unable to focus on tasks due to poor attention, weakness, pt. reports fatigue after 20 minutes, pt  too sedated after receiving pain medication to tolerate more thant 45 minutesof therapy, etc..... Since the rehab director at that facility was not a OT, she could not argue my decision on a professional basis. I left that institution because personally was against my personal values and professionally I felt it was unethically against my profesional beliefs as well.

I have worked in a SNF-long term care for the past 15 years.  I have seen significant changes, like you said with the changes in the medicare RUGS.  Just wanted to tell you that working for a contract company for me was actually a worse experience!   After being at the same facility for 10 years, they switched to a contract company for a two year period, while they are in the process of building new programs/ buildings.  Were we turned over to a contract company and you hit the nail on the head.  As a therapist clinical judgement was almost gone with the new company dictating where all pt's should fall  upper two RUG level as much as possible.  Also with medicare B patients pushing to see them for high amounts of minutes, even if not clinically warrented based on my assessment. I was even told to go see a pt who was ill with a positve flu, to try to get the minutes.  And as you said, your ethics are pushed to the limits.   Its a shame because therapy went from quality to quanity!! 

I have choosen to leave my current contract employer, as my professional ethics and  personal values did not match this companies.   My questions is you have the state reviewers who look at SNF, but with my experience do they have much interaction with therapy.  So who then would monitor these companies and their  medicare usage practice??

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laur

Nice Job Laurie, I agree completely, I work for a company PRN not my full-time job, and I had to eval 2 persons that were diagnosed terminal and placed a hospice and the company wanted them see daily at a very high level! When's it gonna end.