1996 A Year of Exploding Change in OT
By E.J. Brown
Upheaval touched everything from the weather to sports this year, and that included occupational therapy. A look back at the past 12 months reveals major new directions for the profession administratively and in the marketplace.
Outside, cities from Maine to Virginia had been digging out from December's legacy when the Blizzard of '96 hit on Jan. 9. Many hospital workers had to be transported to and from work by snowmobile and four-wheel-drive vehicles at the height of the storm. Cabin fever attacked other people, who just could not go anywhere at all for days. A Bayer Corporation study of how people were coping indicated that many were using creative occupations to shed the stress.
Inside, occupational therapists were debating how to handle the weather professionally. Managed care had grown by leaps and bounds in 1995. MCOs had already invaded Medicare, and HCFA set up a study to determine the quality of care its recipients were receiving under new reimbursement guidelines.
Mental health services were still being hit hardest. A case in point was Florida, where legislators, trying to stem a 4.5 percent rise in Medicaid mental health costs over the past five years, had moved to case management and dropped reimbursement rates by more than $20 an hour. They added a 2-percent co-payment for patients. The CEO at one mental health center in Ft. Lauderdale feared that the Sunshine State would be forced to ration care as federal aid shrank.
Ironically, the World Health Organization announced concurrently that a study of 26,000 hospital patients in 15 countries showed that psychiatric illnesses which caused loss of energy, feelings of hopelessness and loss of motivation were more disabling than physical illnesses.
The ACR published its first guidelines on the management of osteoarthritis, noting that OTs should play an integral role in the process, according to Mark C. Hochberg, MD, in an article in the November '95 edition of Arthritis and Rheumatism.
And occupational therapy lost one of its best when Javan E. Walker, director of the OT program at Florida A&M died suddenly at his home in Tallahassee on Jan. 29. Walker was only 55.
On April 4, the American Occupational Therapy Certification Board announced that it had changed its name to the National Board for Certification in Occupational Therapy (NBCOT), and had instituted a certification renewal program that would eventually require all practitioners to meet continued competency requirements every five years to stay certified.
The move was made to enable the certification board to keep better track of the practice worthiness of its certified OT personnel as they continued their OT careers, for the protection of the consumer. Beginning next April, those therapists up for recertification who had not returned an NBCOT re-certification application along with a $75 fee would not be able to use the initials OTR or COTA behind their names.
Meanwhile, 10,000 occupational therapy personnel jammed Chicago's Navy Pier in AOTA's biggest-ever national conference, held Apr. 15-19. The 1996 Representative Assembly made some monumental moves to help launch the profession into the 21st century. The assembly approved resolutions to put psychosocial treatment back into the physical disabilities arena and to re-evaluate the structure of the national association.
The RA also approved a resolution to educate academic fieldwork coordinators to find and keep the best fieldwork sites as affiliation slots continued to decline. In the face of the challenge, 1996 Slagle lecturer David Nelson told his colleagues "Why the Profession of Occupational Therapy Will Flourish in the 21st Century." Actual "doing" heals the mind and body fastest, he said.
On May 6, ABC News reported that occupational therapists might be among a number of rehab professions defrauding the public by charging exorbitant fees for possibly unnecessary treatment. The report caused an outcry among practitioners, many of whom said they did not know what their facilities actually charged for their services.
An AOTA/AOTF study noted that lack of consistency might be jeopardizing OT's position in mental health. Therapists, it said, focused more on components of function than on outcomes.
In summer, everyone's fancy turned to sports. On July 19, the 1996 Summer Olympics opened in Atlanta, drawing the attention of the world to the U.S. A terrorist bombing in the city's Centennial Park during the Games killed one woman. It marred the event but did not dampen the Olympic spirit.
On Aug. 15, 103 nations sent their athletes to the first televised Paralympic Games held at the same stadium; 200 world records were smashed. OT hopeful Jennifer Barrett broke one of them, in the F-42-46 Discuss Throw.
Amid the melee, a team of mentally disabled athletes claimed discrimination by the Atlanta Paralympics Organizing Committee (APOC), saying they were deliberately left off promotional materials and out of the opening ceremonies. APOC denied the charge and apologized.
Asst. Sec. of Education Judy Heumann shocked many when she announced that 35 percent of American high schoolers with disabilities drop out of school. She said schools must provide better sports programs for children with handicaps.
In mid-summer, the 11th annual International Conference on AIDS convened in Vancouver, BC. There were whispers of a possible cure on the horizon with new developments in genetics and medicine, but medical representatives warned that no one should start taking such possibilities for granted.
The Pennsylvania Economy League predicted that large numbers of hospital employees in hospital-saturated areas will lose their jobs in the next five years due to mergers and downsizing. Up to 40,000 will be laid off in the Philadelphia area alone, the league said.
The U.S. Preventive Service Task Force, a division of the U.S. Public Health Service, released new guidelines on preventive care that said providers should do more counseling with their patients and less testing.
Fieldwork columnist Pat Crist lashed health care alliances that were dropping or limiting their fieldwork contracts, shortening the supply even further below the demand. A small debate arose of the pages of ADVANCE over who should bear the brunt of the responsibility for training OT students. Clinicians charged that students were coming to them unprepared for the clinic; academic educators defended their curricula, and one reader suggested that clinicians were practicing too much like PTs.
School columnist Barbara Chandler challenged school-based therapists to move into the regular classroom, enlarging their sphere of activity in the schools to students who are not disabled but may be dysfunctional. This they might do, she said, by educating school administrators about OT's skill range.
Meanwhile, the managed care debate continued. Through the summer OT writers had suggested how to handle the changes in health care. Some believed that managed care was a boon to the profession. Readers seemed to disagree, suggesting that the whole managed care concept was a boon to the insurers, and not to anyone else.
In early October, occupational therapy personnel from across the country met at AOTA's first SIS Practice Conference in St. Louis, MO. A more informal event than the national meeting, this convention focused more directly on practice issues. The conference will become an annual mid-year event.
As states and regions held their local gatherings, OTs around the country were looking pretty much in the same direction: the future, and how to meet its challenges. Not everyone agreed on the answer.
Texas clinician Barbara Plummer went before AOTA's Executive Board to challenge NBCOT's right to claim ownership of the OTR/COTA initials by registering them with the U.S. Patent Office. Claiming the act was a violation of anti-trust legislation, Plummer filed a Resolution asking the 1997 RA to direct AOTA to take back the independent certifying power it had granted AOTCB in 1986. The RA will discuss the issue at its meeting next April.
In November, President Clinton won a second term of office, but Republicans strengthened their majority in Congress, leaving health care reform in limbo.
As 1997 begins, the occupational therapy community awaits the forward-thrust of the major new directions the profession has taken this year.
ADVANCE would like to thank its readers for their support and participation in getting the news out to OTs this year. We wish all a happy holiday.