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What is assistive technology (AT) in OT? 

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What is assistive technology (AT) in OT? 

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This video explain more in depth what AT in OT is, such as how it i defined, the ranges of AT, and client cases.

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What is the Human Activity Assistive Technology (HAAT) model and how do we choose AT?

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What is the Human Activity Assistive Technology (HAAT) model and how do we choose AT?

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The HAAT model is a framework that has the practitioner look at the client, the activity, the AT and the environment/context. When selecting AT for a client, it is important to understand the clients physical function, cognitive abilities, and emotional factors, as well as their needs and wants, before choosing and fitting them to a device (Cook & Hussey, 2015).
Cook, A., & Hussey, S (2015).  Assistive technologies: principles and practice. St. Louis, Mosby-Elsevier.

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Let's start here: Basics of AAC (Augmentative and Alternative Communication). In this video, you will learn the basics of what No tech, low or mod tech, and high- tech means, what exactly fits within each category, and how to choose the best AT for individuals.

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Basics of AAC (Augmentative and Alternative Communication)

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Adapts ™ Portable Transfer Slings: a transfer sling that can be utilized for everyday use or in tighter spaces, such as on airplanes. (Abilities Expo)

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Communication Board: individuals who cannot verbalize or struggle to verbalize, may utilize this board in order to communicate with others.

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Softwheel
In-wheel suspension for wheelchairs to enable more comfortable rides, better safety, and overall health. (Abilities Expo)

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Sesame Enable: touch free control of smartphones, tablets, and PC's for individuals with disabilities.

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How to write a letter of medical necessity, in order to advocate for clients who could benefit from specific devices.

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Before writing the letter, confirm the following:

The child is covered by the insurance.

The diagnosis is a covered diagnosis (e.g., developmental delay may not be covered).

The item requested is not an exclusion of the policy (e.g., physical therapy).

The components of a medical necessity letter:

Identifying information: child's name, date of birth, insured's name, policy number, group number, Medicaid number, physician name, and date letter was written.

A statement of who you are: the child's primary care physician.

The date you last evaluated the patient.

The diagnosis of the patient. Think carefully about what diagnoses to include (include as many as possible) as some diagnoses may be an exclusion. One insurance refused to cover PediaSure for a child with a diagnosis of autism because it was an uncovered diagnosis; however, on appeal, they covered the PediaSure for the same child for a diagnosis of chronic constipation, a covered diagnosis.

Pertinent medical history (e.g., for a wheelchair approval, it would be appropriate to state that the child has cerebral palsy with severe motor impairment).

Document pertinent medical, developmental, or evaluative information. For the child with poorly controlled asthma for whom you are requesting a nebulizer, you would summarize what treatments have already been in place and how many ER visits and hospital admissions the child has had in the past year.

Document why the requested evaluation/treatment/equipment is medically necessary. This is critical to the process, but unfortunately, the definition of medically necessary varies from insurance to insurance. Medicaid's definition of being medically necessary is:

Reasonably calculated to prevent, diagnose, or cure conditions in the patient that endangers life, causes suffering or pain, physical deformity or malfunctions, or threatens to cause a handicap; and

There is no equally effective course of treatment available for the recipient which is more conservative or less costly.

A summary statement. In this statement, try to emphasize the logical conclusion (e.g., A nebulizer is medically necessary for this child with a diagnosis of asthma. Since this insurance covers the diagnosis of asthma and durable medical equipment is a covered benefit, it would be appropriate to approve funding for this child's nebulizer.)

Signature, professional qualifications, and contact information in case the reviewer has questions.

Keep a copy of the letter in the patient's file. You/the family will need it if you/the family need to file an appeal.

Special circumstances:
Equipment request:

Indicate which therapist evaluated the child for the requested equipment and refer to the therapist's report or letter.

State if the disability is permanent or temporary and how you expect the child's condition to evolve over time.

Give a rationale for replacing existing equipment (e.g., the child has outgrown their current chair and it was determined by the child's physical therapist that the current chair could not be adequately "grown" to meet the child's needs).

Emphasize how the requested item will prevent the onset of secondary disability or increases the individual's functional abilities, thus improving the child's overall condition.

Avoid referring to caregiver convenience and/or doing "nice" things for the child.

Children with disabilities:

Focus on how the service/evaluation/equipment will: prevent the onset of an illness, untoward condition, injury and or secondary disability;

Reduce, correct, or ameliorate the physical, mental, developmental, or behavioral effects of an illness, condition, injury, or disability; and/or

Assist the individual to achieve or maintain sufficient functional capacity to perform age-appropriate or developmentally appropriate daily activities.

For Professionals

Sample Letters of Medical Necessity (Dr. Bach)
Offers sample letters of medical necessity and allows users to create their own letter by filling in the blanks; developed by Dr. John Bach, Professor of Physical Medicine and Rehabilitation and Co-Director of the Jerry Lewis Muscular Dystrophy Association Clinics.

Examples of Letters of Medical Necessity (Rifton)
Offers downloadable examples of letters of medical necessity as well as equipment-specific letters, such as bathing systems, toileting systems, supine standers, and gait trainers). (Although geared toward Rifton-made equipment, the letters may be adapted.); Rifton is a commercial manufacturer of equipment for the disabled.

Request for a Letter of Medical Necessity Form (Portal) ( 27 KB)
A simple, one-page, downloadable form in Word for parents to fill out as a way to help the clinician write a letter of medical necessity; created by the Medical Home Portal.

Insurance Preauthorization for Diagnostic Test Form (University of Utah) ( 46 KB)
Sample letter in Word that can be downloaded and completed by a geneticist when a family is requesting pre-authorization of diagnostic testing; Division of Medical Genetics, University of Utah Medical Center.

Sample Letters of Medical Necessity, Genetic Testing (GeneDx.com)
Includes letters for genetic testing related to several cardiac and neurologic conditions and for whole exome sequencing; GeneDx is a commercial company providing genomic testing and related services.

Current Authors and Reviewers:

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Before writing the letter, confirm the following: The child is covered by the insurance. The diagnosis is a covered diagnosis (e.g., developmental delay may not be covered). The item requested is not an exclusion of the policy (e.g., physical therapy).

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Wheelers' Paramill: a cardio experience for individuals who utilize wheelchairs. (Abilities expo)

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Toyota Mobility side access seat:
https://www.youtube.com/watch?v=a0rrHbtgwks&feature=emb_title
(Abilities expo)

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References:

Medical home portal (2011). Writing letters of medical necessity. Retrieved from:

https://www.medicalhomeportal.org/issue/writing-letters-of-medical-necessity

OT Potential (2018). Telehealth Occupational Therapy - Everything You Need to Know. Retrieved from:

https://otpotential.com/blog/telehealth-occupational-therapy

Tech Owl AAC Community (2019) Communication boards. Retrieved from:

https://aaccommunity.net/2018/11/communication-boards/

Videos:

AAC:

https://www.youtube.com/watch?v=hWefkLfeGv4&feature=youtu.be

Adapts Portable Transfer Slings:

https://www.youtube.com/watch?time_continue=5&v=ULt_HLOmiVo&feature=emb_title

Sesame Enable:

https://www.youtube.com/watch?time_continue=27&v=EWC6iis--kY&feature=emb_title

Softwheel:

https://www.youtube.com/watch?time_continue=78&v=xh2evJs2fDM&feature=emb_title

Toyota AT:

https://www.youtube.com/watch?v=a0rrHbtgwks&feature=emb_title

TEK RMD:

https://www.matiarobotics.com/

What is AT?:

https://www.youtube.com/watch?v=anhesZIzqFM&feature=youtu.be

Wheelers’ Paramill:

https://www.youtube.com/watch?v=v_mWZUnja0Q&feature=emb_title

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Telehealth: digital capabilities to talk to OTR/L and/or have online therapy appointments.

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OT Potential * Occupational Therapy Resources

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Live video (also called "synchronous") is exactly what you'd think. Store-and-forward is also called "asynchronous," and is used to transmit imaging, as well as store and send health records. Remote patient monitoring involves electronically transferring information like blood pressure results or blood glucose levels. MedBridge Go and other forms of patient-facing HEP software are forms of mobile health.

At this point, most forms of telehealth occupational therapy will use a blend of these methods to deliver care, so it's honestly not that important to know the four types.

Why telehealth?

Telehealth was originally devised to bring much-needed healthcare services to underserved or rural populations, enabling patients to receive care when they might not otherwise be able to.

But even for patients who can access care, telehealth has its appeal. In today's modern age of on-demand technomania, telehealth is wonderful option in terms of convenience and, frankly, staying on trend. If other professionals are meeting customers' demands for on-demand care, why can't occupational therapists?

Consider a post-CVA patient whose son would normally need to drive her to OT, but now she can ask questions and receive teletherapy in the comfort of her own home, and her son doesn't have to miss work.

In any case, teletherapy is great for patient education, management of chronic illnesses, medication management, and more, and we occupational therapists are recognizing ways that we can provide our care remotely, as well.

Who is currently using telehealth?

Physicians: reimbursed for remote care

Physicians have been incorporating telehealth into their practice for years, as Medicare does pay for certain types of remote care. Here are some of the most popular disciplines:

Mental health practitioners: addressing unmet needs

Therapists and counselors are using telemedicine to deliver care to address the overwhelming need for increased mental health delivery in the U.S.

Surveys have indicated that 43.8 million Americans have a behavioral health crisis in a single year. The scary thing is 60% of those people don't receive treatment.

One of the reasons why telehealth is really taking off in the mental health world is that it addresses the fundamental reasons why people don't seek treatment for mental illness: lack of access and lack of resources.

And, perhaps most importantly, telemedicine delivery is discreet and convenient. Anyone who has experienced a mental health crisis can attest to the fact that real-time, convenient treatment delivered in a private manner is priceless.

Speech-language pathologists: reaching kids in underserved areas

Preliminary research has shown that teletherapy does show promise in addressing the lack of care for children in geographically remote and underserved areas. Perhaps that is why so many teletherapy SLP providers serve a pediatric clientele.
Telehealth SLPs can remotely address articulation and phonology, expressive and receptive language, fluency, voice, and pragmatics.
Being a less hands-on discipline than OT and PT, relatively speaking, it's no surprise that teletherapy has taken off in SLP a bit more quickly.

Physical therapists: telehealth in traditional practice

Physical therapists are just starting to use telehealth in an appreciable way.

There are several companies popping up that hire physical therapists to treat remotely. At this time, it's pretty tough to land a full-time benefited telehealth physical therapy position, so many roles are part-time or PRN. However, many traditional brick-and-mortar PT clinics have started incorporating teletherapy into their practice.

There is also a growing movement of private, cash-based PT practitioners, many of whom are opting to use telehealth as part of a niche-based practice, if not transferring their services to exclusively telehealth in nature.

As I already mentioned, some of us use forms of telehealth already. But if you're wondering who is working completely remotely as a telehealth occupational therapist, the answer is that more and more people are doing it every day.

One of the reasons why more occupational therapists have not gone full-throttle and dived headfirst into teletherapy is that Medicare does not currently reimburse for our use of remote medicine at this time.

Medicaid does reimburse for OT teletherapy in certain states, and third-party payers are spotty with their reimbursement. This uncertainty of payment has kept many OTs from really digging into the world of telehealth quite yet, but it's coming. And it has already started in certain niches.

Pediatrics is leading the way

As is the case with speech-language pathology, pediatric occupational therapists make up most of the early adopters of telehealth in the OT space.

Across the board in rehab, the pediatric world has been one of the earliest to start implementing teletherapy. I was trying to determine why that is, and it may be related to the fact that children cannot drive themselves to therapy.
Pediatric teletherapists typically work with children on sensory integration, fine and gross motor skills, visual motor skills, and school-related self-care skills.
This care can be delivered via schools (the school sets up the platform and all of the therapy settings, rather than-or in addition to-using on-site therapists. Parents can also book teletherapy from their own homes. For children up to age five, early intervention teletherapy can help provide much-needed caregiver and family education, helping mitigate future academic and social risks.

Other areas where telehealth can help in occupational therapy include:

The pros of telehealth

Improves access to those who wouldn't otherwise get OT

Convenient

Easier on the OT's body

Puts more emphasis on patient education and pain science

Delivers care on-demand to meet today's consumers

The cons of telehealth

But what about the rules?

Telehealth OT is a bit like the Wild West. There's very little consistency between states in the way of laws. Some states have established laws and regulations regarding telehealth, while others haven't even touched the subject. The AOTA has provided a chart (accessible to members only) that details information about telehealth and OT on a state-by-state basis.

Here are some other considerations to keep in mind.

Maintaining HIPAA

HIPAA applies to all medical professionals or healthcare organizations that are providing telemedicine services. According to HIPAA Journal, it's vital to consider the channel of communication used to transmit ePHI (electronic protected health information). Here are the stipulations, and you'll notice that they sound pretty close to what we use for non-telemedicine!

Only authorized users shall be able to access ePHI

A secure system of communication shall be used to protect the integrity of ePHI

There must be a system of monitoring communications with ePHI to prevent malicious or accidental breaches.

Maintaining standards of care

Across the board, practitioners of telemedicine are expected to adhere to standards of care that are the same-no more, no less-as what they'd provide during face-to-face visits.

Navigating reimbursement

Medicare does not currently reimburse for telehealth services, and Medicaid does reimburse on a state-by-state basis, so you'd need to check with your individual state regarding whether you could receive reimbursement.

Another consideration is third-party payers. Traditionally, insurance companies' reimbursement policies change like the wind, and it's no different with telemedicine.

The best way to find out whether an insurance company reimburses for telehealth OT is to ask them directly. Try to find a contact at each third-party payer you use, and make nice with him or her. That person will become your go-to for all things related to payments in your particular state, for your particular services provided.

What is the pay like?

The pay depends on several factors. Obviously, if you're a private practitioner, you'll set your own fee schedule. However, if you join an existing organization as a staff therapist, you'll likely earn similar rates to what you'd make in a traditional brick-and-mortar clinic.

From what I can tell, ranges per hour will be anywhere from $35-45/hour, and in states with higher living expenses, the rates might be higher (how refreshing!).

One important thing to consider is that many of these roles are per diem, so you might not receive sick time, PTO, or health insurance.

What is the schedule like?

The beauty of telehealth OT is that you can set your own schedule. The other side of the coin is that you might not get all the hours you need, especially if you're a new grad trying to pay off loans.

It's per diem care at its finest. But this can also be a blessing or a curse, depending on how many hours you need.

How to get into telehealth

As of today, there are three ways you can get involved with teletherapy. Here's how to do each.

1. Start your own practice

If you start your own practice, you'll need to understand state laws where you're planning to treat, get licensed in the state(s) where you're planning to treat, set up a business, attract your own patients, get liability insurance, set up a fee schedule, and all that fun stuff that goes along with owning your own clinic.

Plus, there's the tech. You'll need to figure out the software you'll want to use, but most solutions make it fairly easy to hang a shingle.

Here are some of the tech solutions for OT telehealth:

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Telehealth Occupational Therapy - Everything You Need to Know - OT Potential

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Whether you are interested in a teletherapy OT job or just want to understand what type of telehealth OT services are out there, this article is your complete guide to the state of occupational therapy and telepractice and your place in it.

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Tek RMD by Matia Robotics: a mobilization device that allows individuals to stand, allowing for more independence. (Abilities Expo) ttps://www.matiarobotics.com/