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Interprofessional primary care: the value of occupational therapy.

Improvement in the health of populations and the patient experience of care requires mindful and strategic approaches related to the cost and quality of health care. The literature supports the cost-effectiveness of the occupational therapist as a member of the interprofessional primary care (PC) team and as a health professional in the treatment of chronic illnesses (Metzler, Hartmann, & Lowenthal, 2012; Rexe, McGibbon Lammi, & von Zweck, 2013). With health care reform moving toward reimbursement for quality care and outcomes rather than fee-for-service, occupational therapists, as part of the interprofessional PC team, are strategically positioned to be part of the solution in addressing the health care system's greatest needs. Through leveraging the roles and responsibilities of occupational therapists on interprofessional PC teams, occupational therapists improve current team functioning and the delivery of PC services (Dahl-Popolizio, Manson, Muir, & Rogers, 2016; Muir, 2012; Tracy et al., 2013).

The Role of Occupational Therapy in PC

An occupational therapist is one potential team member who can contribute significant value to the health care team. Occupational therapists are skilled in addressing physical dysfunction and behavioral and mental health issues and in working with individuals across the lifespan to maximize function and participation. The role of occupational therapy (OT) in PC is not yet well defined and is dependent on such factors as the business model of the setting, the requirements of the interprofessional team, the patients' needs, and the awareness that the other team members have the skill set that OT contributes to the interprofessional PC team (American Occupational Therapy Association [AOTA], 2013; Donnelly, Brenchley, Crawford, & Letts, 2013). However, because the role of OT is frequently misunderstood, occupational therapists are often overlooked and underused as members of the interprofessional PC team (AOTA, 2013; Dahl-Popolizio, Manson, Muir, & Rogers, 2016; Donnelly et al., 2013; Donnelly, Brenchley, Crawford, & Letts, 2014). Table 1 provides brief, illustrative vignettes demonstrating what occupational therapists can do with complicated patient issues in the PC setting. Table 2 provides examples of common conditions where occupational therapists can be a primary or supplemental provider in PC.

Over the recent decades, most occupational therapists have pursued specialized positions in mental health or rehabilitative settings, despite their broad training. Reimbursement guidelines and the demands and requirements of the practice settings where occupational therapists work were the primary influences of this trend toward specialization. This narrowed focus has resulted in a lack of understanding by the medical community regarding occupational therapists' broad scope of training and their qualifications for the many clinical services they provide. With the expansion of integrated care, reimbursement opportunities, and the focus on value-based quality care, occupational therapists are increasingly becoming members of the PC workforce and interprofessional care team. The OT assessment focuses on how each patient's complaints or symptoms affect his or her ability to complete daily activities, or how his or her daily activities influence one's health (AOTA, 2010a). Health problems often result from these habitual daily activities. Occupational therapists identify barriers, both internal and external, to optimal function (Metzler et al., 2012), which equates to identification of barriers to optimal health. Occupational therapists' training and philosophy enables them to provide clinical services to improve self-management of health conditions and independence with activities of daily living, including those activities that affect health and adherence to medical instruction (Dahl-Popolizio et al., 2016).

When a patient requires additional assistance beyond the traditional medical visit for issues such as coping skills to deal with anxiety, exercises to address an acute musculoskeletal injury, or developmental screening to identify developmental delays, they typically receive a referral to an outside clinic or another provider. Occupational therapists on the interprofessional PC team immediately address these issues. This results in increased access to care and facilitates cost containment, as the referral to an outside provider may not be necessary and more patient needs can be immediately and collaboratively addressed in house (Dahl-Popolizio et al., 2016).

How OT Can Contribute to the Interprofessional PC Team

Interprofessional teams are typically comprised of multiple health care disciplines applying their unique skill sets and attitudes to supplement the contributions of the other team members (Hall & Weaver, 2001). Occupational therapists, with their broad skill set, contribute to the coordination of care and provide patient care to meet the needs of the patients in their most meaningful context, such as work, home, family, or community. Occupations, as defined by the AOTA, include any activity in which people engage throughout the day (Roberts, Farmer, Lamb, Muir, & Siebert, 2014). These actions and activities are the occupations addressed by an occupational therapist (AOTA, 2010a). The Manitoba Society of Occupational Therapists (2005) discusses the unique role of OT in individual health:
   How people perform their occupations is
   believed to be an important determinant of
   health and is influenced by personal factors,
   environments and the occupations that
   people do. Occupational therapy is the only
   health profession whose education is
   entirely devoted to the study of occupational
   performance and its impact on people's
   health and wellness, (p. 3)


This approach of addressing patient motivation in relation to functional activities has been the basis of OT for nearly 100 years and aligns with the World Health Organization's International Classification of Functioning (2014).

The occupational therapist on the interprofessional PC team is an additional professional who assists with many issues that complicate health and increase health care costs. For this reason, an occupational therapist is a benefit to the collaborative interprofessional PC team and the patients. With the top of the license principle, using their full skill set, occupational therapists provide whole-person care for populations, groups, and individuals in the PC setting, especially for those with or at risk of developing chronic illnesses (Roberts et al., 2014). This care is continuous, comprehensive, and coordinated over the lifespan and across all elements and levels of the health care system and includes collaboration with other team members, patients, caregivers, and families to make optimal decisions regarding overall health. With an emphasis on quality improvement and management of chronic conditions, costs will be reduced and the health of the population will improve (AOTA, 2013).

Occupational Therapist Education and Training

The American Occupational Therapy Association (AOTA) is the national professional organization of OT and provides accreditation and academic program consistency through the Accreditation Council for Occupational Therapy Education (ACOTE). The AOTA (2010b) outlines minimum standards that an occupational therapist must have to safely and effectively provide OT services to individuals, groups, and populations. An occupational therapist enters the field after earning either a master's or clinical doctoral degree in OT, passing a national certification examination, and obtaining licensure through the state in which they intend to practice. Core curriculum comprises biological and physical sciences, including anatomy, physiology, neuroscience, kinesiology, and biomechanics. Core content of OT educational programs also includes knowledge and understanding of human behavior and analysis of how disease, disability, trauma, and injury impact an individual's physical and mental health. Occupational therapists learn about the physiological process of diseases as well as the psychological and physical implications to function and quality of life that diseases impose. Through their training, OT practitioners deliver services to promote health and wellness, prevent disease and disability, develop skills not yet obtained, and provide compensatory or remedial strategies to improve an individual's function with his or her everyday living skills (ACOTE, 2011).

Integrating behavioral health into PC is cost-effective, and it is critical to address frequently co-occurring medical and behavioral health issues (National Association of State Mental Health Program Directors, 2012). It is not widely understood that occupational therapists receive training in mental and behavioral health and have a unique skill set focusing on roles, habits, and routines that can add to the expertise and effectiveness of the interprofessional PC team (AOTA, 2010a). The profession's educational standards related to behavioral health include knowledge of the current Diagnostic and Statistical Manual of Mental Disorders (DSM) relating to "psychiatric diagnoses, etiology, symptoms, impairments, clinical course, and prognosis" (AOTA, 2010a, p. S35; ACOTE, 2011). Further, OT educational standards include, but are not limited to, the ability to effectively evaluate and provide appropriate clinical care for patients with common comorbidities of mental illness and chronic medical conditions, such as diabetes, obesity, substance abuse, chronic obstructive pulmonary disease, attention deficit hyperactivity disorder, and autism. Occupational therapists are educated in multiple models of evidence-based group and individual approaches to provide clinical care effectively, including cognitive behavior therapy, psychoeducation, behavioral approaches, motivational stages of change, social and emotional learning, and more (AOTA, 2010a). Furthermore, in the last 5 years, the ACOTE (2011) mandated that all OT educational programs require at least one of the student's clinical rotations to focus on "psychological and social factors that influence engagement in occupation" (p. 34).

After graduation, an occupational therapist may practice as a generalist in a variety of settings or complete additional training and earn a board certification in one of several specialty areas. Depending on the needs of the specific PC setting, these specialist skills can complement the general OT training and meet the needs of the patient population (see Table 3).

What Occupational Therapists Currently Contribute to PC

As a generalist working in PC, the occupational therapist's clinical care strategies focus on improving overall function and self-management of health (Donnelly et al., 2014). The PC setting has required a renewed focus on the generalist approach to OT practice. In this model of care, occupational therapists provide rapid, targeted evaluations and brief, evidence-based clinical care strategies consistent with the pace of the PC clinic. An occupational therapist in PC practice does not negate the need for referrals to specialized OT services, such as neurological rehabilitation, certified hand therapy, and developmental rehabilitation, when patients need more involved clinical care than can be provided in the PC setting. They do, however, address issues that do not require the acute medical expertise of the physician and other non-physician providers (Dahl-Popolizio et al., 2016).

Occupational therapists use evidence-based strategies and assessments to identify and address a wide variety of client needs. Occupational therapists in PC can provide individual and group treatment for behavioral activation, patient engagement, and psychoeducation regarding symptom and disease self-management. In addition, occupational therapists can provide population health management using risk stratification to place patients in appropriate individual and/or group programs for the most efficient use of resources. Population health management strategies focus on preventative care, chronic disease management, and management of behavioral health issues, as well as behaviors affecting health. Occupational therapists evaluate for adaptive equipment when it is necessary to maximize function and safety and minimize pain.

Business Case for OT in PC

To fully demonstrate the benefit and sustainability of OT in PC, a business case must be built, as uncertainty about funding an OT position and reimbursement for services have been identified as barriers to inclusion of occupational therapists on the interprofessional PC team (Donnelly et al., 2013; Muir, Henderson-Kalb, Eichler, Serfas, & Jennison, 2014). In addition to explaining the services occupational therapists provide, it is critical to convey that they are not simply an additional expense, but a billable service (Dahl-Popolizio et al., 2016). Occupational therapists are able to use current procedural terminology (CPT) codes commonly billed in PC. They also provide services reimbursed under the CPT codes of physical medicine and rehabilitation, tests and measurements, therapeutic procedures, orthotic and prosthetic management, evaluation and therapeutic services, muscle and range of motion testing, and special otorhinolaryngologic services (American Medical Association [AMA], 2017; Dahl-Popolizio et al., 2016). It is common knowledge that when patients are unable to access in-house services, they often have difficulty obtaining these services elsewhere due to system and patient barriers to referral completion. As members of the PC interprofessional team, occupational therapists are available to address these patient needs immediately. This facilitates the cost- effectiveness (cost minimization and cost utility) of care teams. Tables 4 provides an example of OT CPT coding and billing in a typical day and demonstrates the potential revenue generation that offsets the cost of providing OT in PC. Table 5 demonstrates possible billing in a typical day and the potential increased revenue obtained by PC providers when an occupational therapist is treating patients with behavioral or rehabilitative needs, allowing the PC provider to see patients with more immediate medical needs. The AOTA is actively working to increase the number of insurers that accept behavioral health and case management codes for OT services. Limitations on the use, frequency, classification, and reimbursement of CPT codes in PC are controlled by payor (insurer), license, federal, and state regulations and policies. Regulatory guidelines must be thoroughly reviewed for sustainable cost control implementation.

Conclusion

Reform is leading us to view health care economics, sustainability, and PC services implementation differently. Medical practices are assuming the risk for their patients' health and the cost of care. In this changing environment, PC practices must consider all aspects of providing patient care, including the management of whole-patient care, ensuring optimal health outcomes, and injury and illness prevention, while providing all services in the most cost-effective and efficient manner. Quality care and outcomes are critical to economics and financial practice management. Including occupational therapists on the interprofessional PC team improves quality of care and efficiency in PC settings and specialty practice screening, intervention, and productivity (Dahl-Popolizio et al., 2016; Hart, Elizabeth, & Parsons, 2015; Macdonald, 2006; Metzler et al., 2012; Rexe et al., 2013; Waite, 2014).

To further address the barriers of lack of understanding of the potential contribution of occupational therapists in PC and current reimbursement strategies for sustainability of occupational therapists in PC outlined in this article, future research is necessary to ascertain the receptiveness of PC physicians to the inclusion of OT in PC. Although OT is not named in its report on the integration of physical and behavioral health care, the American Medical Association (AMA) supports the integration efforts of interdisciplinary teams providing team-based care to address the medical and behavioral needs of patients in PC (McIntyre, 2015). The authors recommend further research into and advocacy with the AMA and other interdisciplinary health care guilds to overcome these barriers to OT in this setting, as the educational background and skill set of occupational therapists offer significant value and complement the skills currently available on the interprofessional PC team.

Sue Dahl-Popolizio: Doctor of Behavioral Health, Clinical Assistant Professor and Occupational Therapist/Certified Hand Therapist with the Arizona State University Doctor of Behavioral Health Program, College of Health Solutions. Practice Scholar Affiliate Northern Arizona University Doctor of Occupational Therapy Program.

Oaklee Rogers: Doctor of Occupational Therapy, Academic Fieldwork Coordinator & Assistant Clinical Professor, and Occupational Therapist, Department of Occupational Therapy, Phoenix Biomedical Campus, Northern Arizona University.

Sherry Muir Doctor of Philosophy, Administrator; Faculty Practice & MOT Program, Associate Professor Occupational Science & Occupational Therapy, Doisy College of Health Sciences and Family & Community Medicine, School of Medicine, Saint Louis University.

Jennifer K. Carroll: Medical Doctor, Master of Public Health, University of Colorado Department of Family Medicine, Director, American Academy of Family Physicians National Research Network.

Lesley Manson: Doctor of Clinical Psychology, Clinical Assistant Professor, Assistant Chair of Integrated Initiatives, Consultant for PCBH Implementation and Auditing, Doctor of Behavioral Health Program, College of Health Solutions, Arizona State University.

References

Accreditation Council for Occupational Therapy Education. (2011). Standards and interpretive guide. Retrieved from http://wwwaota.org//media/Corporate/Files/EducationCareers/ Accredit/Standards/2011-Standards-and-Interpretive-Guide.pdf

American Medical Association. (2017). About the integrated physician practice section (IPPS). Retrieved from wwwama-assn.org/about-integrated-physician-practice-section

American Occupational Therapy Association. (2010a). Specialized knowledge and skills in mental health promotion, prevention, and intervention in occupational therapy practice. American Journal of Occupational Therapy, 64(Suppl. 6), S30-S43. http://dx.doi.org/10.5014/ajot.2010.64S30-64S43

American Occupational Therapy Association. (2010b). Standards of practice. American Journal of Occupational Therapy, 64(Suppl. 6), S106-S111.

American Occupational Therapy Association. (2013). Review of new models of primary care delivery. Washington, DC: Author.

Centers for Medicare & Medicaid Services. (2015). Physician fee schedule search. Retrieved from https://wwwcms.gov/apps/physician-feeschedule/license-agreement.aspx

Dahl-Popolizio, S., Manson, L., Muir, S., & Rogers, O. (2016). Enhancing the value of integrated primary care: The role of occupational therapy. Families, Systems, & Health, 34(3), 270-280. http://dx.doi.org/10.1037/fsh0000208

Donnelly, C., Brenchley, C., Crawford, C., & Letts, L. (2013). The integration of occupational therapy into primary care: A multiple case study design. BMC Family Practice, 74(60), http://dx.doi.org/10.1186/14712296-14-60

Donnelly, C., Brenchley, C., Crawford, C., & Letts, L. (2014). The emerging role of occupational therapy in primary care. Canadian Journal of Occupational Therapy, 81(1), 51-61. http://dx.doi.org/10.1177/0008417414520683

Hall, P., & Weaver, L. (2001). Interdisciplinary education and teamwork: A long and winding road. Medical Education, 35(9), 867-875. http://dx.doi.org/10.1046/j.1365-2923.2001.00919.x

Hart, E. C., & Parsons, H. (2015). Occupational therapy: Cost-effective solutions for a changing health system. The American Occupational Therapy Association. Retrieved from: http://wwwaota.org//media/Corporate/Files/Advocacy/ Federal/Fact-Sheets/Cost-Effective-Solutions-for-a-ChangingHealth-System.pdf

Macdonald, D. (2006). Occupational therapists: An environmental scan of the economic literature. Canadian Association of Occupational Therapists. Retrieved from http://wwwcaot.ca/pdfs/Environmental%20Scan.pdf

Manitoba Society of Occupational Therapists. (2005). Occupational therapists and primary health care. Retrieved from http://wwwmsot.mb.ca/wpcontent/uploads/2014/05/ Position_PaperPrimaryHealthCare.pdf

McIntyre, J. (2015). Report of the council on medical service (CMS Report 6-A-15). Retrieved from The American Medical Association website: https://wwwamaassn.org/sites/default/files/media-browser/ public/about-ama/councils/Council%20Reports/ council-onmedical-service/a15-cms-reporto.pdf

Metzler, C. A., Hartmann, K. D., & Lowenthal, L. A. (2012). Defining primary care: Envisioning the roles of occupational therapy [Editorial]. American Journal of Occupational Therapy, 66, 266-270. http://dx.doi.org/10.5014/ajot.2010.663001

National Association of State Mental Health Program Directors. (2012). Fact sheet on accelerating integrating of primary care, behavioral health and prevention: The SBHA role. Alexandria, VA: Author.

Rexe, K., McGibbon Lamini, B., & vonZweck, C. (2013). Occupational therapy: Cost-effective solutions for changing health system needs. Healthcare Quarterly, 16(1), 69-75.

Roberts, P., Fanner, M. E., Lamb, A. J., Muir, S., & Siebert, C. (2014). The role of occupational therapy in primary care. American Journal of Occupational Therapy, 68(Suppl. 3), S25-S33. http://dx.doi.org/10.5014/ajot.2014.686S06

Waite, A. (2014). Prime models. Showcasing occupational therapy's role on primary care teams. OT Practice. 19(1), 8-10. http://dx.doi.org/10.7138/otp.2014.197f1

World Health Organization. (2014). International classification of functioning, disability and health. Retrieved from http://wwwwho.int/classifications/icf/en/

Sue Dahl-Popolizio

Arizona State University, sue.dahlpopolizio@asu.edu

Oaklee Rogers

Northern Arizona University, oaklee.rogers@nau.edu

Credentials Display

Sue Dahl-Popolizio, DBH, OTR/L, CHT; Oaklee Rogers, OTD, OTR/L; Sherry Muir, PhD, OTR/L; Jennifer K. Carroll, MD, MPH; Lesley Manson, PsyD

DOI: 10.15453/2168-6408.1363
Table 1
Brief, Illustrative Vignettes on Issues Addressed by Occupational
Therapists in the PC Setting

                                    Examples of Occupational
Case Description                    Therapy Clinical Care

45-year-old male presents with      * Complete a postural
complaints of wrist, hand, and        assessment, develop a
shoulder pain that worsens            customized home exercise
throughout the day, duration 6        program to improve postural
weeks. Pain is significantly          alignment, increase patient's
limiting his ability to work at       flexibility, and decrease his
the computer, which he does at        complaints of pain.
least 8 hr-day. He is a college     * Complete an office work
professor, with teaching and          space evaluation, make
research responsibilities. He has     specific ergonomie
tried over-the-counter anti-          recommendations, and educate
inflammatory medication, but with     regarding good body mechanics
no real relief.                       for sitting and computer use.
                                    * Discuss how these principles
                                      apply to the home office space
                                      as well.
                                    * Educate natient on modifvine
                                      his routine to include short
                                      standing activity breaks and
                                      brief full body stretches to
                                      relieve muscle tension.
                                    * Instruct patient on median
                                      nerve glides to prevent
                                      further development of carpal
                                      tunnel syndrome.
                                    * Give handouts with visual
                                      cues to assist patient with
                                      carryover at home for all of
                                      the above information.

Mom brings in 5-year-old male for   * Educate parents on
a prekindergarten physical with       age-appropriate routines and
no real concerns, other than he       expectations, and discuss ways
is a little overweight and likes      to seamlessly implement them
to play on the computer or watch      into their daily lives.
TV. With questioning, mom             Provide handouts to improve
explains that at daycare, he          follow through.
usually prefers crafts and          * Establishing healthy
tabletop games to more active         routines (meal time, activity
play. At home, he watches TV          choices, and bed time
while mom cooks dinner, which         routines) to promote healthy
they eat in front of the TV.          physical activity levels and
After dinner, he plays video          improve healthy behaviors.
games or watches TV with his        * Provide suggestions on
father. He goes to bed around 11      age-appropriate activities to
p.m. after a big battle. He is        improve hand function and fine
very hard to wake up in the           motor control in preparation
morning, around 6 a.m., to go to      for school activities, such as
daycare.                              handwriting.
                                    * Discuss creating healthy
                                      habits and routines around
                                      physical activity/exercise,
                                      social
                                      interaction/participation, and
                                      screen time for electronic
                                      media (e.g., meals
                                      without TV).

Nurse case manager identifies 10    Group education sessions
people whose A1C has been high        developed in collaboration
for more than 6 months who have a     with nurse and occupational
BMI over 30 and have poor             therapist, conducted 1 hr per
medication compliance. Referred       week for 6 weeks:
to occupational therapist for       * Establishing healthy
group intervention.                   routines (meal time, activity
                                      choices, and bed-time
                                      routines).
                                    * Choosing healthy foods and
                                      label reading at the grocery
                                      store.
                                    * Time saving cooking tips.
                                    * Establishing a routine to
                                      increase physical activity and
                                      medication compliance.
                                    * Managing stress.
                                    * Thought and behavior
                                      modification strategies to
                                      improve mood and resulting
                                      behaviors.
                                    * Sleep hygiene.
                                    * PHQ-9, a depression
                                      assessment, can be
                                      administered to determine if
                                      depression is a factor in poor
                                      control of diabetes.

70-year-old woman with long         * Administration of GAD-7
history of smoking, chronic           (anxiety assessment).
obstructive pulmonary disease,      * Assist patient to tell the
and anxiety presents to primary       difference between symptoms
care several times per year for       of anxiety and inadequate air
follow-up after repeated ED           supply/exchange.
visits.                             * Develop coping strategies to
                                      increase self-management of
                                      anxiety (guided imagery,
                                      cognitive behavioral therapy)
                                      and reduce risk of panic
                                      attack.
                                    * Pursed lip breathing
                                      strategies.
                                    * Appropriate
                                      exercise/activity to optimize
                                      health.
                                    * Group interventions for
                                      support and education.
                                    * Collaborate with medical
                                      clinician for
                                      behavioral/pharmacological
                                      strategies for smoking
                                      cessation.

Note. ADLs = activities of daily living; PHQ-9 = Patient Health
Questionnaire-9; GAD-7 = General Anxiety Disorder-7. Table is
adapted, with permission, from "Enhancing the Value of Integrated
Primary Care: The Role of Occupational Therapy," by S. Dahl-
Popolizio, L. Manson, S. Muir, and O. Rogers, 2016, Families, Systems,
& Health, pp. 274-275. Copyright 2008 by the American Psychological
Association.

Table 2
Examples of What OT Can Contribute to the Team-Based Care
with Common Conditions Seen in PC

                      Occupational
                      therapist can           Occupational
                      address medical/        therapists can
                      rehabilitative          address behavioral
Diagnosis             issues                  health issues

* Diabetes            * Medication            * Coping strategies
* Cardiac Diseases      adherence             * Adjustment
* Hypertension          strategies              to illness
* Depression          * Diet                  * Family education
* Anxiety               modification            around what to
                        strategies              expect and how to
                      * Developing              help family member
                        schedules and           succeed with plan
                        habits to improve     * Educate
                        likelihood of           regarding
                        adherence               community
                      * Activity program        resources
                        that is consistent
                        with patient goals
                        and interests
                      * Educate
                        regarding
                        self-management

* Low Back Pain       * Education             * Coping
* Shoulder Pain         regarding postures      strategies around
* Tendinitis          * Activity                loss of function,
                        modification            loss of
                        education               employment, loss
                      * General exercise        of meaningful
                        education               recreation, change
                                                in family roles
                                              * Strategies to
                                                manage co/morbid
                                                depression and/or
                                                anxiety
                                              * Chronic pain

Note. Table is adapted, with permission, from "Enhancing the Value of
Integrated Primary Care: The Role of Occupational Therapy," by S.
Dahl-Popolizio, L. Manson, S. Muir, and O. Rogers, 2016, Families,
Systems, & Health, p. 273. Copyright 2008 by the American
Psychological Association.

Table 3

Current Recognized Specialty Certification Areas
Board Certifications Specialty Areas

* Hand Therapy (CHT--Certified Hand Therapist)

* Gerontology (BCG)

* Mental Health (BCMH)

* Pediatrics (BCP)

* Physical Rehabilitation (BCPR)

* Driving and Community Mobility (SCDCM or SCDCM-A)

* Environmental Modification (SCEM or SCEM-A)

* Feeding, Eating, and Swallowing (SCFES or SCFES-A)

* Low Vision (SCLV or SCLV-A)

* School Systems (SCSS or SCSS-A)

Table 4
A Typical Day with OT Available in PC

CPT Code *       Number of   Minutes spent     Per unit fee
(visit type)     patients    with patient

97110 (ex)           2            30          $32.54/15 min
97535 (ADL)          4            30          $35.04/15 min
97530 (act)          5            30          $35.04/15 min
97150 (group)       10            60         $17.52 (untimed)
97003 (eval)         1            30         $85.45 (untimed)
97532 (cog tx)       2            30          $26.82/15 min

Total net reimbursement for a typical 8 hr day
Total net reimbursement per year based on
this typical day (50 weeks)

CPT Code *                                        Billed/     Hours/
(visit type)                                     day/code    day/code

97110 (ex)                                        $65.08      1 hr
97535 (ADL)                                       $140.16     2 hr
97530 (act)                                       $175.20    2.5 hr
97150 (group)                                     $175.20     1 hr
97003 (eval)                                      $85.45     .5 hr
97532 (cog tx)                                    $53.64      1 hr

Total net reimbursement for a typical 8 hr day    $694.73
Total net reimbursement per year based on
this typical day (50 weeks)                     $173,682.50

Note. * CPT codes (all modifiers) retrieved from the Centers for
Medicare & Medicaid Services (2015). Salaries vary greatly and are
dictated by setting and region. Current salary range across the nation
according to the Bureau of Labor and Statistics (http://www-bls-gov)
is approximately $50-$98,000 per year, with 114,600 jobs in 2014,
which is expected to increase by 27% by 2024. As PC is an emerging
practice setting, there are no current statistics regarding salaries
in this setting.

Table 5
Potential PCP Reimbursement With and Without OT

A. Typical Day Without OT

CPT Codes *       Number of      Total
(visit type)       patients     revenue

99213
(basic)               16       $1,167.04
$72.94

99214
(moderate)            2         $216.68
$108.34

99203
(new basic)           2         $218.10
$109.05

Total Revenue:                 $1,601.82

B. Typical Day With OT

CPT Codes *       Number of      Total
(visit type)       patients     revenue

99213
(basic)               4         $291.76
$72.94

99214
(moderate)            12       $1,300.08
$108.34

99203
(new basic)           2         $218.10
$109.05

99204
(new moderate)        1         $165.90
$165.90

99205
(new ill)             1         $208.45
$208.45

Total Revenue:                 $2,184.29

Table includes typical PCP schedule of billable visits (A) versus
using OT as part of the PC interprofessional team and (B) increasing
PCP availability to see new and established high-need patients

Note. * CPT codes (all modifiers) retrieved from the Centers for
Medicare & Medicaid Services (2015). See Table 4 for potential
OT billing.
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Author:Dahl-Popolizio, Sue; Rogers, Oaklee; Muir, Sherry Lynne; Carroll, Jennifer; Manson, Lesley
Publication:Open Journal of Occupational Therapy
Article Type:Report
Date:Jun 22, 2017
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