#151 Caregiver Training Codes with Rachel Wiley

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Over 53 million people in the US provide unpaid caregiving services.
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That is a stunning one in six people.
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The complex role of caregiving can entail everything from behavior management, symptom detection, nutritional guidance to medication administration and transfer skills.
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As you can imagine, insufficient caregiver training can lead to increased patient risks for safety and injury, worsening symptoms, loss of function, and higher healthcare utilization costs.
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And for the caregivers themselves, unmet training needs are associated with higher anxiety, depression, burden, and lower self-esteem.
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Prior to 2024, healthcare workers like OTs and PTs face significant billing barriers for caregiver training.
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But in 2024, new caregiver training codes were introduced that every OT and PT needs to understand.
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In this course, we'll look at these codes with dementia expert Rachel Wiley.
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We'll talk about what they entail with a focus on how they can be implemented in practice.
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But we'll also talk about their current limitations and future directions for truly meeting the massive needs of caregivers and their patients.
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So let's dive in.
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Welcome to the OT Potential Podcast.
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I'm your host, Sarah Lyon, OTRL, and I wanted to let you know that this podcast may qualify as continuing education for you.
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You are probably listening to this podcast on a free podcast platform.
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But to gain CEU credit, you will need to be a member of the OT Potential Club, our OT Continuing Education platform.
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You can go to OTpotential.com to learn more.
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Okay, here we go.
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As I mentioned at the top, joining us today is Rachel Wiley, MS OTRL CDP.
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Rachel is an occupational therapist and the founder and owner of Dementia Collaborative LLC.
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Rachel is certified in Skills to Care for caregivers of individuals living with dementia, and she is the creator of the Dementia Clinical Practice Certification.
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Rachel is also a certified master trainer for skills to care through Jefferson Elder Care and trains occupational therapy practitioners from around the world in the Skills to Care program.
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She is also currently a volunteer advisory council member for Dementia Society of America and a volunteer board member for Vermont Occupational Therapy Association and the Equitable Life Organization International.
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Previously, Rachel also owned and operated a patient care practice, day-by-day home therapy for six years, serving clients living with dementia and their care partners in the Delaware Valley in their homes throughout patient insurance.
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Finally, through the Dementia Collaborative's Dementia Squad, Rachel hosts a group of dementia specialists, occupational therapists bi-monthly to discuss clinical practice challenges and host guest speakers on dementia-related topics.
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Okay, that is what I want you to know about Rachel.
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I also have one more quick technical note about billing codes that I want to say before we jump into this discussion.
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CPT is a registered trademark of the American Medical Association.
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And because official CPT billing code text is copyrighted and requires a paid license to quote directly, our caregiving code descriptions are drawn directly from the public domain text in CMS's 2024 Medicare Physician Fee Schedule Final Rule, which I will link to in our show notes.
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Okay, without further ado, we will patch Rachel into our live studio.
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Rachel, welcome back to OT Potential.
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It's so great to have you.
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Thank you so much for having me, Sarah.
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I am so thankful you are back.
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I honestly wish you and I could be here talking about just best practices in dementia care, how the evidence has advanced.
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There's so much great evidence in this area.
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But unfortunately, we have a huge barrier to implementation currently, which is our reimbursement options and codes for meeting complex care needs.
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I've been really fired up about how hard it is to have a sustainable practice in this area.
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I recently wrote a blog post called Why OTs and PTs Are Blocked from Serving Older Adults.
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Like we just do not have the right reimbursement for complex care.
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Other people see this problem.
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There's little fixes coming.
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I would say they're not enough, but today we are going to look at one of the little fixes that is out there and kind of use that as a springboard to talk about where we need to go from here.
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So you have been living in this world of dementia care, of helping adults with complex care needs.
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You've just dedicated your time, your career to it.
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Tell me a little bit about the journey of your career and the challenges that you have faced in serving older adults.
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Absolutely.
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I'm happy to chat about that, Sarah.
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And I also want to take a second to just thank you for your advocacy efforts.
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I think, you know, for those of us who kind of live in this space, we recognize the challenges of maintaining and sustaining a practice to serve this population.
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Um, but I'm so grateful to have people like you who help us advocate for being able to continue the work that we're doing.
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So thank you, thank you.
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And your blog post is incredible.
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So thank you for doing that.
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So, in terms of my journey, so I've always wanted to work with older adults, specifically older adults living with dementia.
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And um, without me getting too in the weeds about my entire life journey, I will say that I eventually realized that in order to do this work of supporting people living with dementia and their care partners or their families full-time, I really had to start a practice because there really weren't any positions open for full-time dementia care occupational therapy practitioners at the time.
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So I started my practice.
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I think it was probably about three years after graduating from OT school.
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And it was fantastic.
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I loved everything about that work, uh, except that it's really not a sustainable business model.
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In order to provide best practice in dementia care, you know, there are certain aspects of care that make it really hard to sustain, financially sustain a practice.
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So low reimbursement, not being able to opt out as OT providers from Medicare, and not being able to see a really high volume of patients when you're doing in-home outpatient care contributed to some of the challenges that we experienced.
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And I would argue that of the CPT codes that were available to me at the time and continue to be available, none of them really truly encompass the complexity of dementia care with the incorporation of caregiver education and training.
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So it's required that I kind of continue to pivot my business model.
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Um, I've since, even though I stopped doing the direct Medicare Part B patient care through my practice, at least temporarily, it's looking like I'm probably diving back into that world with some grant support probably in the next couple of months.
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But uh right now I'm doing private pay caregiver consultations only.
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So it's not that direct patient care treatment.
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Um, rather, it's like caregiver coaching kind of.
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So really just trying to figure out like how do I keep my practice alive so that I can continue to support this population, but in a way that I'm not bleeding money every month.
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So yeah, I think that's been that's been a big portion of my journey in order to figure out how to continue to support this population.
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I hadn't really put this shared part of our journey together, but I definitely became an OT because I wanted to serve adults with complex care needs.
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Um, I started in a skilled nursing facility because that is the one viable option.
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I definitely did not realize the barriers that exist to seeing patients with complex care needs in like outpatient, like you looked around and you didn't see any physicians.
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And now I would be like, oh, it's because there's not this model.
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You piece that together that the problem is like at our reimbursement level at the code level.
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Did you realize that earlier than I did?
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Because I just realized it literally like this year.
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Yeah, yeah.
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That's such a great question.
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So I think to some degree, I knew that it would be challenging because I was working, I did at least like dabble a bit in some Medicare Part B dementia care OT positions.
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I was more per diem um at the time.
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So I didn't really know what it would look like, truly look like full time.
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Of course, before I started the practice, I, you know, did the math.
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I went to a lot of business classes to make sure I had a viable business plan.
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I think there were a lot of aspects of business that I underestimated in terms of, you know, when you're when you're not running a business and you are a clinician, I think your expectation about how many patients you can see is greater.
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And then when you're actually managing the administrative burden of the practice, you realize, okay, I can't see as many patients as I initially intended.
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So that was a factor in all of this.
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Um, Medicare reimbursement also continued to be cut instead of go up.
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So I graduated um OT school around like 2013.
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I can't say this with certainty, but I think that was around the time where we were at like almost like peak Medicare reimbursement.
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So I think I was also naive and optimistic that we would see increases in reimbursement as opposed to reduction.
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So I was kind of looking at it as like, okay, it might be tight year one, year two, but it's going to get better because we'll see increases in reimbursement rates.
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Little did I know that that that wasn't going to be the case.
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And now it all makes sense why I couldn't find an OT, full-time OT position in this space.
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Yeah.
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And our codes were just truly written for these like low complexity orthopedic fit like cases.
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You can think the traditional outpatient clinic works towards like there's a high volume of people circling through.
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And when you're seeing tennis elbow, you can see six patients before lunch.
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You can see a lot.
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And I remember just years ago, you said to me, like, I see like two or three patients, and I'm emotionally exhausted because it's so much work.
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Like, and there is no difference in our codes from that low complexity where you're you're looking at one thing to older adults where you're looking at 10 different, totally emotional things that take your whole entire focus.
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You can't be in a gym managing multiple patients.
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Exactly.
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Even yesterday, and this is a slightly different example because it's in a position that's grant funded, but I work in primary care one day a week, specifically supporting cognitive, um, you know, doing cognitive assessments and helping with dementia care.
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And because I'm grant funded, I have a lot of flexibility in terms of how long I see people.
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But I was with this particular patient for well over an hour for an initial visit.
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And the care partner was involved in the session.
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But even in that initial visit, there was like physical aggression that manifested.
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I was scratched, she was really agitated, the care partner was really anxious and agitated.
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And I just think like if I didn't have the flexibility of grant funds to be able to like manage the nuance and I was feeling like I was on this time crunch, that could have escalated the situation to the point where everyone left upset and uncomfortable.
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Um, when you're dealing with the complexities of dementia care, especially the behavioral and psychological symptoms of dementia or responsive behaviors, you have to have time to be able to not only support your own emotional health, but your emotional uh bandwidth directly impacts the quality of life and what will happen to the behaviors of your patient as well, if that makes sense.
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Yeah.
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It's exhausting and so rewarding.
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Yes.
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So you and I are not the only person in the world looking at dementia care, complex care needs.
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It's definitely something that uh here in the United States, CMS is looking at.
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We just know we are on this trajectory now by 2050, the number of older adults is gonna double.
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I think I read this morning that the number of people with dementia is going to close to triple.
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Like we are just staring down these huge shifts.
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And so, on some level, uh people are like, okay, we need to start getting ready for this.
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And that I assume is why we got these caregiver training codes.
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These codes, uh, I think I maybe I'll just say them and then we can talk a little bit more about them.
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I want to I want to read the definitions just so we can be on the same page.
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Because as I said in the beginning, these are not the official definitions.
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The official definitions are protected by CPT and the American Medical Association.
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So we have a set of these caregiver training codes.
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The first is CPT code 97550.
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It reimburses around$50, and it is for an initial 30 minutes of caregiver training.
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It entails caregiver training and strategies and techniques to facilitate the patient's functional performance in the home or community, including ADLs, instrumental ADLs, transfer, mobility, communication, swallowing, feeding, problem solving, and safety practices.
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The big caveat is it has to be done without the patient present, but face to face with the caregiver.
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So that's kind of the core one for us.
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And then there's an add-on code.
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If you go above that 30 minutes, that reimburses around$25.
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And you add that on for each additional 15 minutes after that 9750.
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And I would also say to that, there is a 60-minute daily minimum.
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So you can't add oh, sorry, maximum.
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Maximum.
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Thank you.
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So you can't add on more than two codes.
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You can do the first one and you can add on two codes.
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So there's kind of that set.
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And then there's another um one for group caregiver training, 97552.
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That is$22 per patient that's represented in the group.
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And that is for strategies and techniques to facilitate the patient's functional performance in the home or community.
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Again, that list of instrumental ADLs, transfer, mobility, communication, swallowing, feeding, problem solving, again, face to face with multiple sets of caregivers.
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That's the code set that was introduced a couple years ago.
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Um, to me, it's an it's an acknowledgement that there is an acknowledgement of the big uh need that's coming up for caregiver training.
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I think it's also an acknowledgement that caregiver training is an intervention with honestly some of the strongest evidence behind it.
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I think that's really unique to dementia care where the uh supporting the caregiver is just like the most supported option.
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So, in some ways, these are really exciting because they acknowledge the problem, they're putting out an initial solution, but they're not perfect.
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So, okay, so I just said all of them.
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What's your initial reaction to these?
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And how are they one step forward for us?
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Yeah, thank you, Sarah, for reviewing all of them.
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I think that, you know, I'll start with the gratitude portion, which is I am grateful to AOTA, APTA, Asha for their collective advocacy for caregiver training codes.
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I do think it was a step, theoretically, a step in the right direction for acknowledging the importance of caregiver training in providing good outcomes for our patients.
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So yeah, I do appreciate that.
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And we'll start there.
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I think there are quite a few challenges with these codes, and I think I can get into some of those um a little bit later.
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But I think really recognizing, kind of like you said, Sarah, kind of recognizing at least that caregiver education is such a crucial aspect of care.
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Again, I can talk about this forever and ever.
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But when we look at best practice for supporting people living with dementia, um, particularly those with moderate or severe dementia, we know that we have to be talking about the dyad, meaning both the person living with dementia and a care partner.
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So yeah, I'm I'm grateful for the um introduction of these codes.
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I will say I'm still, and this is my own bias from doing mostly home care.
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So I'm sure that there are avenues in which this will be helpful, but I still have questions about the CPT code for group caregiver training.
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My brain is still like, huh, I wonder what circumstances that would be most relevant, because I think of caregiver training as being so individualized and adapted and tailored based on the individual needs of our patient.
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So I'm still curious about context in which that is most relevant.
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But I think a lot of the feedback I've been getting from OTs who have been in this space of dementia care and trying to incorporate these codes are reimbursement, which we'll talk about in a minute, but also this kind of maximum of 60 minutes is kind of odd and doesn't uh is not always conducive to best practice.
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I think if we're looking at some of the evidence-based models out there, um, some of our sessions go longer than 60 minutes.
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So um it does make it challenging to consistently incorporate everything we need to incorporate and be able to bill for all of it.
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I want to say the math allowed to kind of transition us to our next question.
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So if you are doing caregiver training for 45 minutes, you are billing that initial code of$50, you're adding on one code, you're around$70 of reimbursement.
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If the patient is present, the caregivers there, then you I think this would fall into the uh bucket of patient education.
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Uh therapeutic activities is$34 per 15 minutes.
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So you're making around$100.
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So these codes are here, but to me, they are valued a little less than like therapeutic activity.
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This leads me to my next question of one.
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This is a two-part question.
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What were therapists doing before these codes?
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We've known for a long time that caregiver training is best practice.
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How are we making it work beforehand?
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And then what reaction are you hearing like on the ground?
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Like, are people like still sticking with how they were doing it before?
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Are they starting to shift their practice?
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What are you just anecdotally hearing?
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Oh, these are such good questions, Sarah.
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Okay, so I can say what we were doing before, I can speak to quite confidently because my entire practice existed before these caregiver codes were available.
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So um, and pretty much our entire business model was built on caregiver education to support those living with dementia.
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So um, some of what we were doing was creative, you know, figuring out how do we provide the best practice, what's necessary for patients to again achieve the outcomes that they need and desire, while also not creating agitation or anxiety.
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So it does require skill and nuance, and sometimes it was gray.
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And I'll just be honest about that.
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But I think for the majority of what we were doing, we did have the patient present.
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The degree to which they were actively involved in a session or how they were present in a session may have been different depending on the individual needs of the patient, how much maybe paranoia, anxiety, agitation they were experiencing dictated maybe how directly involved they were or were not involved in the session.
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But regardless, the patient was always present in the home for the entirety of the session.
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That allowed us to have the flexibility to bill some of these other codes.
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So I would say things like, you know, self-care or therapeutic activities being some of the things that were most applicable to a lot of what we were training caregivers on.
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But even that was difficult because, you know, I know that preventing a patient from pushing her grandchildren into the pool is beneficial for everyone.
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Like it's keeping the family safe.
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It's keeping the patient hopefully safe and not, you know, being uh unnecessarily institutionalized.
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But like documenting that in a way that perfectly fits under a CBT code is not easy.
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So I do think that a lot of of this space, um, both then and now is difficult in terms of like how do we document this in a way that whoever might be reviewing or auditing is clear that yes, this benefits the patient, but it also makes sense under the code that we're billing.
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I do think that many clinicians continue to bill in the same way because just as you noted, Sarah, the reimbursement is better.
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So when we're dealing with this like highly complex care and intervention, to yes, it might be easier to document under a caregiver code, um, but we're getting reimbursed less for it.
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So there's not a whole lot of incentive to completely remove the patient and then build the caregiver education code outside of, again, maybe documentation being a little easier.
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I think one of the circumstances where occupational therapists in this line of work are using the caregiver education codes more consistently is when maybe they're doing the initial evaluation in the home.
00:23:24.960 --> 00:23:34.000
So patients present, care partners present, they're doing a thorough, long in-home initial evaluation, possibly some degree of treatment along with that session.
00:23:34.079 --> 00:23:38.240
And then they're doing follow-up sessions via telehealth with the care partner.
00:23:38.640 --> 00:23:42.640
And so the patient isn't necessarily directly involved in that telehealth session.
00:23:42.720 --> 00:23:58.000
And I believe that's often when, especially now that these codes are finally consistently reimbursed under a telehealth model, um, that's I think where OTs that I've heard who have used the code find it most relevant.
00:23:58.319 --> 00:24:09.279
If the clinician continues to provide all in-home care and the patient is always present, again, there's not necessarily incentive to be using the caregiver codes.
00:24:09.519 --> 00:24:11.759
Does that answer your question, Sarah?
00:24:13.039 --> 00:24:18.480
Yes, there's like so many threads on there that I would love to comment on.
00:24:18.559 --> 00:24:21.599
I'm just going to say a couple off the top of my head.
00:24:21.839 --> 00:24:37.440
One, just your call out of the grayness of like our codes were written again for like um an orthopedic population where active patient participation, again, when you're treating tennis elbow, is very clear.
00:24:37.839 --> 00:24:43.119
It becomes less clear with someone with advanced dementia what is the expectation there.
00:24:43.279 --> 00:24:54.400
Um, they just were not written for this complex need, even though there's a lot of potential clients out there who would fall into this gray area.
00:24:54.640 --> 00:25:07.039
I also loved your call out about um one of my big uh frustrations with how we do patient education currently is we have to tie it to the related CPT code.
00:25:07.200 --> 00:25:09.519
It has to come back to self-care.
00:25:09.680 --> 00:25:17.119
And across diagnoses, I'm like, there's a degree of that I would love to just be able to sit down and talk about the diagnoses.
00:25:17.279 --> 00:25:24.720
And in the case of dementia, to be like, um, here's what we understand about behaviors, here's why it might be happening.
00:25:24.960 --> 00:25:36.400
It might be something like they're jumping out of the car as it's moving, like something like strange and then so important to talk about.
00:25:37.119 --> 00:25:39.279
But then how do you tie that back?
00:25:39.680 --> 00:25:47.759
Like we have to go through this extra hoop of somehow tying that back to self-care or therapeutic activity, or we technically can't educate on it.
00:25:48.079 --> 00:25:48.720
So true.
00:25:48.880 --> 00:25:52.640
And think about the like hospitalizations that we're preventing.
00:25:52.720 --> 00:26:01.519
I mean, I had a patient where they were jumping out of cars, and we did sit down and do like a full problem-solving session to figure out why.
00:26:01.759 --> 00:26:08.319
This was a very unique case that I know I've talked about with some other groups before where Wells Fargo was the trigger.
00:26:08.480 --> 00:26:11.039
This patient had a bad experience with Wells Fargo.
00:26:11.119 --> 00:26:13.519
They were under the impression that Wells Fargo stole their money.
00:26:13.599 --> 00:26:18.079
So anytime the daughter drove past a Wells Fargo, the woman was trying to exit the vehicle.
00:26:18.160 --> 00:26:20.240
That took a lot of time to figure that out.
00:26:20.480 --> 00:26:24.559
And like document patterns and try to figure out like what is the connection.
00:26:24.880 --> 00:26:32.240
So, you know, that's that amount of time that we spent, in my mind, it's crucial because like now we have a very clear trigger.
00:26:32.319 --> 00:26:40.880
We have a plan, um, not only like safety locks and all the things, but also we have routes where we avoid Wells Fargo and now just on trying to jump out of the car.
00:26:41.119 --> 00:26:49.359
In my mind, that's again preventing a potential hospitalization because she's not having the severe injury of exiting a moving vehicle.
00:26:49.599 --> 00:27:06.480
But being able to document that, I mean, the amount of cognitive energy on the clinician's part to like after the session try to think about okay, I know that that was therapeutic, that I used my skill set in order to come up with these strategies.
00:27:06.640 --> 00:27:08.079
I know it fell under OT.
00:27:08.240 --> 00:27:19.680
How in the world do I document that in a way that's clear that it's supporting her goals, which again, I think safety, that one was a little more clear-cut, but also in a way where it connects to a CPT code.
00:27:19.759 --> 00:27:27.359
I mean, the the creativity and amount of documentation to get there sometimes is um burdensome, to say the least.
00:27:28.640 --> 00:27:29.200
Yes.
00:27:29.440 --> 00:27:39.359
The so I'm just going to say one more problem too, like when you're looking at something so complex and being like, okay, how do I tie this back to the CPT code?
00:27:39.519 --> 00:27:45.680
We also have this problem of our CPT code official definitions are not publicly disclosed.
00:27:45.920 --> 00:27:49.359
So then you also have to go through the hoop of finding them.
00:27:49.519 --> 00:27:53.440
And I honestly don't have access to them as a continuing education provider.
00:27:53.680 --> 00:27:58.559
Technically, your EMR should have them, but they usually don't make them available to you.
00:27:58.720 --> 00:28:04.640
So it's like hoop after hoop, and we're just trying to solve this complex case already.
00:28:04.720 --> 00:28:07.119
And then it feels like there's extra hoops to jump from.
00:28:07.440 --> 00:28:07.920
So true.
00:28:08.079 --> 00:28:12.880
Um, I wanted to linger on the like, okay, here's our codes.
00:28:13.200 --> 00:28:16.559
How do we implement them and what are the limitations?
00:28:16.720 --> 00:28:22.720
I feel like you've alluded to those things, but can we just say it explicitly one more time?
00:28:22.799 --> 00:28:26.640
And I would love to add on do you know, do you know people doing this?
00:28:26.799 --> 00:28:28.480
Or is this just hypothetical?
00:28:28.640 --> 00:28:29.599
Fine, either way.
00:28:29.839 --> 00:28:30.480
Great question.
00:28:30.640 --> 00:28:33.680
I do know of some OTs who are doing this.
00:28:33.839 --> 00:28:39.680
I would say, like our little dementia squad OTs, some of them are using caregiver education codes.
00:28:39.920 --> 00:28:48.160
Those who are using caregiver education codes, from my understanding, the majority of them are doing it, how I mentioned, where it's like a telehealth model.
00:28:48.319 --> 00:28:51.440
So if they're doing a follow-up visit where it's telehealth.
00:28:51.599 --> 00:29:15.920
And this is often most applicable and relevant when you have a patient whose responsive behaviors are things like agitation because of some another person being in the home, anxiety related to like talking about the disease in front of them, paranoia when you are experiencing, when that person's experiencing those types of things, again, we're thinking about what's the best quality of life for that patient.
00:29:16.160 --> 00:29:24.079
And so it makes sense to do a telehealth visit with them not involved, because why would we knowingly trigger behavior?
00:29:24.240 --> 00:29:28.000
So I think that that's a circumstance where there are OTs using these codes.
00:29:28.240 --> 00:29:56.240
Again, I've heard from these OTs that the 60-minute cap is not ideal because a lot of these really complex scenarios do require lengthy sessions to really dig into, um, especially if we're using evidence-based models, the process of understanding why a particular behavior is happening and then working with the care partner and their unique needs and relationship and dynamic to develop tailored strategies, that takes a long time.
00:29:56.400 --> 00:29:59.440
So 60-minute cutoff is not ideal.
00:29:59.680 --> 00:30:04.240
Um, and then as you mentioned before, the reimbursement.
00:30:04.400 --> 00:30:17.119
Again, when we are looking at like, okay, well, if we involve the patient, the reimbursement's higher because we can use these different codes, there's not a lot of incentive to continue to use just the caregiver education codes.
00:30:17.200 --> 00:30:33.599
So reimbursement being lower and not being valued like these other codes, when I would argue that there's actually more skill sometimes involved in caregiver education, depending on the, again, the unique needs and the complexities.
00:30:33.680 --> 00:30:37.920
But I think that the skill set involved in that is highly skilled.
00:30:38.079 --> 00:30:42.240
Um, and so that the reimbursement being low is an issue.
00:30:42.559 --> 00:30:54.400
And then let's see, I think I again mentioned this briefly, but you know, we we have to understand the relationship dynamics between the care partner and the care recipient or the person living with dementia.
00:30:54.640 --> 00:31:08.400
We also have to understand, you know, using the, we usually use the transtheoretical model to help hopefully understand a care partner's readiness or willingness to um both understand the diagnosis and to change their behavior.
00:31:08.480 --> 00:31:15.440
And then we as clinicians need to completely modify and adapt our approach to meet that care partner where they're at.
00:31:15.680 --> 00:31:27.359
Again, that takes like a lot of kind of like rapid fire skill to be able to assess and evaluate those types of situations and make those on-the-fly adaptations in order to achieve the outcomes you need.
00:31:27.440 --> 00:31:33.440
So I think it's a skill set that needs to be valued, um, reimbursement rates.
00:31:33.599 --> 00:31:39.279
And then the last piece I'll say on this, and then I'll I'll stop ranting about all the limitations.
00:31:39.440 --> 00:31:51.039
But the other piece, the part that made me most worried when these caregiver codes were coming out, by 2024, I had just pivoted my practice.
00:31:51.200 --> 00:32:00.400
So I was just kind of in this transition mode of going from a Medicare Part B reimbursement model, knowing that that wasn't sustainable, as much as I wanted to keep it alive.
00:32:00.480 --> 00:32:06.000
I had made the hard decision to transition, close the practice, and move to just caregiver education.
00:32:06.240 --> 00:32:09.279
So in that model, I could charge privately.
00:32:09.440 --> 00:32:20.319
I do like sliding scale to help offset, you know, I can hopefully serve some individuals more accessibly and charge people who can afford it maybe a little bit more.
00:32:20.720 --> 00:32:26.400
That model relied on the fact that caregiver education standalone was not reimbursed by Medicare.
00:32:26.480 --> 00:32:28.559
So that was a clear-cut business model.
00:32:28.720 --> 00:32:33.440
And then when these codes came out, it made my whole practice model again kind of gray.
00:32:33.519 --> 00:32:35.119
Like, okay, is this allowed?
00:32:35.200 --> 00:32:40.480
Because now caregiver education is covered by Medicare and we're not opt-out providers.
00:32:40.720 --> 00:32:43.680
You know, I still feel okay with the model.
00:32:43.759 --> 00:32:53.279
And after, you know, speaking with attorneys, we're we agreed that because there is no direct patient care, I'm not doing a patient evaluation.
00:32:53.359 --> 00:32:57.200
And so I don't have a therapy plan of care to embed this caregiver training into.
00:32:57.440 --> 00:33:00.640
It's still okay for me to be charging privately.
00:33:00.799 --> 00:33:03.279
Um, but it does make me feel just uneasy.
00:33:03.359 --> 00:33:06.240
I don't want to do anything that makes things less accessible.
00:33:06.559 --> 00:33:09.519
Certainly don't want to do anything even close to unethical.
00:33:09.680 --> 00:33:20.480
So um, yeah, it just made my practice model and many of us who had to pivot our models um a little just a grayer model wherefore it was a little more black and white.
00:33:21.440 --> 00:33:23.759
Yeah, so code set that was here.
00:33:24.000 --> 00:33:36.880
I mean, I think in the minds of Medicare to help people like you, but it's actually potentially muddied the waters in an already muddy water area anyway.
00:33:37.200 --> 00:33:37.599
Yeah.
00:33:37.920 --> 00:33:42.720
We have um people in the comments uh chiming in.
00:33:42.880 --> 00:33:48.640
We have one person who does uh work in a mental health setting that is able to use these codes.
00:33:48.799 --> 00:33:57.119
You and I are really uh using um dementia as kind of the case study because that is where most of the caregiver training is.
00:33:57.279 --> 00:34:01.440
But I just wanted to say aloud, um, these are not specific to dementia.
00:34:01.519 --> 00:34:02.880
They're really for all caregivers.
00:34:03.119 --> 00:34:06.799
I think a mental health setting is a great um example.
00:34:06.960 --> 00:34:11.920
And we do see more um, there are sustainable mental health practices.
00:34:12.159 --> 00:34:21.039
I would say usually because they're not catering just to the needs of older adults, like it's when Medicare becomes involved that we get really limited.
00:34:21.679 --> 00:34:31.440
So, okay, we've talked about the codes, we've said out loud um how they're being implemented, some of the limitations.
00:34:32.320 --> 00:34:38.880
I do just want to, in good faith, talk about best practices around implementation.
00:34:39.440 --> 00:34:49.840
Let's like put you in the zone of like, okay, you are um back in like an outpatient setting, doing what you hear people talk about.
00:34:50.000 --> 00:34:52.400
You're probably using it through telehealth.
00:34:52.639 --> 00:35:01.280
I know there's great resources out there for um like assessing caregiver burden as a way to kind of start this process of caregiver training.
00:35:01.519 --> 00:35:05.920
What can you share with us about assessment when it comes to supporting caregivers?
00:35:06.480 --> 00:35:09.360
Okay, this is where you're gonna have to rein me in, Sarah.
00:35:10.079 --> 00:35:11.199
Yeah, really excited.
00:35:11.920 --> 00:35:12.239
Right.
00:35:12.559 --> 00:35:13.679
I'll keep it succinct.
00:35:13.760 --> 00:35:14.239
I'll try.
00:35:14.639 --> 00:35:21.280
So assessing caregivers is such a crucial part of supporting individuals with complex care needs.
00:35:21.440 --> 00:35:25.039
Again, I'm very biased in my work because dementia care is like my whole life.
00:35:25.119 --> 00:35:27.679
So I'm sorry that that's all the examples I've been using.
00:35:27.760 --> 00:35:34.719
But when we think about individuals living with dementia, we know that we need to be involving care partners.
00:35:34.800 --> 00:35:40.800
So assessing their needs is again a crucial part of um best practice.
00:35:41.039 --> 00:35:55.039
So there are lots of different ways that we can incorporate caregiver assessment into a patient's plan of care, or um again, even potentially their own subset, but that's a conversation for another day.
00:35:55.199 --> 00:35:57.519
Um, I think we need to look at a few different things.
00:35:57.679 --> 00:36:00.639
So I do think we need to consider level of burden.
00:36:00.719 --> 00:36:05.920
So there are some assessments for that, self-efficacy, mastery, their like readiness level.
00:36:06.000 --> 00:36:07.920
Again, I mentioned the trans theoretical model.
00:36:08.000 --> 00:36:15.840
So understanding their um, even like their willingness to be a caregiver, that's an important part of um the puzzle as well.
00:36:16.079 --> 00:36:36.960
Understanding their mood, their physical health, any sort of competing roles, relationship history and dynamics with the care recipient, health literacy, cultural framing around caregiver obligations, their knowledge about dementia, all of these are really important factors in being able to provide high quality and impactful caregiver education.
00:36:37.119 --> 00:36:47.599
So, in terms of some assessments that I use most often or are most familiar with, again, please feel free to put in the comments if there are any others that you prefer and use.
00:36:47.760 --> 00:37:00.800
Um, the first one I'll mention, I will say there's like a caveat to this, that this first assessment I'll mention is part of the evidence-based skills to care program, which I'm super biased because I do teach and train people in that one.
00:37:00.880 --> 00:37:05.119
So that one's called the Caregiver Assessment of Management Problems or the CAMP.
00:37:05.199 --> 00:37:07.360
Um, it's loosely based off the COPM.
00:37:07.440 --> 00:37:16.320
So it really looks at three different categories of how is a caregiver handling or managing different aspects of care for the person living with dementia.
00:37:16.400 --> 00:37:23.679
So we go through ADLs and IADLs, we go through common behaviors, and then we also look at caregiver concerns.
00:37:24.000 --> 00:37:42.960
We also know, just like a little sign statistic from the Alzheimer's disease facts and figures report, we know that care partners of people living with dementia are at their own much higher risk of their own health and medical complications, even compared to care partners of people with other chronic conditions.
00:37:43.119 --> 00:37:47.360
Um, so this particular subset of caregivers is especially vulnerable.
00:37:47.519 --> 00:37:54.000
And again, I'm very biased, but I think that's why we spend so much uh attention on this particular population.
00:37:54.239 --> 00:37:58.000
But outside of the camp, we have some other assessments.
00:37:58.159 --> 00:38:02.639
Um, many of you have probably heard of the Zaret, the Zaret Burden interview.
00:38:02.800 --> 00:38:05.519
Honestly, that's not one I use as often.
00:38:05.679 --> 00:38:10.880
I feel like it doesn't always capture exactly what we're going for, but I think it's probably one of the most common.
00:38:11.119 --> 00:38:17.760
Some of the ones I like a little more are the modified caregiver strain index or the perceived change scale.
00:38:18.000 --> 00:38:29.360
I also try to incorporate some like depression screens, possibly anxiety screens, so things like the PHQ9 or geriatric depression screen, depending on the age of the care partner.
00:38:29.760 --> 00:38:44.239
There's also things like the capacity card sort, which helps us again understand if the care partner is underestimating, overestimating, or accurately estimating the functional capacity of the person living with dementia.
00:38:44.320 --> 00:38:48.719
So it helps us again kind of adjust our education based on where they're falling.
00:38:48.960 --> 00:38:54.559
Again, another bias and disclaimer, but I created something called the caregiver concerned checklist.
00:38:54.719 --> 00:39:12.320
So just like a my idea of a really thorough checklist of like some of the most common challenges that can occur in dementia care and trying to help caregivers identify what are some of the biggest issues and also like what resources and supports might they currently be already accessing.
00:39:12.559 --> 00:39:27.039
And then there are, I know I'm going on a whole list because I can chat about this forever, but some other assessments we may consider are also care partner assessments that help us understand the functioning of the person living with dementia.
00:39:27.199 --> 00:39:29.920
So that can be things like the AD8.
00:39:30.320 --> 00:39:34.719
This is particularly helpful when it comes to like the diagnosis of Alzheimer's disease.
00:39:34.800 --> 00:39:51.760
So we might not use it in OT practice quite as often, but we probably are going to be using things like the neuropsychiatric inventory questionnaire or even the quality of life in Alzheimer's disease scale, which can be completed by both a person living with dementia and the care partner.
00:39:51.920 --> 00:39:58.639
Um and then you can kind of compare like their perceptions of the individual's quality of life, which can be really insightful.
00:39:58.800 --> 00:40:01.760
So sorry, I know that was that was a ramble.
00:40:01.840 --> 00:40:03.679
I love this particular topic.
00:40:04.000 --> 00:40:04.559
That's awesome.
00:40:04.639 --> 00:40:16.400
And it makes me really excited because on our newly updated website, I can create an entry for all those assessments and link them to this episode.
00:40:16.559 --> 00:40:23.360
If you're listening live right now, that will probably take me at least a week to do because I'm still getting oriented in this.
00:40:23.440 --> 00:40:24.639
But I know we have some of them.
00:40:24.800 --> 00:40:26.320
If we don't have them, we'll add them.
00:40:26.480 --> 00:40:31.280
And then in about a week, you'll can see those attached to the show notes.
00:40:31.599 --> 00:40:42.960
Okay, so that's uh tons of resources out there to kind of get the ball rolling on caregiver training with some standardized assessments or, like you said, like an informal checklist.
00:40:43.199 --> 00:40:45.599
What can the training look like then?
00:40:45.760 --> 00:40:55.840
Um, again, if you're on that telehealth screen and you're billing this code, what are some like best practices that you would be keeping in mind based on your knowledge of the space?
00:40:56.159 --> 00:40:56.559
Yeah.
00:40:56.800 --> 00:41:11.599
So first thing to consider again, especially from a reimbursement standpoint, is we're always thinking about how do we connect this back to the patient needs and patient goals, because that's ultimately how we're getting reimbursed for these types of services.
00:41:11.679 --> 00:41:14.480
So we always want to kind of have that in the back of our mind.
00:41:14.639 --> 00:41:22.880
But in terms of best practice, um, I know I mentioned this already, but I'm just going to reiterate it's important that we're treating the dyad.
00:41:22.960 --> 00:41:29.280
So caregiver training is a crucial part of intervention when we're talking about advanced neurocognitive disorders.
00:41:29.519 --> 00:41:44.159
I would argue that if we're working with a person living with advanced dementia without a care partner, I'm not 100% sure what it is that we are therapeutically doing because there's not going to be that carryover from session to session.
00:41:44.320 --> 00:41:53.679
So unless we're going in and making like significant environmental modifications, we really have to involve the caregiver, the care partner in our treatment session.
00:41:53.760 --> 00:41:57.679
So there are a lot of different um things that we may consider.
00:41:58.239 --> 00:42:15.360
You know, again, and I don't mean to put this in a way that um I hope this sounds compassionate when I say this, that we can also kind of look at the care partner as they are like a delivery mechanism of the intervention.
00:42:15.519 --> 00:42:27.840
Again, we can't assume that that person living with advanced dementia is going to be able to carry over and implement what we're talking about or use, even use environmental modifications in a way that we've designed.
00:42:27.920 --> 00:42:35.760
So we really rely on that care partner to be able to deliver the intervention that it is that we've we've collaboratively designed, if that makes sense.
00:42:35.920 --> 00:42:38.559
Um, so it is crucial to involve them.
00:42:38.800 --> 00:42:46.320
Not surprisingly, the evidence suggests that tailoring interventions to the specific needs of the person living with dementia yields the most effective outcome.
00:42:46.480 --> 00:42:52.159
So we know that when we talk about best practice, there is no one size fits all approach.
00:42:52.480 --> 00:42:58.800
Tailoring, which is our bread and butter as OTs, is the most effective intervention.
00:42:58.960 --> 00:43:10.239
We also know from research that problem solving based approaches in dementia care are also the most effective, especially when it comes to addressing the responsive behavior side of things.
00:43:10.400 --> 00:43:21.360
So OTs, we really are in the sweet spot of being able to meet a lot of the most challenging aspects of care in this realm, in this line of work.
00:43:21.519 --> 00:43:27.039
And we'll just keep advocating to be reimbursed appropriately for the skills that we provide.
00:43:29.039 --> 00:43:40.559
The care partner is the partner of the patient client, and they are also your partner in problem solving, in brain, like brainstorming, and really making that tailored approach.
00:43:40.639 --> 00:43:49.440
I think just the anecdote that you shared about how varied um uh the what the presentation of dementia can look like.
00:43:49.599 --> 00:43:56.079
There's a reason there's no one size fits all caregiver training because the presentation is so varied.
00:43:56.320 --> 00:43:59.760
Maybe you said this, but I'm just curious about it the like environment, the importance of environment.
00:44:00.079 --> 00:44:02.400
Environmental fit, like I hear that in the research.
00:44:02.480 --> 00:44:04.159
Like, what does that mean to you?
00:44:04.480 --> 00:44:07.119
Does that mean like modifying the environment?
00:44:07.440 --> 00:44:07.760
Yeah.
00:44:07.840 --> 00:44:25.519
So it it also depends on the circumstances, but I would um I would say that our evidence suggests that environmental modification and activity engagement modification are two of the most important aspects in caregiver communication.
00:44:25.760 --> 00:44:30.079
So maybe we'll say the three of those are three of the most impactful interventions.
00:44:30.239 --> 00:44:34.719
Again, when we look at um, I know that again, this is my world.
00:44:34.800 --> 00:44:37.360
So I have this tiny little bias.
00:44:37.440 --> 00:44:39.280
And I'm sorry that this is all I'm talking about.
00:44:39.360 --> 00:44:53.840
But if we're thinking about responsive behavior, um, responsive behavior, the research suggests that non-pharmacologic intervention, meaning environmental modification, activity engagement, and and care partner communication modification.
00:44:54.000 --> 00:44:58.320
Um, and when I say activity engagement, I'm also going to lump in like task modification as well.
00:44:58.480 --> 00:45:09.920
But those aspects, those interventions are just as effective as pharmacologic interventions for addressing responsive behavior, except they don't come with the side effects of many of the medications.
00:45:10.239 --> 00:45:17.039
So I continue to be a huge advocate for, you know, non-pharmacologic approaches, like what we're doing is OT.
00:45:17.119 --> 00:45:20.239
Again, by no means am I saying like no medications.
00:45:20.320 --> 00:45:22.639
Sometimes they are very, very necessary.
00:45:22.960 --> 00:45:35.119
Um, but when we look at the evidence, we know that all of these different things that are within our skill set as OTs are really what's best practice and most effective without the side effects.
00:45:35.440 --> 00:45:42.400
This is such an advanced area of practice when you get to the level that you're describing.
00:45:42.559 --> 00:45:45.840
I want to hear about opportunities for further training.
00:45:45.920 --> 00:45:49.440
Um, I know you have a bias because you are a trainer as well.
00:45:49.599 --> 00:45:52.400
Uh, but what tell us just what's out there?
00:45:52.639 --> 00:45:58.400
I also want to call out specifically, again, the most research here is around dementia.
00:45:58.639 --> 00:46:03.280
Those are the programs, the advanced trainings that I know of.
00:46:03.440 --> 00:46:15.119
Um, I don't know of any advanced trainings off the top of my head for caregivers of neurodivergent children or like there's lots of applications of this code.
00:46:15.199 --> 00:46:19.760
And I think because they're so new, I haven't seen the trainings come out yet.
00:46:19.920 --> 00:46:26.400
Uh, but tell us what you know exists and if you have any insight into like the broader caregiver training landscape.
00:46:26.719 --> 00:46:31.360
Okay, yeah, I might have to mull on the broader caregiver training landscape a bit.
00:46:31.440 --> 00:46:33.840
It's such a fascinating question.
00:46:34.000 --> 00:46:37.440
Yeah, and I might have to do a follow-up with you because I'm curious about that.
00:46:38.239 --> 00:46:41.760
When it comes to we'll have to dig into that one.
00:46:42.000 --> 00:46:53.519
Um, but in terms of a lot of the training programs that are available specifically in the caregivers of people living with dementia side of things, we do actually have a ton of different programs available.
00:46:53.679 --> 00:46:59.440
So the first thing that I'll say is the Benjamin Rose Um best practice caregiving.
00:46:59.519 --> 00:47:05.760
So they have a whole database um run by the Benjamin Rose Institute, I believe, publicly available.
00:47:06.000 --> 00:47:09.840
And they have uh their website is two categories.
00:47:10.079 --> 00:47:17.519
You can either say, like, I'm a professional looking for a certification or a training, or I'm a caregiver and looking for a program.
00:47:17.840 --> 00:47:24.000
And so this includes you have to meet like strict criteria for your program to be um included in that.
00:47:24.079 --> 00:47:25.840
So those are the evidence-based programs.
00:47:26.000 --> 00:47:27.760
There's lots of great programs in there.
00:47:27.920 --> 00:47:33.280
I will call out a few that I know have an OT-specific component.
00:47:33.519 --> 00:47:40.000
Again, I'm very biased because I've been utilizing and implementing Skills to Care and I now teach Skills to Care.
00:47:40.079 --> 00:47:43.039
So take what I say with that piece with a grain of salt.
00:47:43.199 --> 00:47:46.480
But Skills to Care is an evidence-based program.
00:47:46.559 --> 00:47:49.679
It is in the Benjamin Rose Best Practice Caregiving Database.
00:47:49.760 --> 00:47:52.960
It was developed by researchers at Thomas Jefferson University.
00:47:53.039 --> 00:47:59.440
Um, and I'm honored that I get to be one of the trainers who gets to train OTs in it, but it's a it's a caregiver training program.
00:47:59.519 --> 00:48:07.360
So the entire program is supporting care partners of people living with dementia to help them manage the most challenging aspects of care.
00:48:07.440 --> 00:48:09.119
So it has a systematic approach.
00:48:09.280 --> 00:48:12.239
It used to be called the environmental skill building program.
00:48:12.559 --> 00:48:17.280
Um, so to your earlier point, Sarah, about the importance of environmental adaptation.
00:48:17.440 --> 00:48:21.199
And again, it's not just it's not just educating caregivers.
00:48:21.440 --> 00:48:23.199
I would argue that none of these programs are.
00:48:23.360 --> 00:48:27.599
It's also in helping them build their skills because dementia is progressive.
00:48:27.760 --> 00:48:30.079
There will continue to be new needs and new challenges.
00:48:30.320 --> 00:48:37.119
So it's not just throwing strategies at them, it's helping caregivers learn how to manage these challenges for themselves.
00:48:37.280 --> 00:48:42.719
Um, so skills to care, um, cope and tap are also in the same category.
00:48:42.800 --> 00:48:46.159
So same researcher kind of has her hands in a lot of these.
00:48:46.480 --> 00:48:51.519
Cope is the care of older persons with dementia in their environment.
00:48:51.599 --> 00:48:52.400
I think I have that right.
00:48:52.639 --> 00:48:54.800
TAP is the tailored activity program.
00:48:54.960 --> 00:48:58.960
Um, cope is like skills to care plus tap kind of.
00:48:59.119 --> 00:49:02.400
So yeah, lots of different great programs in that realm.
00:49:02.639 --> 00:49:05.920
Um, there are also lots of broader dementia trainings as well.
00:49:06.000 --> 00:49:18.800
So not necessarily specific for occupational therapists, but we have the um uh certified dementia practitioner program is through the NCCDP, I believe.
00:49:19.119 --> 00:49:23.119
The uh Crisis Prevention Institute runs some really great training programs.
00:49:23.280 --> 00:49:25.199
One of them is dementia capable care.
00:49:25.760 --> 00:49:28.880
Again, I'm very biased because I created this one.
00:49:28.960 --> 00:49:35.679
I also have a little imposter syndrome with this one, but the dementia clinical practice certification um is one that I developed.
00:49:35.760 --> 00:49:45.760
I'm very grateful for the input from occupational therapy and physical therapy clinicians who I consider experts in this realm to help me continue to make that one the best that it can be.
00:49:45.920 --> 00:49:49.920
So work in progress, but we're in our third cohort so early on.
00:49:50.079 --> 00:49:51.119
But I'm always happy.
00:49:51.199 --> 00:50:02.880
If anyone wants to reach out to me to brainstorm, I'm happy to help people try to figure out like what might the best training fit for them be, especially depending on the setting that they're in and the kind of work that they want to do.
00:50:02.960 --> 00:50:05.920
But there are lots of wonderful programs available.
00:50:06.239 --> 00:50:10.639
This is truly such a well-researched, well-studied intervention.
00:50:10.800 --> 00:50:20.960
Like when I look out across the realm of what OTs do, I'm like, this really stands out as one where we have lots of research, lots of structure, lots of possible programs.
00:50:21.280 --> 00:50:21.760
So true.
00:50:22.000 --> 00:50:28.639
I want to say one thing out loud that is not an answer for anyone to hang their hat on.
00:50:28.719 --> 00:50:30.320
It's just me musing.
00:50:30.480 --> 00:50:33.840
Um, I'd love to get, I guess, your reaction to it too.
00:50:34.159 --> 00:50:45.840
We had someone in the comments uh comment about uh trying to use these with commercial insurance and not seeing that they're reimbursed consistently.
00:50:46.159 --> 00:50:54.079
There is an AARP, AARP article that is in our show notes that is about the rollout.
00:50:54.320 --> 00:51:03.679
And I do think that that is something that was said in there too, that one commercial insurances haven't even added these codes sometimes.
00:51:03.840 --> 00:51:09.039
And then even if they have to this person's point, they're also getting denied.
00:51:09.199 --> 00:51:14.000
Um, I just wanted to add the musing of for commercial insurance.
00:51:14.159 --> 00:51:16.480
Well, one, these were written through Medicare.
00:51:16.559 --> 00:51:20.800
They're thinking of older adults, they're really thinking, I think, of your use case, Rachel.
00:51:21.039 --> 00:51:29.039
If you think commercial insurance in the whole population, my mind's really swinging, swinging down to infants and moms.
00:51:29.360 --> 00:51:44.320
And if this becomes an option through a commercial insurance to provide trainings for moms, we see it's kind of the same parallel in research of like obviously if you want to help an infant, you train the mom.
00:51:44.559 --> 00:51:44.960
Yes.
00:51:45.119 --> 00:51:47.920
Um, so sorry, parent.
00:51:48.639 --> 00:51:50.000
Yeah, yeah, the parent.
00:51:50.239 --> 00:51:56.400
So just musing about the implications of this if they do get adopted by commercial insurances.
00:51:56.480 --> 00:52:00.800
Um, I think this is a huge need for older adults, but all the way down to infants.
00:52:00.880 --> 00:52:05.440
And I'm excited to see the research continue to evolve.
00:52:05.760 --> 00:52:09.519
Any thoughts on that across thinking across the lifespan, real quick, Rachel?
00:52:09.599 --> 00:52:11.039
We're getting down to our last five minutes.
00:52:11.280 --> 00:52:11.519
Absolutely.
00:52:11.679 --> 00:52:11.840
I know.
00:52:11.920 --> 00:52:12.159
I'm sorry.
00:52:12.480 --> 00:52:12.639
I know.
00:52:13.920 --> 00:52:14.880
I just love this topic.
00:52:15.039 --> 00:52:16.880
But I think I think you're absolutely right.
00:52:17.039 --> 00:52:22.719
Again, I know my lens is like so hyper-focused on supporting the needs of people living with dementia and their care partners.
00:52:22.960 --> 00:52:31.280
I agree that the more we can see this code be reimbursed across the spectrum, I think it will hopefully benefit everyone, every population.
00:52:31.440 --> 00:52:44.400
There's oftentimes care partners involved, regardless of the condition or the age, especially when we're talking about like increased complexity of a diagnosis, there's usually some degree of care partner involvement.
00:52:44.559 --> 00:52:45.920
So yeah, I would love to see that.
00:52:46.000 --> 00:52:59.599
Again to your earlier point, Sarah, I think one of the reasons we're talking so specifically about this population is we have so many restraints when it comes to those who have Medicare because of that, you know, not opt-out provider piece.
00:52:59.679 --> 00:53:04.559
But it doesn't mean that it can't have broader positive implications across the board.
00:53:05.039 --> 00:53:15.360
We've talked kind of broadly here today about the caregiver training codes, but also just about the difficulty of really meeting the needs of patients with complex care needs.
00:53:15.599 --> 00:53:27.280
Again, we're working from this code set that feels really geared towards low complexity, but the needs, the need is really present now and will continue to grow for high complexity care.
00:53:27.920 --> 00:53:31.039
You are steeped in this world, you live it every day.
00:53:31.360 --> 00:53:33.280
We have four minutes left.
00:53:33.599 --> 00:53:35.119
What needs to change?
00:53:35.440 --> 00:53:36.880
Tell it to us in three minutes.
00:53:37.119 --> 00:53:37.440
Okay.
00:53:38.079 --> 00:53:39.760
I think systemic changes.
00:53:40.079 --> 00:53:45.360
You know, I think uh, and I know I won't be able to articulate all the systemic changes in three minutes.
00:53:45.599 --> 00:53:51.599
I think it would be uh potentially easy for me to say, like, clinicians need to do this, this, and this.
00:53:51.760 --> 00:53:53.039
I don't think that that's the case.
00:53:53.199 --> 00:53:55.360
I think clinicians have the skill set.
00:53:55.519 --> 00:53:58.559
I think clinicians want to provide best practice.
00:53:58.719 --> 00:54:11.039
Um, and when we have a system that doesn't make it easy to implement best practice or makes it really hard for us to figure out like, how do we bill, what codes do we bill, how do we document, how do we get that reimbursed?
00:54:11.280 --> 00:54:16.800
We we often stray away from it because it makes it way too hard to figure out how to do it.
00:54:17.039 --> 00:54:25.039
So I think systemic changes to make it clearer and easier on being able to implement what we know to be best practice for our patients.
00:54:25.199 --> 00:54:31.519
Um and I'm also just gonna say uh increase reimbursement for OT services.
00:54:31.679 --> 00:54:34.800
We deserve to get paid for the value that we provide.
00:54:35.519 --> 00:54:44.320
My overarching takeaway from this conversation is like I said at the top, I would love to just be talking to you about best practice.
00:54:44.639 --> 00:54:57.039
We unfortunately aren't in an era where we need to think about the structures that allow us to implement best practice and be really vocal about what's working, what's not working.
00:54:57.199 --> 00:55:04.079
We can't assume that our insurance companies that Medicare know what we're seeing on the ground.
00:55:04.159 --> 00:55:06.079
So we have to tell them.
00:55:06.400 --> 00:55:08.480
That's my takeaway from this time.
00:55:08.639 --> 00:55:09.840
We touched on so many things.
00:55:10.000 --> 00:55:13.760
What's up the what's at the top of your mind for the takeaway from today?
00:55:14.159 --> 00:55:22.000
And I realize I don't think I said this, but I just want to kind of add on what you just said, Sarah, which is I don't think oftentimes clinicians are at the table.
00:55:22.159 --> 00:55:31.199
Like we might have academics or researchers who are advocating for us, but if they're not doing the clinical care, they're not doing the billing, they probably don't understand.
00:55:31.360 --> 00:55:40.400
Um, and this is no shade to them, but they don't understand potentially the nuance that creating new codes means if if we haven't advocated for the reimbursement that aligns with that.
00:55:40.639 --> 00:55:42.800
So yeah, making our voices heard.
00:55:42.880 --> 00:55:48.400
And I appreciate that you have made that easier for all of us with all of your advocacy efforts.
00:55:48.559 --> 00:56:02.480
So thank you so much for all of the amazing work that you're doing, Sarah, and for having these conversations, even though they're not always fun to talk about, um, even though I mean I think they're enjoyable, but sometimes it's hard to talk about the difficulties of reimbursement.
00:56:02.559 --> 00:56:03.840
So thanks for going there.
00:56:04.079 --> 00:56:04.559
Yeah.
00:56:04.800 --> 00:56:11.679
Rachel, I'm so thankful one for just like your willingness and ability to share so clearly.
00:56:11.840 --> 00:56:19.039
Um, and also just for the trajectory of your career where you have learned some of these hard things through trial and error.
00:56:19.280 --> 00:56:24.719
You've really been a trailblazer in doing the work and then articulating what is and isn't working.
00:56:24.800 --> 00:56:35.440
And I just so appreciate your willingness to share about that and um just the importance of this work and finding a pathway, a pathway forward for us to keep doing it.
00:56:35.519 --> 00:56:38.320
So thank you so much for your time today and for being here.
00:56:38.880 --> 00:56:40.079
Thank you so much, Sarah.
00:56:40.159 --> 00:56:44.320
I'm so grateful to you for your platform for OT Potential.
00:56:44.400 --> 00:56:46.480
And thank you so so much for having me today.
00:56:46.559 --> 00:56:48.000
I'm really honored.
00:56:51.440 --> 00:56:54.800
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00:56:54.960 --> 00:57:04.239
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00:57:04.400 --> 00:57:11.119
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00:57:11.280 --> 00:57:20.079
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00:57:20.320 --> 00:57:24.480
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