4 Ways the Affordable Care Act Will Transform Occupational Therapy—for the Better

Today’s blog post comes from Veda Collmer, OTR, WebPT’s in-house counsel and compliance officer. Veda is a licensed occupational therapist and attorney—quite the combo!

The theme of Occupational Therapy Month—“Transforming lives, building independence”—has inspired me to write about the transformation of occupational therapy itself. In the years following the 2010 passage of the Patient Protection and Affordable Care Act (ACA), I’ve been studying up on how the new law will change the face of health care in the United States—particularly, how it will affect occupational therapy. Policymakers and politicians have realized that the “old” model of healthcare delivery is expensive and ineffective. If healthcare reform plays out the way our leaders in Washington envision, the cost of health care will be lower, and the quality will be higher—leading to more positive patient experiences. Healthy routines and prevention—which form the foundation of the OT profession—are crucial to the achievement of that vision. Thus, occupational therapy— with its unique framework of “therapy by doing” and its holistic approach to addressing the social, cultural, physical, and emotional dimensions of an individual—complements this new model perfectly.

Here are four ways the ACA will positively transform OT:

1. More people will be able to access OT services.

The ACA expands access to health care in general, and as part of that expansion, insurances must cover a wider variety of services. A qualified health insurance plan—that is, a plan certified to be sold on the Health Insurance Marketplace—must cover ten essential benefits. These benefits include mental health care and substance abuse treatment as well as rehabilitation and habilitation services.

OT once had solid roots in mental health rehabilitation. In the past, OTs provided services in psychiatric hospitals, community settings, and residential facilities, teaching skills to equip patients with the tools necessary to enhance their lives. However, over the last several years, the availability of OT in mental health settings has slowly eroded. Before the ACA, insurance didn’t cover mental health treatment—or, in some cases, such treatment was inaccessible due to cost-sharing requirements and treatment limitations. The result: OTs interested in mental health specialties could not find fieldwork opportunities or jobs.

Fortunately, the ACA emphasizes the importance of mental health and substance abuse treatment by requiring qualified insurance plans to cover those services. The ACA also expands on the Mental Health Parity and Addiction Equity Act of 2008  (MHPEA) by requiring insurance plans to cover mental health and substance abuse services in the same manner as medical and surgical care. This means insurance plans cannot impose different requirements—like increased cost-sharing and treatment limitations—for mental health services. Additionally, the ACA extends the MHPEA to individual and small group markets. More access, better coverage, and increased recognition of the importance of mental health treatment all will help reinvigorate the OT’s role in health care.

As a form of habilitation, OT has proven highly effective in early intervention treatment. Historically, though, access has been a problem. Before the ACA, private plans excluded habilitation services. Furthermore, families couldn’t access habilitation services if their state didn’t provide them or if their children didn’t qualify for Medicaid. The scope of coverage still varies considerably from one region to another, and the differences aren’t always clear—which means there’s still plenty of work to do on that front. The good news is that the AOTA is advocating for a clearer definition of habilitation. I believe that in time, habilitation services—including OT—will be available for more children.

2. We’ll see new models of OT delivery.

In the future, OT delivery will be more efficient and effective than it is under the traditional direct (i.e., one-to-one) model. The ACA promotes more team-based, collaborative care. Enter: accountable care organizations and medical homes, which are designed to reduce costs and improve care coordination. Because primary care providers and OTs share similar treatment approaches, pilot programs for these models have placed OTs in primary care physicians' offices. To serve in these roles, some OTs will become generalists. In line with the rollout of these types of care delivery models, coaching and educational strategies for improving patient health literacy will become crucial, and OTs are well positioned to fulfill that need.

In addition to promoting new models of care delivery, the ACA will encourage OT delivery in a natural environment. The ACA-created Center for Medicare and Medicaid Innovation (CMMI) is piloting the Independence at Home project and lauding the importance of the once-popular house call. As part of those efforts, primary care teams are seeing people with chronic conditions in their homes as well as making early referrals to OT. The CMMI also is transitioning people from nursing homes and hospitals to home-based care. OTs will play a critical role in helping more people achieve independence at home.

Finally, telehealth (i.e., remote delivery of healthcare via communication and information technologies that allow the provider and the patient to be in different physical locations) will allow for OT delivery to patients in rural and underserved areas of the country. Evidence shows that telehealth is effective in improving patient outcomes and health literacy. While the federal government still needs to hash out all of the licensure requirements around telehealth, many states are changing their laws to support this low-cost, highly effective model of service delivery.  

3. OTs will deliver better care with better outcomes.

The current fee-for-service payment model is inefficient and expensive. In fact, research shows that fee-for-service reimbursement produces uncoordinated care as well as sloppy care transitions—both of which lead to unnecessary hospital readmissions and wasteful spending. With healthcare reform comes things like quality measures (i.e., Physician Quality Reporting System) and a stronger emphasis on evidence-based practice as the foundation of clinical decision-making. To that end, the AOTA has made evidentiary resources—such as practice guidelines and open access articles—available to empower OTs to use evidence-based practice.

4. OTs will join the public health movement.

Because most of the diseases plaguing the US are preventable (e.g., diabetes, obesity, and heart disease), the overall approach to health care is shifting toward prevention and population health improvement. Public health initiatives incorporate a broad view on what makes a population healthy. OT fits nicely into this framework, as it promotes healthy routines, prevention, and safety. Thus, OTs will play a key role in public health initiatives such as:

• Fall prevention
• Heart disease and stroke prevention
• Nutrition and physical activity education aimed at obesity reduction
• Workplace wellness programs

As you can tell, the ACA will transform the future of OT—and I’m not the only one who’s making that prediction. In fact, OT leaders have been thinking about the changing role of OT for a long time. If you have a moment, take a look at this inspiring article, which was written long before the ACA was a glimmer in Congress’s eye.

How do you envision OT evolving in the years to come? What changes have you witnessed already? Share your thoughts in the comment section below.