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2 posts from February 2009


New Book to Provide “Frames of Reference for Pediatric Occupational Therapy”

I am really excited that my new book, the third edition of Frames of Reference for Pediatric Occupational Therapy will be coming out March 1. This edition is completely updated with many new frames of reference for treating children. Jim (Hinojosa from New York University) and I worked hard to make sure this edition contains cutting edge information, with well known international contributors. It has a new frame of reference for helping children with handwriting problems and an updated learning theory that can be easily applied to activities of daily living.  There are also frames of reference for increasing participation in childhood occupations and for social participation.  All the photos are new and wonderful.

To all therapists who work with children, or students that are interested in working with children. I would welcome your thoughts on this new edition and would be very willing to answer your questions.

Some other notes from the department…

1.  Great human interest story.  One of our P2 students had a fire in his apartment two weeks ago, and was unharmed but lost everything.  The rest of the students have banded together and are fund raising for him.  They have a competition, which ever class raises the most money for Kuma, gets a Dunkin Donuts breakfast for the whole class.  They have raised hundreds already.  I think this is an amazing example of people banding together to help a fellow student.

2.  On Thursday March 24, Dr. Winnie Dunn from the University of Kansas is coming to speak with our students.  She is world renown in occupational therapy having written numerous books and received every award that the OT world gives. Our students initiated and raised all the funds for this. They have invited local clinicians, and the students from the four other OT schools in the city. It should be an amazing event, especially since it was all student initiated.

Dr. Paula Kramer, chair of the Occupational Therapy Department at University of the Sciences, holds a PhD, MS and BS from New York University. She is a recipient of both the A. Jean Ayres Award from the American Occupational Therapy Foundation, three service commendations from the AOTA and a service recognition award from both Presbyterian Homes and Services and the American Occupational Therapy Association. She has also received several grants from the PHS foundation to provide programs to enhance wellness in seniors in affordable housing communities. Dr. Kramer has co-authored several textbooks that are widely used in occupational therapy programs across the country. She chaired the Accreditation Council for Occupational Therapy Education of AOTA for five years and serving on the Board of Directors of the American Occupational Therapy Association, Inc.


Impact of Stimulus Package on Healthcare

The stimulus bill includes both short-term and long-term health care provisions.  The short-term provisions assist people who will have trouble accessing health care because of the economic downturn.  This includes subsidies for people who are laid off and use COBRA to extend coverage.  COBRA premiums can be very expensive.  It also includes assistance for states in covering Medicaid costs.  Medicaid rolls will likely expand as more laid off workers are thrown into poverty.  It also includes funding for care for underserved populations, including the elderly and those living in underserved regions.

The long-term provisions are of more strategic importance.  They have profound implications for the future of the American health care system.  One major set of provisions encourages the broader adoption of health information technology.  It provides large incentive for physicians and hospitals to computerize their medical records.  It also implements penalties in a few years for those who do not.  These are in the form of lower Medicare reimbursement.  Observers have been complaining for many years that health care is much slower than many other industries in adopting IT.  For about twenty years, customers have been able to access basic information about their bank accounts through ATMs.  For about 10 years, they have been able to access complete information about their investment accounts with financial institutions.  Of course, we would hardly want to use banking as the model of an industry to emulate right now.  However, it seems odd that most patients cannot access their health information electronically or even schedule appointments online, when they can book airline tickets or hotel rooms this way with ease.

Increased use of IT has the potential to substantially improve health care quality.  Many of the thousand of errors that are made each year result from poor communication among providers and poor coordination of care.  IT will greatly help with this.  On the other hand, IT will probably not reduce costs.  Over the next few years, it will likely cost more to implement than it saves.  This is not to say that it should not be encouraged.  However, it is to say that we should not expect dramatic savings as the ultimate benefit.

Greater use of Health IT is likely to further promote consolidation of the health care industry.  Physicians in smaller practices will need to rely on larger entities to install and support their systems, even with the government subsidies.  There will also be a need to link systems so that information can be shared across providers.  The structure of the industry, therefore, is likely to change as this initiative moves forward.

The other major long-term provision establishes a board to conduct comparative effectiveness analyses of new medical treatments.  These will be used to determine which treatments will be eligible for reimbursement under Medicare, Medicaid, and SCHIP.  Comparative effectiveness analyses compare new treatments to existing ones in terms of cost and effectiveness.  They can result in decisions to deny coverage for new treatments if they do not offer measurable improvements in either respect.  This is similar to mechanisms in place in a few other industrialized countries, most notably England, which has the National Institute for Clinical Excellence (NICE) to advise its national health system.  However, in, there is a government-run health care system that directly relies on NICE to set reimbursement policy.  In the United States, the effect of the private sector will be indirect.  Nevertheless, private insurers generally follow Medicare coverage decisions, and it is likely that they will do the same with comparative effectiveness decisions of the new board.

Neither of these long-term initiatives implements broad-scale health care reform.  However, they may serve as “ice breakers” in that they initiate some elements of significant structural change.  They make it easier to implement broader reform down the road, and they would likely each be part of a broader reform package.

Robert Field, JD, MPH, PhD, is chair of the Department of Health Policy and Public Health at University of the Sciences in Philadelphia. His expertise extends into healthcare law and regulation, health system planning and development, and health policy analysis. Dr. Field recently published a book, "Health Care Regulation in America: Complexity, Confrontation and Compromise" which gives a comprehensive overview of the healthcare system in the United States. He is frequently asked to comment for major newspapers and broadcast outlets on late-breaking developments in healthcare.

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