GREAT NEWS! RTV Videos Now Streamed

I thought I'd never see this day come! All Recreation Therapy Videos (RTV Videos) will be available throughout the world via streaming.

See for yourself. To view the RTV video "Models of Practice: Health Protection/Health Promotion Model" go to http://purl.dlib.indiana.edu/indl/general/video/VAA9654

I first viewed the video on my computer (which is a few years old) and the quality was okay. I then viewed it on my wife's newer computer that has a big screen and what a difference. The picture and sound were great. So I guess the lesson is that the better the computer the better will be the viewing quality.

I'll have more later on the exciting development of having the RTV Videos (all 23!) available via streaming. But I wanted to tip you off ASAP as to their availability and let you sample what viewing them will be like.

It should be mentioned that none of this would have been possible without the work of the Indiana University Library. The IU Library is responsible for the streaming of the videos. I'll plan to later provide more about the wonderful staff at the IU Library.

Sherilyn Reynolds Retired from MSH

Soon after making the post that this year's Madison RT Workshop had been cancelled, I received an email message from Sherilyn Reynolds, M.S.,CTRS, who informed me that she was retiring from Madison State Hospital and that Friday was her last day.

I am pleased for Sherilyn that she can enjoy her retirement. But she will be greatly missed at Madison State Hospital and by RTs throughout Indiana.

Sherilyn and Judy Gayle (also now retired) were primarily responsible for establishing the Madison RT Workshop years ago. The Workshop has become something that many Hoosier RTs have looked forward to each summer -- as they have attended the Workshop sessions and enjoyed the charm of Madison, Indiana.

By the way, both Sherilyn and Judy are alums of Indiana University having received their master's degrees from IU (through the "M.S. via TV" distance learning program). My congratulations to both Sherilyn and Judy for wonderful careers as RTs. I will miss both of them a great deal.

This Year's Madison RT Workshop Cancelled

Sherilyn Reynolds, M.S., CTRS, the Rehab Director at Madison State Hospital, recently announced that the annual Madison RT Workshop will not be held this summer. The Madison RT Workshop has been held for a number of years in June at the Madison State Hospital in Madison, Indiana. It is planned to be resumed in June or July of 2010.

Many Mentally Ill in Jails!

I just received a release from the Bazelon Center for Mental Health Laws on the numbers of persons with mental illness now in jails. In part, in follows. I have remarked following the information from the release. Here is part of the release followed by my comments:

A new study on the prevalence of adults with serious mental illnesses in jails will be released at a congressional staff briefing on Monday, June 1 at 2pm in Room 226, Dirksen Senate Office Building (Washington DC).

Presenters are the study co-author, Fred Osher, M.D. Director, Health Systems and Services Policy, Council of State Governments Justice Center; Judge Steven Leifman, Special Advisor on Criminal Justice and Mental Health, Supreme Court of Florida; Art Wallenstein. Director, Montgomery County Department of Correction and Rehabilitation, MD; and Fred Frese, Ph.D., a psychologist who is a leading expert and spokesperson on serious mental illnesses, diagnosed with schizophrenia at age 25.

Among the key findings:

14.5 percent of men and 31 percent of women entering the jails studied were found to have serious mental illnesses. These rates are three to six times higher than those found in the general population.
The gender difference is particularly important given the rising number of women in U.S. jails
If applied to the 13 million jail admissions reported in 2007, the findings suggest that more than 2 million bookings of a person with a serious mental illness may occur annually.

This information is disturbing to me. It is apparent that many (if not most) of those with mental illness belong in treatment centers, not jails. The "do gooders" who have forced persons with mentall illness into jails by closing state psychiatric hospitals should hang their heads in shame!

Years ago, when I worked at a state hospital, I would guess that half our patients came to us on court orders. We were able to provide these individuals with treatment from caring mental health professionls, often with wonderful results.

Our society has take a big step backwards by closing off opportunities for those with mental illness to gain treatment. Instead, persons with mental illness now are sent to jail! What a misguided approach.

Meadowood Position in B-town

As far as I know, Meadowood Retirement Community in Bloomington (aks, B-town)has not hired a recreational therapist as Program Director. This is a wonderful opportunity for someone.

The advertised description is:

Meadowood Retirement Community. A Five Star Senior Living Community is currently recruiting for the following position: Full-Time Program Director to lead, develop and manage the activities and therapeutic recreation programming in our Health Pavilion. Position is responsible for supervision and direction of activities staff as well as ensuring the therapeutic recreation needs of our residents are met and documented as required by state and federal regulations. Position requires strong organizational, communication, supervisory and social skills. Successful candidate will possess the creativity and charisma to develop innovative and stimulating activities. To apply, please: visit www.5sqc.com. e-mail resume to akeith@5sqc.com. or apply in person at 2455 Tamarack Trail, 47408 between 8am-8pm, 7 days a week. 812-336-7060. EOE.

Contact person is:

Arlyn Keith
Meadowood R.C.
2455 Tamarack Trail
Bloomington, IN 47408

New Instructor’s Guide

The Instructor’s Guide for the 6th edition of my book, Therapeutic Recreation Processes and Techniques (Austin, 2009), should be available very soon from Sagamore Publishing, Inc.

The new Instructor’s Guide will contain something never available to those instructing RT/TR courses. I’ll reveal what this is as soon as the Guide is released by Sagamore Publishing. I believe the entire profession will welcome this new development!

TR Week Needs to be Revised

NCTRC has announced it is promoting National Therapeutic Recreation Week to be held July 12-18, 2009. Now that Canada and the USA share the certification program isn't it time to hold a North American Therapeutic Recreation Week?

And let's move TR Week from the summer to a week during the academic year so universities can promote it with their students.

So next year let's have a North American Therapeutic Recreation Week (or better yet a "North American Recreational Therapy Week") in the fall or spring!

CTRA Endorses CTRS Credential

I just received this (below) announcement from NCTRC. I think it is a real step forward for Canada and the USA. Both CTRA and Bob Riley and NCTRC are to be congratulated on this achievement!

The Canadian Therapeutic Recreation Association (CTRA) and the National Council for Therapeutic Recreation Certification (NCTRC) entered into a formal agreement pertaining to the endorsement and the promotion of the Certified Therapeutic Recreation Specialist (CTRS) credentialing program. The purpose of this agreement is to acknowledge the CTRS designation as the benchmark for the qualified provider of RT/TR services and to promote its use throughout Canada and the United States. Formal endorsement of this agreement occurred on May 15, 2009 at a signing ceremony conducted at the CTRA Annual Conference, held in Calgary, Alberta, CA.

What Will the Future Bring for RT?

Sometimes I worry about the current and emerging generations of recreational therapists. These newer professionals did not have to fight to establish our profession – as many of us who are in our 60s and 70s had to do. I wonder if younger recreational therapists (i.e., those in their 20s, 30s, and 40s) really have the same passion for our profession as those of us who are older.

Will the younger recreational therapists act as advocates for our profession? Will they, for example, take the time to write letters to the CMS as we have been asked to do by ATRA and NCTRC?

Will the younger RTs support our profession by maintaining memberships in ATRA and ATRA chapters? The membership of ATRA is not what it once was -- so I believe there is cause for worry about the commitment to our profession displayed by our current RTs.

I wish I had more faith in the newer RTs. But I’m just not sure if they will support our profession to the degree needed for it to succeed.

I do know a great number of Hoosier RTs who are in their 20s, 30s, and 40s. Many of them are currently providing a great deal of leadership within the Recreation Therapists of Indiana (RTI) ATRA chapter. I’m proud of them and what they are accomplishing.

I also see some young professionals nationally who are active in our profession. It would be nice to see their numbers grow.

Before I form an opinion about the ability of the current and emerging generations to carry on the progress we have made as a profession, I will wait to see what happens in the coming years. I sure hope the current and emerging generations will rise to the occasion!

I Sent in My Letters. Have You?

I sent in my letters in response to the public policy alert I posted earlier today. The same letter can be used for both the "Three Hour Rule" and the for Medicare Benefits Policy Manual. You just have to submit the letter to each of the two places indicated in the public policy alert.

Here (below) is the letter I sent:

May 25, 2009

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1538-P
P.O. Box 8012
Baltimore, MD 21244-8012

To Whom It May Concern:

As a university professor, for 35 years I taught, researched, and wrote my about my profession of recreational therapy. I am now retired but I am taking the time to write to you because I know of the value of recreational therapy and hope that my letter will help you to understand the importance of including recreational therapy services under the Medicare Program.

I am responding specifically to the Proposed Rule for the Inpatient Rehabilitation Facility (IRF) Prospective Payment System for Fiscal Year 2010 (42 CFR, parts 412, May 6, 2009). My principal concern relates to the proposed changes to the so-called “Three Hour Rule” that is used as a guideline for determining a patient’s need for a relatively intense level of therapy services.

Under the current Three Hour Rule, the physician and rehabilitation team are given flexibility to determine, on a priority basis, which skilled modalities are appropriate for each patient in the IRF setting. A number of specific therapies are explicitly identified as “skilled modalities,” including but not limited to physical therapy (PT), occupational therapy (OT), speech language pathology (ST), and orthotics and prosthetics (O&P). Until recently, over half the fiscal intermediaries permitted recreational therapy services to be counted as a skilled modality for purposes of qualifying under the Three Hour Rule.

The proposed changes restrict the current language of the Three Hour Rule by limiting the therapies that may be counted toward the total amount of therapy time to PT, OT, ST and O&P only, leaving no discretion for clinicians to determine the appropriate mix of therapy services for each patient. The modification, as proposed, excludes recreational therapy, despite the fact that recreational therapy provided in an IRF must be medically necessary and ordered by a physician as part of the patient’s treatment plan.

Elimination of recreational therapy as counting toward the Three Hour Rule will have a negative impact on access to this important therapy and is not reflective of current practices in inpatient rehabilitation. Furthermore, such an exclusion is not consistent with CMS policy on medical necessity and deference to the judgment of the treating physician.

Recreational therapy, when provided by a qualified recreational therapy professional (nationally certified and/or state licensed), has been shown to have a statistically positive effect on Functional Independence Measure (FIM) score gains for both stroke and spinal cord injury patients (See Williams, R., et al, 2007 and Hawkins, B., 2009) and is commonly successfully employed with a variety of other patient populations (see Austin, 2009).

I am therefore requesting that CMS explicitly include recreational therapy in the list of therapy services that may be counted under the Three Hour Rule when ordered by a physician as part of a patient’s plan of care and provided by a qualified recreational therapy professional. This should be reflected in both the regulations and the Medicare Benefits Policy Manual.

Furthermore, I would like to offer my support to the position and request made by Congresswoman Tauscher and Congressman Thompson in their letter to Charlene M. Frizzera in which they requested that recreational therapy be included under the Three Hour Rule.

Sincerely yours,



David R. Austin, Ph.D., CTRS
Professor Emeritus
Indiana University
3040 N Ramble Road West
Bloomington, IN 47408

We Each Need to Write 2 Letters -- See Below

What follows is an ATRA ACTION ALERT regarding Inpatient Medical Rehabilitation. All RTs need to take the time to write two letters to CMS in order to make sure RT is included (an example letter is provided below).

On April 29th, 2009, the Centers for Medicare and Medicaid Services (CMS) issued its 2010 proposed rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS). CMS has also proposed to revise the Medicare Benefits Policy Manual (MBPM) provisions on coverage of IRF services and has established a separate comment period and process for these changes.

Taken together, the proposals represent one of the most comprehensive set of rules changes governing access to inpatient rehabilitation services in years and will set the stage for IRF care for the foreseeable future.

Proposed CMS Change:

In reference to the “3-hour Rule,” the removal of the phrase “other skilled rehabilitative modalities” and insertion of “… active and ongoing therapeutic intervention of at least two therapy disciplines (physical therapy, occupational therapy, speech-language pathology, or prosthetics/orthotics therapy)…” in both the IRF-PPS final rule for 2010 and the Medicare Benefits Policy Manual.

Proposed ATRA Member Actions:

Given the impact such a change will have for years to come, ATRA needs all RT professionals to:

1) Submit two comment letters to CMS (Note: Because CMS will make changes to two different rules and regulations, comments need to be submitted to two different sources); and

2) Solicit similar comments to CMS from your colleagues in your IRF setting including Physicians, Physical Therapists, Occupational Therapists, Nurses and other providers. You can share the draft letter with them.

Drafting a Comment Letter:

1) Please review the attached draft letter. Add your personal information in the beginning paragraph.

2) Your comments addressing the proposed rule change must be submitted to CMS as soon as possible. While the deadline may be June 29th, we need to demonstrate an influx of responses well before that date so PLEASE DO NOT DELAY in drafting and sending your comment letter. The final deadline is no later than June 29th, 2009 at www.regulations.gov under file “CMS-1538-P”.

3) Your comments addressing the proposed MBPM changes are due no later than June 30th, 2009 at mbpmcomments@cms.hhs.gov. Please send as soon as possible.

4) If you can fax or email ATRA a copy we would appreciate tracking the responses (email national@atra-tr.org or fax 601-582-3354.
[Please use your personal or agency stationary for your response. Also, please ask your administrators to submit a letter on our behalf using facility letterhead. Delete this instruction in your final letter]

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1538-P
P.O. Box 8012
Baltimore, MD 21244-8012
Re: Proposed Rule for Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2010 (42 CFR, parts 412, May 6, 2009)

To Whom It May Concern:

I am a recreational therapist practicing in XX city and XX state.

I would like to take this opportunity to respond to the Proposed Rule for the Inpatient Rehabilitation Facility (IRF) Prospective Payment System for Fiscal Year 2010. My principal concern relates to the proposed changes to the so-called “Three Hour Rule” that is used as a guideline for determining a patient’s need for a relatively intense level of therapy services.

Under the current Three Hour Rule, the physician and rehabilitation team are given flexibility to determine, on a priority basis, which skilled modalities are appropriate for each patient in the IRF setting. A number of specific therapies are explicitly identified as “skilled modalities,” including but not limited to physical therapy (PT), occupational therapy (OT), speech language pathology (ST), and orthotics and prosthetics (O&P). Until recently, over half the fiscal intermediaries permitted recreational therapy services to be counted as a skilled modality for purposes of qualifying under the Three Hour Rule.

The proposed changes restrict the current language of the Three Hour Rule by limiting the therapies that may be counted toward the total amount of therapy time to PT, OT, ST and O&P only, leaving no discretion for clinicians to determine the appropriate mix of therapy services for each patient. The modification, as proposed, excludes recreational therapy, despite the fact that recreational therapy provided in an IRF must be medically necessary and ordered by a physician as part of the patient’s treatment plan.


Elimination of recreational therapy as counting toward the Three Hour Rule will have a negative impact on access to this important therapy and is not reflective of current practices in inpatient rehabilitation. Furthermore, such an exclusion is not consistent with CMS policy on medical necessity and deference to the judgment of the treating physician. Recreational therapy, when provided by a qualified recreational therapy professional (nationally certified and/or state licensed), has proven to have a statistically positive effect on Functional Independence Measure (FIM) score gains for both stroke and spinal cord injury patients (See Williams, R., et al, 2007 and Hawkins, B., 2009) and is commonly utilized with a variety of other patient populations.

I am therefore requesting that CMS explicitly include recreational therapy in the list of therapy services that may be counted under the Three Hour Rule when ordered by a physician as part of a patient’s plan of care and provided by a qualified recreational therapy professional. This should be reflected in both the regulations and the Medicare Benefits Policy Manual. Furthermore, I would like to offer my support to the position and request made by Congresswoman Tauscher and Congressman Thompson in their letter to Ms. Charlene M. Frizzera, Acting Administrator for CMS dated May 4, 2009.

Thank you for your consideration of my views.

Sincerely,


Your name
Title
Mailing Address
City, State, Zip
Telephone number

cc: ATRA National Office

May is Healthy Vision Month!

Get an Eye Exam:
Your Eyes Are the Windows to Your Health: Schedule an eye exam, today!

Wear Sunglasses and a Hat:
One of the easist ways to protect your vision is to wear sunglasses when you are outdoors. This applies to everyone from infancy to old age. Hats and visors are also recommended, particularly when you are outdoors for long periods of time. Sports enthusiasts, including snow skiers, will find that tinted lenses will not only protect against UV light but also increase visibility by enhancing contrast.

Great Opening at Meadowood in B-town

A few days ago I posted that the Meadowood Retirement Community in Bloomington, Indiana, is currently searching for a recreation therapist. This is a wonderful opportunity for an outstanding RT. You can work at a premier facility and have access to IU's TR program that has students eager to do placements at Meadowood.

The advertised description is:

Meadowood Retirement Community. A Five Star Senior Living Community is currently recruiting for the following position: Full-Time Program Director to lead, develop and manage the activities and therapeutic recreation programming in our Health Pavilion. Position is responsible for supervision and direction of activities staff as well as ensuring the therapeutic recreation needs of our residents are met and documented as required by state and federal regulations. Position requires strong organizational, communication, supervisory and social skills. Successful candidate will possess the creativity and charisma to develop innovative and stimulating activities. To apply, please: visit www.5sqc.com. e-mail resume to akeith@5sqc.com. or apply in person at 2455 Tamarack Trail, 47408 between 8am-8pm, 7 days a week. 812-336-7060. EOE.

Contact person is:

Arlyn Keith
Meadowood R.C.
2455 Tamarack Trail
Bloomington, IN 47408

VA RT Openings in Florida, Texas & Illinois

IU alum Andy Brown, M.S., CTRS, recently sent out information on RT position openings within the VA.

Bay Pines positions were opened today (2 full time and 1 half time position) on USA Jobs. Contact Heather Wojtkum (contact information below).

Heather Wojtkun M.Ed, CTRS
Lead Recreation Therapist - Mental Health
Center for Sexual Trauma Services
Internship Coordinator
Bay Pines VA Healthcare System
PO Box 5005 Bay Pines, FL 33744
(727) 398-6661 x7185
Pager: 257-2206
heather.wojtkun@va.gov

William Bogucki announced that the Waco VA Hospital has a vacancy for full time Recreation Therapist position. They will most likely re-advertise on USA Jobs and DEU for interested candidates soon. If interested you should contact Bogucki.

Lisa Wells has announced that the Hines VA (located in the suburbs of Chicago) has two RT positions coming open. One is with the Blind Rehab Center and the other is in Spinal Cord Injury. If interested please contact Lisa Wells, Recreation Therapy Chief, at 708-202-2261 or by e-mail at lisa.wells@va.gov

RT Position Opening at Wellstone

IU alum Jessica Herndon recently sent out this announcement about an opening at Wellstone Regional Hospital where she works at an RT:

Wellstone Regional Hospital is currently searching for a Recreational Therapist in our Specialized Therapy Department. Wellstone is a 100-bed behavioral health facility specializing in the treatment of children, adolescents, adults, and the geriatric population. We are conveniently located in Southern Indiana, only minutes from Downtown Louisville, Kentucky.

The therapist is responsible for assessing, evaluating, planning and programming services for a population ranging in ages from 5 to 100 in our bed behavioral health facility. Services include: acute inpatient hospitalization for child, adolescent, adult and geriatric psychiatry, and adult chemical dependency. Our facility also provides long term residential psychiatric care ranging in ages from 5 to 18 on a 12 bed unit. Other job duties could include: holiday planning, once weekly outings, and special events. We are looking for a highly motivated and organized individual to compliment our team of specialized therapists including recreation, expressive, horticulture, and pet therapy in providing a high level of quality patient care. We encourage and will help provide resources in maintaining continuing education.

Qualifications: Minimum of a Bachelors Degree of accredited university and eligible to sit for national exam conducted through the National Council on Therapeutic Recreation Certification (NCTRC); drug testing, background checks, CPS checks, Sex Offender Registry check, fingerprinting. References must be verifiable.

Shift would consist of full time days, some evenings and weekends.

Benefits include but are not limited to 401k, tuition reimbursement, dental, health, vision, STD, LTD, Critical illness, etc. Pay is based on experience.

Please contact Jodie Peres by calling 812-258-1080.

Do You Know About e-physician.info?

A recreational therapist in North Carolina contacted me following a couple of my posts that discussed possible shortages of RTs and the need to identify the supply of RTs available.

She suggested I take a look at e-physician.info

I just gave e-physician.info a quick look. I did an NPI (National Provider Identifier)search of health care providers in Indiana under the category of recreation therapists. Do you know what I found? I found a list of only 16 RTs! I did recognize some of the names, including Vicki Scott and Andy Brown. But come on, only 16!

On the e-physicaian.info wedsite it states all health care providers are elgible for NPIs. I wonder why more Hoosier RTs have not gotten listed. Perhaps, like me, they weren't aware of the list.

At any rate, the uninformed individual looking at the list of RTs in Indiana on e-physicaian.info might think there are only 16 RTs in the entire Hoosier state.

I want to learn more about the NPI system and will report on the RT Blog if I discover anything of interest. In the meanwhile, please comment on this post if you are acquainted with the NPI listing.

TR in Special Education Text Being Updated

I recently received a message from Cathy Coyle, from Temple, who is working on a project with Candy Aston and Lisa Mische to update the TR in Special Education Text that was published by ATRA.

It is good to learn of interest in TR in special ed. It has been awhile since I've seen much about what is happening in that area.

I'm sure that Cathy Coyle would enjoy hearing from you if you are involved in TR in special education.

Types of People and Turkeys Flying

I'm still clearning my home office. And I've found a lot of interesting things. I'll try to share some of them on the RT Blog.

Today I want to share some quotes from a talk I made in the Fall of 1986. The title was "Issues and Trends in TR."

One quote I used was from Ann Landers. It read: "There are only three types of people: those who make things happen, those who watch things happen, and those who say 'What happened?'"

I went on to give this unattributed quote: "Eagles will soar, you need to get the turkeys to fly."

I suggested that most RTs are those that make things happen and that they need to get the turkeys to fly!

I guess these quotes still pertain today. But does it seem to you that today we have more colleagues than ever who just watch things happen or ask "What happened?"

You eagles still have some work to do to get those turkeys to fly!

Reunions

My 50th class reunion for the class of '59 of Hanover High School was better than I had even imagined it would be! It was great to my old classmates, some I hadn't seen in 50 years. What impressed me was how nice eveyone was to one another and how little their personalities had changed. Eveyone agreed it was so much fun that we should get together again next year.

It would be great to get together a reunion for the Founding Members of ATRA. It would be our 25th anniversary.

See You Next Week

I just received some unexpected and interesting information from an RT from North Carolina who was reacting to the posts on RT shortages. I plan to follow-up on her information early next week -- but today I'm off to my 50th high school class reunion. Can you believe 50 years! I can't!

Is There Data on Availability of RTs in Indiana and Nationally?

I just received a press release titled "Governor signs HB1210 to address shortage of mental health professionals in Indiana."

The press release in part read:
"The Indiana General Assembly passed HB 1210. This bill creates mental health services development programs to provide incentives to attract psychiatrists, psychologists, psychiatric nurses, and public sector psychiatrists to practice in Indiana. It creates the mental health services development programs board to administer the programs."

Reading this on the heals of yesterday's post on possible RT shortages, made me wonder if we have data on the availability of recreational therapists in Indiana and nationally to work in mental health. I haven't seen such data. It would seem timely for someone to conduct a study to determine the availability of RTs in Indiana and nationally.

Shortage of RTs?

I recently read with interest a post on Charlie Dixon's Recreational Therapy Blog.
He stated that: "over the course of this past several months I have heard from about six employers that they are having a difficult time finding someone to take their recreation therapist or activity director job opening. They say that they have posted job openings at the Therapeutic Recreation Directory, Monster.com, local newspapers, etc and was not able to find a suitable candidate and/or very few people applied for the job.

"There is a state psych hospital near where I work that has had extreme difficulty in finding a TR for their rec therapy position for several years!

"I don’t know what the real answer is. I can only speculate… can it be that the position is in a very rural area and no one wants to relocate to such a setting? Can it be that people are “picky” with the types of jobs or places they are willing to work? Are people not willing to “pay the dues” and work in lower paying or less desirable jobs? Are the pay scale too low? With more colleges dropping TR programs are there not enough TRs out there?

I also hear from others having gone through many interviews and not being selected."

I wonder just what is going on with the situation with jobs. There are fewer and fewer universities producing RTs. Perhaps this enters into the shortage. Also, I know that at many universities students take undergraduate degrees in RT and then go on for a master's degree in PT or OT instead of entering the field.

As for those who interviewed and were not selected, perhaps they should look at the quality of professional preparation they have received. Too many universities simply have weak programs that do not adequately prepare their graduates to do clinical work.

Will RT Ever Make Curriculum Changes?

I mentioned yesterday that I was cleaning up my office. In doing so I found an article titled “Perceptions of Therapeutic Recreation in Higher Education” that had appeared in the 1994/95 issue of the Annual in Therapeutic Recreation. Dave Compton and I had authored it.

One of the findings of our research was: “The current curriculum structure appears to be a clear concern of the respondents. The needs range from adding more core TR classes to complete revision of the curriculum. The probability of fulfilling this need is deemed ‘moderate’ by the respondents.”

This was 15 years ago folks! And little has been accomplished to improve curriculum standards for our profession over this time.

It is clear to me that the respondents in our study were overly optimistic when they anticipated the probability of meeting the need for curriculum change was “moderate.”

We should have acted long ago to improve a situation that has existed for far, far too long. Shame on us.

Chronic Illness and RT

I'm cleaning up my home office in anticipation of painting it and putting in new carpeting (after 20 some years of neglect!). In the process I found a chapter from a book titled Chronic Illness (Hyman & Corbin, 2001).

In chapter 1 of that book it is stated that by 2030 150 million Americans will have one or more chronic conditions -- and of those 42 million will have activity limitations. The author goes on to say: "Addressing their varied health care needs is one of the major challenges facing the present health care delivery system" (p.1).

This population of Americans with chronic illnesses is one that we RTs should focus on. What better profession than RT to help those with chronic conditions to lead full and productive lives!

Happy Mother's Day!

Peg Connolly Scholarships for ATRA Annual

ATRA is now accepting applications for Peg Connolly Scholarships.

Eight Peg Connolly Scholarship stipends are available for RT students to attend ATRA's Annual Conference, including conference registration, lodging accommodations and meal stipend ($100). Students are responsible for their transportation to/from the conference. This scholarship is a "working scholarship." Students assist in various aspects of implementing the conference such as room hosting, registration and monitoring social events. The deadline for applicaition is May 22nd.

Meadowood Position is Great Opportunity

I posted the Meadowood RT position opening yesterday. I wanted to inform those who are not familiar with Meadowood that the position offers a great opportunity. First, Meadowood is a five-star facility. Many of the residents are retired faculty from Indiana University. Second, there is an opportunity to associate with the IU RT/TR program that has wonderful faculty and students eager to do placements at Meadowood. Third, Bloomington is a wonderful university community in which to live. If you are thinking about applying, you should do so!

Harvard Health Pub on Yoga

Harvard Health Publications today released an article titled "Yoga for Anxiety and Depression." It is a positive article in terms of the therapeutic value of yoga.

The article states: "Available reviews of a wide range of yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as meditation, relaxation, exercise, or even socializing with friends."

RT Opening, Bloomington, Indiana

Sherri Ganka at Meadowood Retirement Community in Bloomington, Indiana, passed along that they are currently searching for a recreation therapist (full-time).

The advertised description is:

Meadowood Retirement Community. A Five Star Senior Living Community is currently recruiting for the following position: Full-Time Program Director to lead, develop and manage the activities and therapeutic recreation programming in our Health Pavilion. Position is responsible for supervision and direction of activities staff as well as ensuring the therapeutic recreation needs of our residents are met and documented as required by state and federal regulations. Position requires strong organizational, communication, supervisory and social skills. Successful candidate will possess the creativity and charisma to develop innovative and stimulating activities. To apply, please: visit www.5sqc.com. e-mail resume to akeith@5sqc.com. or apply in person at 2455 Tamarack Trail, 47408 between 8am-8pm, 7 days a week. 812-336-7060. EOE.

Contact person is:

Arlyn Keith
Meadowood R.C.
2455 Tamarack Trail
Bloomington, IN 47408

CMS Proposed Rule -- Please Read

The following is from ATRA via Thom Skalko. Should you wish to contact Thom his contact information is at the end of the post.

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule yesterday that would update payment rates and clarify the framework for Medicare patient selection and care in inpatient rehabilitation facilities (IRFs) during fiscal year (FY) 2010. (Thank you for your patience in waiting for this notice and the associated press material.) The proposed rule would apply to more than 200 freestanding IRFs and over 1,000 IRF units in acute care hospitals, and would be effective for discharges occurring on or after October 1, 2009.

CMS projects that the payment rate update for IRFs will be 2.4 percent in FY 2010, based on the Rehabilitation, Psychiatric, and Long-term Care (RPL) market basket. If finalized as proposed, the rule would increase total payments to IRFs in FY2010 by $150 million.

The proposed rule's patient selection and care provisions are intended to ensure that Medicare beneficiaries who need the intensive rehabilitation services provided in IRFs continue to have access to high quality care. In addition to the proposed rule issued today, CMS is posting draft revisions to the Medicare Benefit Policy Manual (MBPM) for public comment. This draft makes conforming changes to the manual based on the proposed rule; it provides detailed policy guidance regarding the selection of patients for admission to IRFs, and the development and implementation of individual treatment plans. The proposals would create a framework that incorporates current best practices in rehabilitative medicine, while promoting more efficient and focused medical review by Medicare’s fiscal intermediaries and administrative contractors.

The proposed rule went on display yesterday at the Office of the Federal Register’s Public Inspection Desk and will be available under “Special Filings,” at: www.federalregister.gov/inspection.aspx

The press release is below and posted at: www.cms.hhs.gov/apps/media/press_releases.asp

Two detailed fact sheets are posted at: www.cms.hhs.gov/apps/media/fact_sheets.asp

CMS will accept comments on the proposed rule until June 29, 2009, and will address all comments in a final rule to be issued on or about August 1, 2009.

MEDICARE NEWS

FOR IMMEDIATE RELEASE
April 29, 2009

CMS PROPOSES FY 2010 PAYMENT AND POLICY UPDATES FOR INPATIENT REHABILITATION FACILITIES

PROPOSALS WOULD CLARIFY AND STRENGTHEN PATIENT SELECTION AND CARE REQUIREMENTS

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on April 28, 2009 that would update payment rates and clarify the framework for Medicare patient selection and care in inpatient rehabilitation facilities (IRFs) during fiscal year (FY) 2010. The proposed rule would apply to more than 200 freestanding IRFs and over 1,000 IRF units in acute care hospitals, and would be effective for discharges occurring on or after October 1, 2009.

The proposed rule's patient selection and care provisions are intended to ensure that Medicare beneficiaries who need the intensive rehabilitation services provided in IRFs continue to have access to high quality care. In addition to the proposed rule, CMS is posting draft revisions to the Medicare Benefit Policy Manual (MBPM) for public comment. This draft makes conforming changes to the manual based on the proposed rule; it provides detailed policy guidance regarding the selection of patients for admission to IRFs, and the development and implementation of individual treatment plans. The proposals would create a framework that incorporates current best practices in rehabilitative medicine, while promoting more efficient and focused medical review by Medicare’s fiscal intermediaries and administrative contractors.

Comments on the draft MBPM revisions should be submitted through a link that will be supplied on the CMS Website, rather than through the www.regulations.gov site used for the submission of comments on proposed regulatory language. CMS intends to issue final updated MBPM policies concurrently with the issuance of the final IRF PPS rule.

“CMS is proposing updates to the current IRF coverage criteria that would better reflect industry-wide best practices, and improve understanding and consistency of medical necessity guidelines,” said CMS Acting Administrator Charlene Frizzera. “The proposed policies were developed by CMS working closely with the National Institutes of Health and medical directors from several fiscal intermediaries, and taking into account input from the rehabilitation community.”

The proposed revisions would clarify requirements for preadmission screening to determine whether a patient should receive rehabilitation services in an IRF or in another, less-intensive setting, post-admission treatment planning, and ongoing care coordination throughout the inpatient stay. Specifically, CMS is proposing to:

· Update and clarify the IRF admission criteria to specify that the patient should be able and willing to actively participate in an intensive rehabilitation program and should be expected to make measurable improvement in his or her functional capacity or adaptation to impairments;

· Require that IRF services be ordered by a rehabilitation physician with specialized training and experience in rehabilitation services and be coordinated by an interdisciplinary team, including at least a registered nurse with specialized training or experience in rehabilitation; a social worker or case manager (or both); and a licensed or certified therapist from each therapy discipline involved in treating the patient. The rehabilitation physician would be responsible for making the final decisions regarding the patient’s treatment in the IRF.
· Specify that IRFs use qualified personnel to provide required rehabilitation nursing, physical therapy, occupational therapy, speech-language pathology, social services, psychological services, and prosthetic and orthotic services.
· Emphasize the importance of the post-admission evaluation to document the status of the patient after admission to the IRF, compare it to that noted in the preadmission screening documentation, and begin developing an overall plan of care to meet the individual patient’s specific needs. The proposed rule would require the overall plan of care to be completed with input from all of the interdisciplinary team members and to be maintained in the patient’s medical record.
· Require the interdisciplinary team to meet weekly to review the patient’s progress and make any needed modifications to the individualized overall plan of care.

Since 2002, Medicare has paid rehabilitation hospitals and rehabilitation units in acute care hospitals for inpatient stays under the IRF prospective payment system (PPS). Under the IRF PPS, the patient is classified into a case-mix group (CMG) taking into account his or her overall physical and cognitive status. Medicare makes a single payment to the IRF based on the CMG assignment. In rare cases, Medicare will make an additional payment, called an outlier payment, to the facility when the costs of treating an individual patient are much higher than the payment for the CMG.

The payment rates set by the IRF PPS for rehabilitation therapy services are higher than would be paid for services in other settings, such as hospital outpatient departments, skilled nursing facilities, or in the home health setting. This is because these patients have more severe and more complex medical conditions that need more intensive and coordinated rehabilitation services. A major reason for updating the coverage policies is to help IRFs select appropriate patients who need the comprehensive and more costly rehabilitation services furnished in the IRF setting.

To be paid under the IRF PPS, each facility must demonstrate on an annual basis that at least 60 percent of its total patient population had either a principal or secondary diagnosis that falls within one or more of the qualifying conditions designated in the regulations governing IRFs. (This is commonly referred to as “the 60 Percent Rule.” The list of qualifying conditions is attached.) In calculating an IRF's compliance rate to determine the IRF’s compliance with the 60 percent rule CMS has historically used a method that extrapolated the compliance rate from Medicare fee-for-service data. It is now clear that the extrapolation method of determining compliance will be more accurate if Medicare Advantage patients are included in these compliance review calculations. Therefore, CMS is proposing to require submission of IRF patient assessment data on Medicare Part C (Medicare Advantage) patients in IRFs.
In other provisions, CMS projects that the payment rate update for IRFs will be 2.4 percent in FY 2010, based on the Rehabilitation, Psychiatric, and Long-term Care (RPL) market basket, and that, if finalized as proposed, the market basket update would increase total payments to IRFs in FY 2010 by $140 million. The RPL market basket was developed to measure the rate of inflation for the resources used in treating the specific types of patients served by these facilities. Also, CMS is proposing to set the outlier threshold for FY 2010 at $9,976, the amount estimated to maintain estimated outlier payments equal to 3.0 percent of total estimated payments under the IRF PPS for FY 2010. The change to the outlier threshold would increase overall IRF payments by $10 million. The total increase in IRF payments under this proposed rule is $150 million.
For facility and patient-level adjustments, which would not increase total IRF payments, the proposed rule would:

· Update the CMG relative weights and average length of stay values using FY 2007 data, which reflect recent changes in IRF patient populations resulting from the 60 percent rule and medical review activities.
· Use the pre-reclassified and pre-floor hospital wage data to determine the proposed FY 2010 rates. The FY 2010 IRF PPS wage index values in the proposed rule are based on the final FY 2009 pre-reclassified and pre-floor hospital wage data.
· Update the rural, low-income patient (LIP), and teaching status adjustment factors using the most recent three years of data (FYs 2005 through 2007).

CMS will accept comments on the proposed rule until June 29, 2009, and will address all comments in a final rule to be issued by August 1, 2009.
--
Thomas K. Skalko, Ph.D., LRT/CTRS
Professor
East Carolina University
College of Health and Human Performance
Belk 1409
Greenville, NC 27858-4353
252-328-0018
SKALKOT@ecu.edu

RT/TR Week

I just read that "National Therapeutic Recreation Week" is scheduled to be held July 12 - 19, 2009.

I have long wondered why RT/TR Week is held in the summer when university programs are not in session and many are on vacation. Why not hold it during the academic year? Students could participate and RT/TR curricula might gain more attention on university campuses.

And why restrict RT/TR Week to the USA? Why don't the USA and Canada join together to hold a North America RT/TR Week?

Concern for University RT Programs

Is anyone else concerned about the state of university RT programs? It seems to me that there are a great many concerns that face us in higher education today.

First, there are several states with only one university with an RT/TR professional prep program. I think this is true for Minnesota and Georgia. I recently read that Florida International's program could be closed. If FIU's program is closed, how many university programs would remain in Florida? The point is that RTs must begin to examine what is going on in their states in terms of higher education and take steps to support university programs. We cannot afford to lose any more quality RT/TR professional preparation programs.

Second, RT/TR curricula need to be strengthened considerably. There is hope that this summer's curriculum conference will produce some positive changes. Let's hope so because large changes are needed to bring RT/TR curricula up to the point where they should be.

Third, and perhaps of the greatest concern, is what is going on with university Ph.D. programs in RT/TR. How many are there today? Over the years we have lost Ph.D. programs at major R1 institutions such as Illinois, Maryland, Florida, Minnesota, and Oregon. This leaves only 4 or 5 Ph.D. programs in our entire country! In the Big Ten, only Indiana and Penn State offer Ph.D. programs. I would go so far as to state that we have a crisis because not enough Ph.D.s are being prepared today. Without adequate numbers of well prepared RT/TR faculty who will do the teaching, research, and scholarship for RT?

I hope both educators and practitioners are alarmed at our current situation in higher education today. And I would call on ATRA Chapters and ATRA to take the lead to address the dire situation. What do you think? Are you also concerned?

Mental Health Awareness Month

May is mental health awareness month.