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Use of the COPM in acute care & inpatient rehab

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Use of the COPM in acute care & inpatient rehab

  • Just wondering if any therapists are currently using the COPM in an acute care or inpatient rehab setting.  If so, what are some of the patient populations with whom you use it?

    Also, how do you "bill" for the time spent on completing it with the patient.  The hospital I am with is considering using it, however there will probably not be time to add it into the initial evaluation and it will more likely occur on the second session. 

    Also, how do therapists bill when using it with the patient again before discharge?  As a "therapeutic activity"?  

     

  • I started using the COPM at an IRF over 10 years ago. I billed it as an evaluation because that's how I used it. The facility's eval was a typical piece of bio-mechanical "junk" asking almost nothing about patients' occupational history or preferences.  I mean this from the bottom of my heart, the COPM and the Enabling Occupation book, liberated my OT practice.  Many COPM's later, I stopped using the actual form but kept up the practice of understanding patients from an occupational perspective.

    Year later in a private practice, I used the COPM again as my eval and outcome measure.  For reassessment purposes, I don't specifically remember, but I do believe "therapeutic activity" is an appropriate CPT.

    Good call on using the COPM. Also consider the accompanying Enabling Occupation book.

    Ron Carson MHS, OT

  • I administer it during the evaluation so I bill it as part of the non-timed evaluation. I have used it in outpatient and work rehab and to a lesser extent IPR. I feel that acute care is too fast paced, most people discharge in a few days. While I do not have the patients in acute care complete the COPM with rating importance of or satisfaction of their performance of the goals because the time frame is so short , I do feel that I include the spirit of the COPM in my goal setting during the evaluation and encourage them to follow up on those goals at the next level of care, IPR, SNF, Home Health or Outpatient, because we have electronic charting so share information from one setting to the next.

  • billing for treatment could be either self care or ther-act  or community re-integration depending on the goals the patient selected to work on. Doctors are looking for who will help them make the switch to patient centered care. Once you let them know that OT will do that for them- you will see your practice take off and you will not be able to keep up with the orders.

    Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm 

    D.B. Reuben and M.E. Tinetti | N Engl J Med 2012;366:777-779

    Free Full Text  Comments  

    Shared Decision Making — The Pinnacle of Patient-Centered Care 

    M.J. Barry and S. Edgman-Levitan | N Engl J Med 2012;366:780-781

    Free Full Text   Audio  Comments  

    Defining “Patient-Centered Medicine” 

    C.L. Bardes | N Engl J Med 2012;366:782-783

    Free Full Text  Comments  

     

  • I may be wrong, but I believe Medicare does not pay for community reintegration.  It may be a regional issue but it seems a while back I read that my Medicare carrier not longer reimburses for this CPT.  And, this makes sense because Medicare therapy-related benefits are primarily paid to make the patients safe and independent in their homes. Power wheelchairs are a great example of this. While beneficiaries may use power w/c's in the community, there must be a demonstrated medically necessary in-home need.

    Ron Carson MHS, OT

  • I work in acute care and do similar to Meredith using the "spirit of the COPM" during my evaluation. The COPM is maybe more appropriate for some populations than others in this particular setting.

    So for example, when I see a client the day immediately following their above knee amputation, he often has not had a chance to engage in many ADLs or IADLs since his surgery. Therefore it would be difficult for him to rate his satisfaction with getting dressed  if he has never attempted to put pants on as a person with a disability. But, I think as the person has more life experiences, that the COPM would be a really good evaluation tool in settings maybe further down the continuum of care.

    That being said, I also see individuals with chronic conditions that worsen over time or individuals with complex conditions that  are frequently readmitted. I believe this type of client would better be able to benefit from the COPM. For example someone who is admitted for congestive heart failure often experiences a general decline and will be very familiar with the trials and tribulations he faces during his daily occupations. In acute care, they will stabilize the client with medicine, but when he goes home he will still face many of the same occupational performance deficits he did before he was admitted. So in this instance the COPM would help to reveal that clients goals and priorities. 

    I think that the COPM provides a better opportunity for clinicians to show progress on client centered goals as opposed to relying on FIM scores which may or may not relate to the clients goals.