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As we move closer to the new world of PDPM, it is very important that our occupational therapy teams continue focus on functional intervention during their treatment session.  This is a great article from the American Occupational Therapy Association which could easily be implemented with our teams.


Hide the Cones & Pegs: How an OT Implemented “Functional Fridays”

AOTA Staff

We love hearing how AOTA members are implementing the Choosing Wisely® five occupational therapy interventions to question in their practices. Cody LaRue, MS, OTR/L, was so inspired by Choosing Wisely that he instituted a new practice called “Functional Fridays” at his facility, Encompass Health Rehabilitation Hospital of Petersburg in Petersburg, VA.

“Our emphasis is always on function,” LaRue says. “But sometimes having certain preparatory activities within reach can cause temptations to use a less than optimal modality for our clients.”

So the team decided to hide the preparatory items in a closet to challenge each OT practitioner on staff to be more occupation-based with their clients.

How do they make Functional Fridays work? Here are three steps that helped it succeed:

Step 1: They approach it as a learning opportunity for the whole team. 

LaRue shared thoughts and principles he learned while preparing for his presentation at AOTA’s Annual Conference & Expo, “Find Me the Function: Throwing Out the Cones, Pegs, and Putty.” The team discussed some of the challenges they face with using functional treatment (treating clients with limited occupational interests and clients at lower functional levels).

Step 2: They problem solve as a team to come up with ideas. 

During OT meetings, the team discusses new ideas by delving into their patients’ interests to really make the most of the limited time they have with each patient (generally 10 to 14 days).

Step 3: They hide the preparatory items in a closet. 

On Fridays the items are out of reach and out of mind. After we started, “every therapist was in the ADL kitchen and even tabletop activities appeared to be activities one would be performing upon returning home,” LaRue says.

What has been the result? “I’ve witnessed a noticeable increase in overall functional treatment,” says LaRue. “Both because therapists have seen the benefits of providing more creative functional treatments but possibly because of the stigma that may now be associated with some of the preparatory items.”

Providing high quality occupational therapy is even more important as major payment changes are beginning to roll out in Medicare, like the Patient-Driven Payment Model (PDPM) in skilled nursing facilities (SNFs). Starting October 1, SNFs will no longer be reimbursed at higher rates for a higher volume of occupational therapy services; practitioners will need to avoid low-value OT (e.g., ROM exercises) and focus on the high value skilled OT services (e.g., ADLs).

To prepare for the PDPM, you should begin by asking yourself whether you’re providing high value OT interventions to your clients. Implementing a “Functional Friday” can be a great way to encourage high quality interventions at your facility and with your OT team.

“I wanted to challenge the team by really causing them to think outside the box,” LaRue says. “This is truly an area that I have a passion for, from getting patients out into the community regularly on outings to creating the most realistic scenarios in our hospital for our patients to succeed at home.

    Beth Reigart
    Clinical Outcomes Specialist