Conflicting Opinions – Professional Obligations for OT Reports

BACKGROUND

Austin is an occupational therapist (OT) who works as an independent contractor for Prompt Rehab. The majority of Prompt Rehab referrals come from GOHOME insurance company.  Austin is asked to complete an attendant care needs assessment for Veronika, who was in a car accident six months ago and lives in a remote northern community.  Austin completes his assessment and report, recommending home modifications and 20 hours of attendant care per day for Veronika. Austin submits his report to Prompt Rehab, which forwards that report to GOHOME insurance.

Following the submission of his report, Austin receives an email requesting a teleconference with Prompt Rehab and the GOHOME insurance adjuster. During the teleconference, the insurance adjuster questions the recommendation for 20 hours of attendant care and home modifications. Both Prompt Rehab and the insurance adjuster request Austin reduce the recommended number of attendant care hours as it will be difficult to find services in the remote community where Veronika lives. Prompt Rehab insists Austin review and modify his written report as they are concerned about maintaining their working relationship with the insurance company.  What should Austin do?

CONSIDERATIONS

  • Austin reviews the relevant resources on the College website: Standards for Occupational Therapy Assessment, Standards for Record Keeping, Guidelines for Working with Third Party Payers, Code of Ethics and the Conscious Decision-Making in Occupational Therapy Practice Framework.

  • Austin refers to the Standards for Occupational Therapy Assessment and notes OTs must record any assessments completed, results obtained, conclusions drawn, and document any professional opinions regarding client status.  Austin reviews the report he submitted to ensure the information is accurate. He determines the report provides an objective, impartial, and non-judgemental assessment.

  • Austin reviews the Standards for Record Keeping, which state that any modifications to a report after it has been distributed must be completed using an addendum, and an explanation for the change must be sent to all recipients of the original document. 

  • As Austin is an independent contractor, he contacts a colleague to seek support, determine if his recommendations are reasonable, and gain insight into how to approach this situation. Austin is careful not to provide any personal health information or specific details about the client or other stakeholders. 

  • Austin contemplates Prompt Rehab and GOHOME insurance’s position and views and his own accountability and responsibilities as a regulated health professional 

OUTCOME 

  • After working through the Conscious Decision-Making Framework and speaking with his colleague, Austin decides the best option is to engage in a dialogue with Prompt Rehab and the GOHOME insurance adjuster to clarify his recommendations and address any outstanding questions about the assessment and results.

  • Austin is satisfied his report includes the assessment methods he used and the results. Austin explains to Prompt Rehab and the adjuster that his professional opinions are based on witnessed observations of the client’s abilities, and the recommendations are based on the attendant care needs of the client to ensure their safety. 
  • Austin is confident his report is reflective of his independent professional judgement and clinical rationale and the recommendations are clearly articulated within the occupational therapy scope of the role. Austin decides the report should not be modified.

DISCUSSION

  • OTs are accountable for their recommendations regarding client care.
  • OTs must be prepared to respond to queries regarding assessment outcomes and provide evidence-informed clinical justification for their professional opinions and recommendations.

  • The Conscious Decision-Making Framework process can assist OTs in managing situations where the requests do not align with professional obligations and do not reflect safe and ethical practice.

  • OTs are expected to remain objective and impartial when providing occupational therapy services and ensure the documentation of any assessment results and recommendations reflect their independent professional judgement, are evidence-informed and clearly outline the client’s needs. 

Watch for part 2 of this case as Austin works with the Conscious Decision-Making Framework to arrive at a decision. 

REFERENCES

  • Code of Ethics
  • Guidelines for Working with Third Party Payers
  • Standards for Occupational Therapy Assessments
  • Standards for Record Keeping
  • Conscious Decision-Making in Occupational Therapy Practice
  • CONTACT

    If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org

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