Practice Area 403 CLINICAL PRIVILEGE WHITE PAPER Background Occupational therapist Occupational therapists (OTs) use specialized knowledge to help individuals improve their ability to perform tasks in their daily living and working environments. Their goal is to work with clients so that they can have productive and satisfying lives. OTs assist people who have permanent disabilities, such as spinal cord injuries, cerebral palsy, or muscular dystrophy are mentally ill, mentally retarded, or emotionally disturbed have an impaired ability to function in a work environment are dealing with alcoholism, drug abuse, depression, eating disorders, or stressrelated disorders Occupational therapy practitioners are also able to prevent injury for their clients or the worsening of existing conditions or disabilities. This promotes independence in people who otherwise might require institutionalization or other long-term care and can help keep healthcare costs low while maximizing the quality of life for individuals, families, and caregivers. OTs work in hospitals as well as outpatient care centers, offices of physicians, individual and family services, community care facilities for the elderly, and government agencies. They may be self-employed in private practice and see clients referred by physicians or other health professionals. They may also provide contract or consulting services to nursing care facilities, schools, and home healthcare agencies. A bachelor s degree from an occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education is the minimum requirement for entry into the field. Occupational therapy coursework includes physical, biological, and behavioral sciences as well as the application of occupational therapy theory and skills. Practitioners must also complete supervised fieldwork. The National Board for Certification in Occupational Therapy gives a national certification examination for OTs and occupational therapy assistants (OTAs). OTs who pass the exam are awarded the title of Occupational Therapist Registered. OTAs who pass the exam are awarded the credential Certified Occupation Therapy Assistant. A supplement to Briefings on Credentialing 781/639-1872 12/04 1
Most states have licensure regulations for occupational therapy practitioners, and a few states require certification. Student OTs should check with the regulatory board in the state(s) in which they intend to work. Positions of societies and academies AOTA The American Occupational Therapy Association (AOTA) is the nationally recognized professional association of approximately 35,000 OTs, OTAs, and students of occupational therapy. The association s mission is to advance the quality, availability, use, and support of occupational therapy through standard setting, advocacy, education, and research on behalf of its members and the public. In regard to the educational requirements for a career in occupational therapy, AOTA states that preparing for a career as an OT requires a student to complete either a bachelor s degree or postbaccalaureate degree; i.e., master s degree or entry-level doctoral degree. Beginning January 1, 2007, all new occupational therapy candidates will need a postbaccalaureate degree. In addition to these degrees, all candidates are required to complete a period of supervised fieldwork. Currently there are two types of fieldwork required for OTs: Level I fieldwork Level I fieldwork is designed to enrich didactic coursework through directed observation and participation in selected aspects of the occupational therapy process. The focus of these experiences is not intended to be independent performance. Each academic program structures these experiences slightly differently. Level II fieldwork The purpose of Level II fieldwork is to develop competent, entry-level, generalist OTs. It includes an in-depth experience in delivering occupational therapy services to clients and focuses on the application of purposeful and meaningful occupation. Level II fieldwork may also focus on research, administration, and management of occupational therapy services. Level II fieldwork requires an equivalent of 24 weeks of experience and may be completed on a full- or part-time basis. For Level II fieldwork, occupational therapy students must be supervised by an OT who meets state regulations and has a minimum of one year of practice experience, subsequent to initial certification. 2 A supplement to Briefings on Credentialing 781/639-1872 12/04
Positions of other interested parties NBCOT The National Board for Certification in Occupational Therapy (NBCOT) grants certification to OTs. Candidates must meet the following eligibility criteria to gain recognition as an NBCOT certificant: Graduate from an accredited occupational therapy education program Complete fieldwork requirements Attest to understanding and adhering to the NBCOT candidate/certificant code of conduct Pass NBCOT s national certification examination, which is based on a comprehensive practice analysis study conducted to determine critical knowledge, skills, and abilities of OTs JCAHO The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has no formal position on the delineation of privileges for OTs. However, in regard to qualifications for OTs, hospitals must comply with the following human resources (HR) and leadership (LD) standards from the 2004 Comprehensive Accreditation Manual for Hospitals: LD.3.70 The leaders define the required qualifications and competence of those staff who provide care, treatment, and services and recommend a sufficient number of qualified and competent staff to provide care, treatment, and services HR.1.10 The organization provides an adequate number and mix of staff consistent with the organization s staffing plan HR.1.20 The organization has a process to ensure that a person s qualifications are consistent with his or her job responsibilities HR.2.10 Orientation provides initial job training and information HR.2.20 Staff members, licensed independent practitioners, students, and volunteers can describe or demonstrate their roles and responsibilities, based on specific job duties or responsibilities, relative to safety HR.2.30 Ongoing education, including in-services, training, and other activities, maintains and improves competence HR.3.10 Competence to perform job responsibilities is assessed, demonstrated, and maintained HR.3.20 The organization periodically conducts performance evaluations A supplement to Briefings on Credentialing 781/639-1872 12/04 3
CRC draft criteria When a hospital receives a request from an OT to become a member of the hospital staff, it should not be the first time the hospital considers whether this type of practitioner should be granted privileges. The policy covering OTs should be drafted in advance by the board and should resolve any liability, peer review, and reimbursement issues. In addition, the board should review federal laws, state laws, and state and local licensing requirements. The advice of the medical staff should be considered as well as the needs of the community and the hospital s mission and strategic plan. Criteria should be in place covering qualifications, scope of practice, and physician supervisory requirements. The following draft criteria are intended to serve solely as a starting point for the development of an institution s policy regarding this practice area. Minimum threshold criteria for requesting core privileges for OTs Basic education and minimum formal training: Applicants must be able to demonstrate completion of the following: An accredited occupational therapy training program Required occupational therapy fieldwork Appropriate state licensure or registration In addition, NBCOT certification is recommended. Required previous experience: Applicants must be able to demonstrate that they have provided occupational therapy inpatient and consultative services for at least 50 patients in the past 12 months. Note: Beginning in 2007, a master s degree or higher will be the minimum educational requirement for OTs. References Core privileges in occupational therapy A letter of reference must come from the director of the applicant s occupational therapy training program. Alternatively, a letter of reference regarding competence should come from the OT s supervisor at the institution where the applicant most recently practiced. Core privileges in occupational therapy include but are not limited to the following: Test and evaluate clients for therapy and support needs Evaluate home and job sites with adaptation recommendations 4 A supplement to Briefings on Credentialing 781/639-1872 12/04
Plan, organize, and conduct occupational therapy programs designed to help clients regain physical or mental functioning or to adjust to their disabilities Fabricate and fit client splints, braces, and other adaptive devices Train clients on use of splints, braces, and other adaptive devices Assess and record client activities and progress Educate and counsel clients and families in regard to specific physical, mental, and/or developmental disabilities Participate in the training of medical and nursing personnel in occupational therapy techniques, and objectives Practice safety, environmental, and/or infection control methods Reappointment Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided occupational therapy inpatient and consultative services for at least 50 patients annually over the reappointment cycle. In addition, continuing education related to occupational therapy should be required. For more information For more information regarding this practice area, contact: American Occupational Therapy Association 4720 Montgomery Lane PO Box 31220 Bethesda, MD 20824-1220 Telephone: 301/652-2682 Fax: 301/652-7711 Web site: www.aota.org Commission on Accreditation of Allied Health Education Programs 35 East Wacker Drive, Suite 1970 Chicago, IL 60601-2208 Telephone: 312/553-9355 Fax: 312/553-9616 Web site: www.caahep.org A supplement to Briefings on Credentialing 781/639-1872 12/04 5
Joint Commission on Accreditation of Healthcare Organizations One Renaissance Boulevard Oakbrook Terrace, IL 60181 Telephone: 630/792-5000 Fax: 630/792-5005 Web site: www.jcaho.org National Board for Certification in Occupational Therapy 800 South Frederick Avenue, Suite 200 Gaithersburg, MD 20877-4150 Telephone: 301/990-7979 Fax: 301/869-8492 Web site: www.nbcot.org 6 A supplement to Briefings on Credentialing 781/639-1872 12/04
Privilege request form Occupational therapist To be eligible to request clinical privileges as an OT, an applicant must meet the following minimum threshold criteria: Basic education and minimum formal training: Applicants must be able to demonstrate completion of the following: - An accredited occupational therapy training program - Required occupational therapy fieldwork - Appropriate state licensure or registration In addition, NBCOT certification is recommended. Required previous experience: Applicants must be able to demonstrate that they have provided occupational therapy inpatient and consultative services for at least 50 patients in the past 12 months. References: A letter of reference must come from the director of the applicant s occupational therapy training program. Alternatively, a letter of reference regarding competence should come from the OT s supervisor at the institution where the applicant most recently practiced. Core privileges: Core privileges in occupational therapy include but are not limited to the following: - Test and evaluate clients for therapy and support needs - Evaluate home and job sites with adaptation recommendations - Plan, organize, and conduct occupational therapy programs designed to help clients regain physical or mental functioning or to adjust to their disabilities - Fabricate and fit client splints, braces, and other adaptive devices - Train clients on use of splints, braces, and other adaptive devices - Assess and record client activities and progress - Educate and counsel clients and families in regard to specific physical, mental, and/or developmental disabilities - Participate in the training of medical and nursing personnel in occupational therapy techniques, and objectives - Practice safety, environmental, and/or infection control methods Reappointment: Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided occupational therapy inpatient and consultative services for at least 50 patients annually over the reappointment cycle. In addition, continuing education related to occupational therapy should be required. I understand that by making this request I am bound by the applicable bylaws or policies of the hospital, and hereby stipulate that I meet the minimum threshold criteria for this request. Applicant s signature: Typed or printed name: Date: A supplement to Briefings on Credentialing 781/639-1872 12/04 7
Clinical Privilege White Papers Advisory Board James F. Callahan, DPA Executive vice president and CEO American Society of Addiction Medicine Chevy Chase, MD Sharon Fujikawa, PhD Clinical professor, Dept. of Neurology University of California, Irvine Medical Center Orange, CA John N. Kabalin, MD, FACS Urologist/Laser surgeon Scottsbluff Urology Associates Scottsbluff, NE Publisher/Vice President: Suzanne Perney sperney@hcpro.com Group Publisher: Kathryn Levesque klevesque@hcpro.com John E. Krettek Jr., MD, PhD Neurological surgeon Vice president for medical affairs Missouri Baptist Medical Center St. Louis, MO Michael R. Milner, MMS, PA-C Senior physician assistant consultant Phoenix Indian Medical Center Phoenix, AZ Senior Managing Editor: Edwin B. Niemeyer eniemeyer@comcast.net Beverly Pybus Senior consultant The Greeley Company Marblehead, MA Richard Sheff, MD Chair and Executive Director The Greeley Company, a division of HCPro, Inc. Marblehead, MA The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Copyright 2004 HCPro, Inc., Marblehead, MA 01945. 8 A supplement to Briefings on Credentialing 781/639-1872 12/04