An assessment of the impact of the Medicare Prospective Payment System on level II fieldwork.

The health care industry has undergone radical change because of the implementation of the Medicare Prospective Payment System (MPPS). This study is an assessment of the effect of MPPS on Level II fieldwork. Six factors that have the potential to influence fieldwork delivery patterns formed the basis of a questionnaire that was mailed to 23 occupational therapy directors in acute care Wisconsin hospitals. The 21 returned questionnaires were tallied by frequency of response and analyzed to ascertain current practice and changes resulting from MPPS. Findings indicate a strong commitment to professional and technical Level II fieldwork education. Departments reporting a decrease in staff were able to deflect the impact of the reductions by modifying their clinical education programs. Although changes were noted in all of the six identified categories, there was only minimal evidence that they were directly related to MPPS. Monitoring change during the 3rd and 4th year of the transition was recommended.