Home Health & Hospice

Customize Care to Meet the Patient's Needs

Homecare Insider, August 16, 2010

Everyday, clinicians confront tough questions, those that require knowledge of certification, payment, and documentation requirements.  Here’s an example.
With the push toward best practices, do you think it’s a good idea to establish visit patterns for the initial certification period?  Our agency is considering a pattern with minimum visits of three a week for the first three weeks.  This would be for our patients subject to the OASIS requirements to ensure that we follow through on implementing all the evidence-based practices (EBP).

Two important points apply to this question.  First, there is no regulatory mandate for an agency to change its processes to incorporate the EBP in OASIS-C.  The agency must decide what is best for its patients.  Not every EBP will apply to all patients.  Staff must customize the care to meet each patient’s needs.

Second, the plan of care must be individualized to meet the patient’s specific needs.  That includes the frequency and duration of visits.  If the same language or frequencies appear on too many plans, it appears that the agency is using canned language.  This can have some serious repercussions.  From a payment perspective, not every patient requires that many visits, so the agency may be encouraging overutilization.  Some patients may need more and then this frequency would not meet their needs.

The issue of canned frequencies has come up in some fraud investigations.  Reviewers believe that the agency is inappropriately utilizing services when it instructs staff to enter the same frequency on all plans without regard to the patients’ situation.  The services do not match the patients’ requirements.  The frequency of visits must be reasonable and necessary to meet each patient’s needs.
An agency must teach staff how to assess and identify patient needs and then customize a plan and visit frequency that will work for the patient.  Remember that the frequency and duration of visits written on the plan of care is the first best guess at the services the agency will provide to help the patient achieve goals of care.  It is not always the final plan.  Within that visit framework, staff can carry through on EBP applicable to the patient.  Throughout care delivery, assess the patient’s condition and response, communicate with the physician, and modify the plan accordingly.

Beacon Health’s Agency Reference Set provides the resources to answer tough questions like this one.  Learn how these three manuals, the Beacon Guide to Medicare Service Delivery, the Conditions of Participation and Interpretive Guidelines, and the “485” Primer and Elements of Content can help.  For information, click on — http://www.beaconhealth.org/cgi-bin/ccp51/cp-app.cgi?pg=prod&ref=pkBARS2.