Home Health & Hospice

Is Therapy ’Necessary’?

Homecare Insider, December 7, 2015

Editor’s note: This week’s Inside Story was adapted from one of HCPro’s best-selling home health & hospice titles, The Post-Acute Care Guide to Maintenance Therapy. This guide contains both regulatory information and analysis as well as hands-on, practical advice for care and documentation. Expert authors Cindy Krafft PT, MS and Diana L. Kornetti, PT, MA provide guidance specific to each post-acute care setting, along with tips from consultants, tools from the Center of Medicare Advocacy, and information from CMS. The guide is packed with downloadable materials, and sample forms and worksheets for easy comprehension of information. Order your copy or get more information here.

Current documentation appears to rely heavily on defining the impairments and limitations that the patient has as the driving reason to provide skilled care. Clearly, therapy would not be warranted when there are no issues to address, but the presence of a measureable, tangible problem does not mean it is warranted. “Necessary” is best understood using a synonym—“indispensable.” The result achieved, whether it was improvement or stabilization, would not have happened without the interventions provided. It may have never happened or would have taken a much longer time, or if a therapist had not been part of the plan, it would have put the patient and/or caregiver at risk.

The skill of the therapist is not simply defining limitations that exist. For example, the therapist may say that the patient requires moderate assistance to complete the toilet transfer. That sounds important, but the patient’s daughter could have told you she has to help the patient get up from the toilet. Just using the term “moderate” is not what reflects expertise. The skill is invoked when the therapist seeks to determine why this assistance is needed and develops a plan to address it. The possible contributing factors include, but are not limited to, strength, balance, vision, pain, cognition, environment, fear, and motor planning. Many times, there is more than one reason assistance is needed, which makes every plan of care different and specific to the patient situation.