“I am just starting a job in homecare next week and am embarrassed to ask this of my new co-workers. What do I do if I call a patient and then they do not answer me once I get to the door? I heard from a friend doing home PT in another state that some agencies pay for the time when visits are missed and others do not. What do you think?”
You are asking a couple of things in your questions. One is do agencies pay for missed visits. Some do and some don’t. We at HHSM urge clinicians to make a missed visit a last resort always- something like 1 in 60 visits is a target rate of acceptable visits to be truly missed.
In general, visits should be set-up so that if a rescheduling is absolutely necessary, it can be done within the same week so that the physician-ordered frequency is maintained. For instance, if you are doing 5 visits per day for a 25 visit week, be sure the Mondays and Tuesdays are booked for 5 or 6 visits per day. One common scheduling mistake is to “hold space open” for possible work early in the week. This sets you up to then not meet productivity (or earn your maximum amount if per visit pay) because missed visits are moved to later in the week.
Missing visits, whether you are compensated for them or not, is a sign that the patient may have compliance issues which you need to address. We never accept the “I’m too weak for therapy” excuse from patients. The patient and/or caregiver needs to be assured that your skills as the therapist will be used to modify the program to fit their needs and tolerance and that they may get worse without your intervention. You are a Doctor-ordered professional service – act like it – citing the example that they wouldn’t skip taking a medication that was prescribed, would they? The doctor feels the therapy will address their functional deficits caused by weakness and is, under Medicare, being deemed reasonable and necessary for their well-being.
The first question you ask is altogether a different one from a scheduling question. If you have arranged with the patient or caregiver to set up an appointment and when you arrive, get no answer at the door, you must act as if it were your own relative. What might have happened to the patient – could they be lying on the floor unable to get help? Could they have going to the ER or doctor in an emergent situation? First, call the home’s number from the driveway. Is the door secure? Let common sense guide you as you then check with the listed contact/POA on your referral to find out what is going on. If you are not able to reach someone, contact the local authorities to do a well-fare check. The fact that you had a pre-arranged time to meet warrants this and a worst-case-scenario must be avoided – this patient is under the care of your agency, and thus YOU. You need to follow this and act like it is an emergency situation – hoping all the while it is not.
“My agency recently posted our HOME HEALTH COMPARE scores from the Medicare website and though we’ve been focused on improving a couple of specific indicators, they didn’t change like I thought they would. How is that information gathered and reported?”
The OASIS data used to calculate the twelve quality measures is updated quarterly and represents a rolling 12 months of data. Administrative information (like name and address) is updated monthly, although it may take a couple of months for new information to be posted. Newly certified home health agencies may not appear in Home Health Compare for a year. This time lag helps to report the data and increases the number of patients that the agency can report on. The OASIS assessment data are also used to identify the service area of a home health agency in the HHC search function. Hang in there and keep focused on the work you are doing to make improvements – they will show up in time. As you may be aware, Medicare has a demonstration model now currently underway in 7 states that uses OBQI results for Pay for Performance standardization. Don’t lose sight that these publicly reported quality results are good objectification for success in the fiscal arena of the future but quality clinical care should remain the primary focus.
Teri N. Thompson and Arnie Cisneros are physical therapists with nearly 40 years of combined home care experience. Co-owners of Home Health Strategic Management in East Lansing, MI, they provide clinical service management and home care consulting expertise. They are nationally renowned speakers regarding the PPS refinements of 2008 and therapy utilization under the New Rule.