If you know what doctors want, why not give it?
Guidelines can help you avoid Medicare denials
If Freud had run a home care agency, surely his big question would have been, "What do doctors want, anyway?"
After all, as a hospital-affiliated agency, you should look at referring physicians as your internal customers. Understanding their needs makes sense. Moreover, working closely with physicians not only benefits your patients, but it also can help your agency avoid Medicare claims denials.
"A lack of physician involvement is one reason HCFA [the Health Care Financing Administration] decides visits are unnecessary," says Joanne G. Schwartzberg, MD, director of geriatric health for the American Medical Association in Chicago. "There often isn’t a doctor [in the agency] to say, Yes, the visits are medically necessary.’ An agency may have a medical advisory board, but there is no active physician presence."
Even if your agency doesn’t have an active medical director, you can still improve communications with your hospital’s referring physicians through a publication of the American Medical Association, titled "Physicians and Home Care: Guidelines for the Medical Management of the Home Care Patient."
More than 55,000 requests from the field
Published in booklet form in 1992, the guidelines are designed to encourage physician involvement in home care and to help them better understand their role in the delivery of medical care in the home. Endorsed by the American Academy of Home Care Physicians, the guidelines are not rigid standards; rather, they are recommendations developed from a consensus of home care professionals. Topics include the role of the physician, the physician-patient relationship, patients’ rights and responsibilities, coordination of care and case management, community resources, location of aging services and resources, and a general discussion of home care who needs it, what is involved, why it is necessary, when to start, and how to implement it.
Since its first printing in 1992, the booklet has been distributed to more than 55,000 providers, including home care agencies, hospitals, nursing homes, doctors, and managed care organizations, says Schwartzberg, a co-author of the booklet along with Sandra Lichty, PhD, and Joan Vatz, MD.
Schwartzberg says the goal of the publication is "to encourage physicians to be more comfortable about incorporating home health care into their practices for their most frail patients."
Home care providers can purchase copies ($3 apiece or $50 for a package of 25) to distribute to physicians.
Plans are to update the guidelines next year, Schwartzberg says, although she couldn’t disclose what new issues will be covered. "We will bring together a group of physicians as advisors to see if there are any new areas we need to consider. But I don’t know what those are yet. I’ve got some ideas myself, but I just can’t say until we meet."
The role of the home care physician
Presented in a concise, easy-to-read format, the guidelines say the doctor has a responsibility "to prescribe, in consultation with members of the home care team, a home care plan of treatment."
Such a role includes:
• management of medical problems;
• identification of the patient’s home care needs;
• establishment/approval of a treatment plan with identification of short- and long-term goals;
• evaluation of new, acute, or emergent medical problems based on information supplied by other team members (according to the guidelines, the team members are the patient, family, friends, caregivers, paraprofessionals, and professionals);
• provision for continuity of care to and from all settings (institution, home, and community);
• communication with the patient and other team members and with physician consultants;
• support for other team members;
• participation, as needed, in home care/ family conferences;
• reassessments of care plan, outcomes of care;
• documentation in appropriate medical records;
• provision for 24-hour on-call coverage by a physician.
Schwartzberg predicts that "the role of the medical director in home care agencies will increase in the future," a trend not lost on the American Academy of Home Care Physicians. "The AAHCP has developed a program for training physicians as medical directors of home care agencies," says Schwartzberg, "and it has been enormously popular."
Above all, Schwartzberg adds, "all this is to help the patient. We shouldn’t lose sight of that."
[Editor’s note: To order copies of "Physicians and Home Care, Guidelines for the Medical Management of the Home Care Patient," write the Department of Geriatric Health, American Medical Association, 515 North State St., Chicago, IL 60610. Telephone: (312) 464-5355. Cost is $3 for individual copies or $50 for packages of 25.]
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