2012 Conference Preview: Challenging the Home Health Therapy Myths and Assumptions

BY BETH LANDRY,
AEGIS AT HOME

Join Beth at conference for “The Future of Home Health Therapy” on July 25. Click here to check out session summaries in the conference brochure!

Competence, skill and expertise of therapists working in home health are often assumed.  Therapists have their license, so they should be competent and doing a great job with patients and for the agency, right?  Have you ever really challenged this assumption in your agency by asking the following questions:

  • Are therapists with years of home health experience the best?
  • Do all or even most therapists adequately understand Medicare and home home health regulations?
  • Is the therapy plan of care appropriate?
  • Does therapy consistently deliver skilled care on every visit?
  • Are the treatment interventions progressed effectively?
  • Does the agency clinical manager feel comfortable and demonstrate the ability in challenging therapists when appropriate?
  • Would therapy documentation withstand an audit?

First think about the myth that therapists with years of experience are the best.

Home health has changed a great deal from a regulatory perspective and from an expectation standpoint in recent years.  Therapists who have been in home health for many years sometimes do not have up to date knowledge. Or worse yet, sometimes they have been trained with erroneous information.

Next consider therapist knowledge of home health and Medicare regulations.  Therapists do not learn much about home health in school and there are very few clinical home health experiences available for students.   In many new hire situations, this is their first experience with Medicare much less Medicare in home health.  Terminology like episodes, re-certifications and OASIS is foreign to them.  Most therapists are bright and eager to learn, but the agency should not assume a therapist can speak knowledgably of home health.

Skilled care, treatment planning and progression in home health are vastly different from all other settings where therapists practice alongside others.  In an outpatient clinic, a hospital, or a skilled nursing facility, therapists discuss clinical and documentation challenges with their peers.  They learn treatment ideas.  In home health, therapists are isolated.  Sometimes they do not know the functional treatment interventions they can and should be providing in the home.  Therapists need coaching, modeling and interaction to provide the best possible clinical outcomes.

Ponder whether there is evidence of the agency clinical manager effectively challenging therapists.  Just like employees in every setting and industry imaginable, therapists need to be challenged to deliver the best possible outcomes for their patients and for the agency.

And finally, it is unwise to assume that documentation is defensible.  Sometimes the treatment and the lack of skilled care are not sufficient to withstand audit, and sometimes treatment is solid but the documentation of the visit is poor.  Often there is evidence of what the patient did in treatment but no evidence of the skilled analysis and modifications that the therapists should be providing.  The question is not how many therapy denials an agency has incurred.  The question is whether therapy documentation can withstand an intense audit.

Solid leadership of therapy is imperative in home health agencies to educate, guide, and hold therapists accountable.  Avoid assumptions and myths.  After all, we all know what happens when one assumes, correct?

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