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JAMA Viewpoint on Home Health Strikes a Chord

Posted 10/2/2013 Categories: healthcare reform, primary care, EMR, research, chronic care

A highly regarded colleague of mine, Dr. Steven Landers, who is the Visiting Nurse Association Health Group President & CEO, published a piece in the Journal of the American Medical Association (JAMA) last week that struck a chord with me, and I need to address three key points he made that I believe are critical to improving the healthcare system in America.

  1. The quantity and quality of research regarding Medicare’s home health program are limited.
  2. To further improve coordination, health information technology policy should address integration of home health records with medical records.
  3. Advanced practice nurses and physician assistants have made important contributions to primary care, and these professionals should be permitted to certify and oversee home health.

First, while it is true that research regarding Medicare’s home health program are limited, I don’t believe we should wait for CMS to conduct it. The leaders in our industry, Amedisys included, must begin to support objective research into the program’s efficacy and areas for improvement. Only then will we be able to prove the value of the skilled care we provide to millions of Americans each day. The Alliance for Home Health Quality and Innovation’s research initiatives are a positive step in that direction – we must continue to build a body of research that is valid and constructive.

Second, Dr. Landers could not be more right -- the lack of integration between EMRs and home health records poses a significant challenge. Our hospital partners are looking to us to help them transition their patients safely home after receiving acute care, but without a clean way to exchange information in real-time, improvements will lag behind. There must be a clear roadmap for how to do it and an incentive to make it work.

Last, but not least, as a physician who has practiced medicine for more than 30 years, I believe strongly that well-trained and qualified advanced practice nurses and physicians assistants are needed now, more than ever to join us in the care for the chronically ill at home. There is a shortage of primary care physicians that care for these elderly patients with chronic diseases. Working alongside these physicians, advanced practice nurses and physician assistants can help improve the communication, quality of care and outcomes of our shared patients if they were allowed to play a more meaningful role.

The time to prove the value of home healthcare is now. The time to make sure we’re a connected healthcare system that can exchange real-time information throughout the continuum is now. The time for collaboration across the spectrum of clinicians to make a difference in caring for our chronically ill population is now.

Well said, Dr. Landers. Thank you for your leadership on these issues. We hope your perspectives also hit home with the key regulators and policy makers we need on board to press forward.

About the Author

Michael Fleming, MD, FAAFP is the Chief Medical Officer for Amedisys, and Past President of the American Academy of Family Physicians and the Louisiana Academy of Family Physicians. Dr. Fleming has served as Speaker of the Congress of Delegates of the AAFP and as Board Chair of the AAFP Board of Directors. He serves as an assistant clinical professor in the Department of Family Medicine at the LSU Health Science Center and in the Department of Family and Community Medicine at Tulane University Medical School.
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Four Tips to Make Face-to-Face Documentation Easy

Posted 11/22/2011 Categories: home health, CMS, EMR, face-to-face, care plan oversight

Face-to-face requirements can be incorporated into your existing workflow with minimal disruption to your practice. Based on the recommendations of our physician consultants, here are four tips for efficiently handling CMS's new face-to-face requirements:

1. Jot in Your Progress Notes

When you see a patient you're referring to home health, jot down the face-to-face required information in your progress note or discharge summary, and just attach that to your referral. CMS even permits you to dictate your face-to-face encounter for your discharge manager or staff to document.

2. Save Time with Your EMR

If you have an EMR, save frequently used phrases to reduce the time spent typing. Saving the text you use over and over again for conditions that are common in your practice - like reason for homebound status - can save a lot of time. It's a lot faster to edit the text for a patient's individual needs than to start from scratch each time.

3. Let Your Staff Help

Your staff can compile the face-to-face documentation by extracting the required information from the patient's chart or your EMR. Have them attach this information to your 485 plans of care for your review and signature.

4. Bill for Certification of Home Health Services

Don't forget about the opportunity to bill for certification of home health services under G0180, which is available to compensate you for time spent approving your patient's plan of care.

Face-to-Face Quick ReferenceWe've put together a face-to-face quick reference card to help you document the CMS requirements efficiently. You can print it and keep it at your desk, or save it to your mobile device for convenient access.

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