Happy Nurses’ Week to Home Care Nurses!

Dear readers, I want to send out a special thanks to all of the hardworking home care nurses in honor of National Nurses’ Week. Nursing is hard job, no matter what the setting, but home care nurses face the unique challenge of working in an environment where their accomplishments often go unrecognized: in the home.

A hospital nurse will take excellent care of a patient with a broken hip after a fall. A home care nurse will notice the hazardous throw rug in the patient’s kitchen and get rid of it before the patient trips over it, preventing the fall, the injury and the hospitalization from ever happening in the first place. We usually don’t take notice when terrible things don’t happen, and yet preventing hospitalizations saves millions of dollars, preserves families and keeps people out of institutions.

I’d say they should make a movie depicting what the world would be like without home care nurses–but it would be one scary movie.

Tell home care nurses that you appreciate them–this week and every week!

70,000 All-Time Views!

Sometime in the last 24 hours, our blog hit 70,000 all-time views. I want to take a moment to thank all of our faithful readers for making this blog a success. We are proud and humbled to be the resource you rely on for tips that help your home care agency succeed.

We’ve been posting on this blog only sporadically–for that we apologize. We’ll get back on track with regular posts and great content after our Annual Meeting.

We hope you’ll continue to read, and that we can count on your for 70,000 more!

 

Practitioners Liable for Failure to Follow Internal Policies and Procedures

Dear readers, here is another great article from Elizabeth Hogue! Be sure to read it carefully!

Practitioners are likely to be held liable if they fail to follow their own internal policies and procedures.  They may also be responsible if they do not enforce their policies and procedures or do not inform employees about their requirements.  This point is illustrated in the decision of the Court in Barkes v. River Park Hosp., Inc., No. M2006-01214-SC-R11-CV Tenn. October 20, 2010.

In this case, Wayne Barkes tilled his garden on the morning of July 26, 2000.  He then used an ax and other hand tools to clear and clean up his yard.  Mr. Barkes stopped working around noon and went into the house because his left arm was hurting.  He soaked his arm in water and applied an ice pack to it.  When the pain did not subside and Mr. Barkes began to feel worse, his wife drove him to the Hospital.  When the Barkes’ first arrived at the emergency room (ER), he was seen and triaged by a paramedic employed by the Hospital.  Mr. Barkes told the paramedic that he had pain in his left forearm and wrist.  Mrs. Barkes also told the paramedic that Mr. Barkes was nauseated.  Mr. Barkes’ vital signs were within normal range.

Mr. Barkes was then seen by a nurse practitioner (NP).  The NP diagnosed a sprain due to overuse.  She did not do a cardiac workup, including asking the patient if he was a smoker or if he had a family history of cardiac problems.  The NP then discussed her findings with a physician in the ER who agreed with her findings and signed the discharge papers.  Mr. Barkes was then discharged from the ER with instructions to take an over-the-counter pain reliever, to ice his forearm, and to rest his arm.  He was not seen or evaluated by a physician.

About two hours after leaving the ER with a diagnosis of sprain, Mr. Barkes collapsed.  Mrs. Barkes found him unconscious on the floor of their home.  He was transported back to the ER where he could not be resuscitated.  Mr. Barkes was pronounced dead of a myocardial infarction and sudden cardiac death.

Mrs. Barkes then sued a number of the providers involved, including the Hospital.  In her suit she claimed that care and treatment provided in the ER fell below the standard of reasonable care under the circumstances.  Specifically, Mrs. Barkes alleged that if Mr. Barkes had been triaged by a registered nurse instead of a paramedic and seen and examined by a physician instead of a nurse practitioner, as required by Hospital policies and procedures, Mr. Barkes would not have died.

The testimony of expert witnesses at trial supported Mrs. Barkes’ allegations.  The Court also agreed with Mrs. Barkes and stated:

Based on the material evidence presented at trial, the jury was entitled to draw the reasonable conclusion that the hospital’s failure to inform the emergency room health care providers of its policies and its failure to effectively implement a system of oversight and enforcement of its policies was negligence that caused Mr. Barkes’ death…

The “lesson” of this case for all types of practitioners is clear: Practitioners will be liable for failure to follow their own policies and procedures.  It does not matter whether the policies and procedures are outdated or need to be revised.  If it is written in providers’ policies and procedures, then providers must meet their requirements.  A crucial question, therefore, for practitioners when developing and revising internal policies and procedures is: Is this the standard to which we wish to be held?  If not, policies and procedures must be revised.

Practitioners have an opportunity to define a reasonable standard of care for themselves.  This opportunity should not be lost due to inattention to policies and procedures.

Coding tip of the week: Patient won’t take his meds!

Hello, dear readers. I’m sure you’ve all heard that ICD-10 has been pushed back by a year–it is supposed to roll out in October, 2014. But that won’t stop us from bringing you great coding tips! This tip is brought to you by Pathway Health Services.

Q: We have a patient who is refusing to take his medication. Is there a E code for him not taking his meds?

A: The only code for patient non compliance with meds is V15.81 (non compliance with medical treatment).  Be careful using this as CMS will cue in on it and it may detract for your skilled need with a reasonable rehab potential with patient compliance involved.  If it were up to me, I would not use that.

OASIS-C tip of the week: Is a discharge OASIS required?

Q: When a current patient has a payer change to Medicare, we have to discharge the old payer and do a new start of care with Medicare as the payer. Is a discharge OASIS required for the first admission? We aren’t really discharging the patient, only the payer.

A: If the initial payer is Medicare, Medicaid or Medicare Advantage, a discharge OASIS assessment would be required if the patient is being discharged for payment purposes. Agency policy may also require completion of OASIS assessments on non-Medicare, Medicaid or Medicare Advantage patients; although this is not a CMS requirement. Regardless of whether OASIS data elements are answered, a discharge comprehensive assessment is required on all patients in a Medicare-certified home health agency, regardless of payer source.

Home Care and Hoarding

Home care professionals are in a unique position. A physician can examine a patient and see physical manifestations of an illness, but a physician won’t see the patient’s surroundings. Home care workers, on the other hand, will go into the patient’s house and see what the patient’s environment looks like and how that environment might be impacting the patient’s health.

Hoarding affects an untold number of people, as it is a hidden problem that often goes undiscovered. A home care worker who is sent to the home of a hoarder might be the first person to discover the problem. But how can you tell the difference between a “hoard” and a disorganized space?

Here are a few signs to watch out for:

1. Belongings start blocking critical places needed for ADLs – sink, bathtub, doors, toilet

2. The patient refuses to let anyone into the house.

3. Rooms cannot be used for their intended functions because they are too cluttered.

When a Medicare Home Health Client requests discharge from the agency is a HHABN required?

Mondays are the hardest, don’t you agree, dear readers? Here’s hoping that this post makes your Monday a little easier. Brought to you by Pathway Health Services.

Q: When a Medicare Home Health Client requests discharge from the agency is a HHABN required?

A: The short answer to your question is NO; when the beneficiary chooses to discontinue home care, you do not have to initiate a HHABN, but you must document the changes in care and the reason the beneficiary discontinued home care in their discharge summary/medical record.

Day at the Capitol

I’m taking a break from blogging about OASIS and Coding to mention that today is NAHC’s day at the Capitol, and our Executive Director is in Washington working to show the world that home care is central to a more effective healthcare delivery model. See her in action here!

In addition, Minnesota Senator Amy Klobuchar took the stage to speak in support of home care. We are very proud and grateful that she was there!

Are you required to do annual performance reviews for therapists?

Dear readers, it’s the start of another week. Well, hopefully this will cure your Monday malaise. This tip is brought to you by Pathway Health Services.

Q: Do the PT/OT/ST evaluations need to be less than 365 days (same as the home health aides?)

A: An annual performance evaluation is required in the CoP’s for Home Health Aides.  An annual performance evaluation for therapists is NOT required in the CoP’s but ensuring their licensure and qualifications on an annual basis IS required.  It is also a requirement that you follow your human resource policy regarding performance appraisals for ALL staff.  Joint Commission standards strongly “recommend” the agency include and interrelate competency assessment to the annual performance evaluation.

Part 2 – Health Care Reform: Disclosure of Items Received by Physicians

Dear readers, we have received another great article from Elizabeth Hogue. Please read it and pass it along!

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule on December 27, 2011, that implements Section 6002 of the Affordable Care Act (ACA).  This proposed rule requires manufacturers of drugs, devices, and biological and medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) to report annually to the Secretary of the U.S.  Department of Health and Human Services (HHS) payments or transfers of value provided to physicians and teaching hospitals.  Information must be reported in an electronic format by March 3, 2013, and on the 90^th day of each calendar year thereafter.  The Secretary is required to publish information received from manufacturers on a public website.  The goal of this requirement is to provide greater transparency regarding payments and items given to physicians.

Manufacturers are required to report:

• Cash or cash equivalents;
• In-kind items or services;
• Stock, stock options, or any other ownership interests, dividends, profits, or other return on investment; and
• Any other form of payment determined by the Secretary.
• Specifically, manufacturers may be required to report:
• Consulting fees;
• Compensation for services other than consulting;
• Honoraria;
• Gifts;
• Entertainment;
• Food;
• Travel, including the specific destination;
• Education;
• Research;
• Charitable contributions;
• Royalties and licenses;
• Current or prospective ownership or investment interests;
• Direct compensation for serving as faculty or as a speaker for medical education programs;
• Grants; and
• Any other payments or transfers of value as defined by the Secretary.

If the regulations are finalized, manufacturers must report anything given to physicians exceeding $10.00 in value.  If the aggregate value of items under $10.00 exceeds $100.00 in any calendar year, however, then these items valued at less than $10.00 must also be reported.

Like the Stark law and regulations, the value of items, such as food, provided to a group practice will be attributed equally to each member of the group.  If, for example, there are four physicians in the group and lunch is provided that costs $100.00, then $25.00 of the cost of lunch will be attributed to each physician, whether or not the physician actually ate any of the lunch.

There are some exceptions to the requirements to report, including such things as product samples, education materials for patient use, in-kind items used for the provision of charity care, and stock dividends of publicly traded companies.

Why are these requirements important to post-acute providers?

Providers have observed that the “bar” for giving items to referral sources seems to be set by manufacturers, especially drug companies.  To the extent that reporting and the resulting transparency on a public website puts a damper on the practices of manufacturers, the “bar” for items of value is likely to change for all referral sources, including wound care practitioners.  Practitioners may ultimately be subject to similar requirements.

The climate with regard to items of value given to referral sources is undergoing rapid change. Manufacturers who provide such items and recipients must adjust to this new climate.

©2012 Elizabeth E. Hogue, Esq.  All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.