According to the updated home health Conditions of Participation (CoPs), qualifications and expectations of skilled professionals are grouped together and moved to Subpart B Patient Care. As is the theme of the home health CoPs, an emphasis has been placed on coordinated, patient-specific, outcome-based care, delivered safely by properly qualified professionals.
The skilled professional needs for home healthcare are defined as:
- Skilled Nursing (SN)
- Physical Therapy (PT)
- Speech-Language Pathology (S-LP)
- Occupational Therapy (OT)
- Medical Social Work (MSW)
- Physicians (in rare circumstances)
Revisions to the CoPs explicitly state that skilled professionals, whether employed directly by home health agencies (HHA) or by contracted services, are expected to provide consistent levels of care and coordination to patients they serve.
Patient-centered care includes the following skilled professional responsibilities:
- Ongoing interdisciplinary assessment of the patient;
- Development of patient-centered outcomes-focused Plans of Care;
- Counseling of the patient, caregiver, and family;
- Education of the patient and caregiver;
- Preparation of notes;
- Communication with all physicians involved in the patient’s Plan of Care;
- Participation in HHA-sponsored in-service training; and
- Participation in HHA’s Quality Assessment and Performance Improvement (QAPI) program.
The updated CoPs highlight the interdisciplinary team approach to providing safe, high-quality delivery of skilled healthcare services authorized and supervised only by qualified professionals. Emphasis has been placed on skilled professionals practicing in alignment with HHA policies and procedures and with state practice acts and federal regulations. Holding skilled professionals to high standards, regardless of employment status, is well stated in the comments section of the Federal Register Rule that finalized the CoPs.
Any professionals or owners who have “make a visit” mentalities, and apply “cookie cutter” plans of care and documentation will not survive the new CoPs. Skilled professionals should be trained on HHA policies, procedures and processes when hired, and periodically throughout employment. Bad habits and practices must be dealt with from an educational and disciplinary approach to avoid deficiencies and costly fines.
Like professionals who work in a single brick-and-mortar setting, skilled professionals working in the home health setting are held to a high uniform standard, which incorporates their professional skill set with state professional practice acts and agency-specific policies to deliver efficient, coordinated, safe and patient-centered care in the home. Agencies are now mandated to create an interdisciplinary team approach to care, modeled however the agency sees fit. For example, if an agency’s management team is familiar with the interdisciplinary approach used in hospice care, they may choose to similarly model the home health interdisciplinary team.
Agencies are encouraged to educate staff and clinicians on the new CoPs for skilled professional services. I also recommend that physician liaisons communicate with ordering physicians to ensure they are aware of the new CoPs and related needs for effective coordination of care. Maintaining open communication can help strengthen physician and referral relationships.
The home health professional is integral to delivering high quality and safe care in the home. The home health professional skill set includes efficient and accurate head-to-toe patient assessment skills, analytical thinking skills, problem-solving abilities, clinical proficiency, patience, effective listening, communication skills and basic technology skills.
Choosing a user-friendly platform for electronic medical documentation will help reduce the high level of stress and burnout experienced by many home health clinicians and allow them to focus on the patient’s needs and care. Quality technology affords HHAs the ability to comply with new standards in an efficient, cost-effective way. For example, the ability to quickly access patient information; search for names and one-touch dial phone numbers of the skilled-nurse team, physicians, caregivers and emergency contacts; document issues while simultaneously communicating with interdisciplinary care team members in HIPAA-compliant messages; and check for potential drug interactions, can all occur through an EMR app on a mobile device to provide efficient, safe and coordinated care.
With technology, HHAs can quickly and easily create truly patient-centered care plans.
To learn more about Axxess’ suite of home health software solutions, including our clinician-friendly mobile app for all mobile devices, and for additional complimentary training, including content regarding the newly revised home health CoPs, visit axxess.com.
