In this blog series, we’ll explore the most common survey deficiencies of skilled home health agencies as reported by the Accreditation Commission for Health Care (ACHC), one of three accrediting organizations for home health agencies (among others) with deemed status from CMS to assure compliance. As we all know, health care is highly regulated and agencies are subject to Florida laws as well as CMS regulations.
One of the top deficiencies reported is about the Plan of Care (POC), specifically, that there is a written POC for each patient accepted to services. Once the agency conducts the comprehensive assessment, the information obtained – in addition to orders from the medical practitioner, which must be received before care is provided to the patient – must be incorporated into the POC. The POC will contain specific treatment orders and measurable goals and objectives for the care that is to be provided with the purpose of the patient’s eventual discharge back to community-based care.
Honestly, we’ve never seen an agency that doesn’t have a POC for each patient. We have, though, seen issues with the quality of the information on the POC. Remember that it all has to tie together from the orders and assessment. Some issues we’ve encountered are missing frequencies for the services. The standard is that duration, frequency and amount of service has to be spelled out in the POC. Therapy services, in particular, must include the specific modalities and procedures that will be used. When your therapist completes his/her therapy assessment, make sure those modalities are explained so that you can include them in the POC.
Another issue concerns medications. First, they must all be listed and also, must match the medications on a medication profile. For the most part, agencies using electronic systems enter info into a medication section that then populates a med profile and POC, but we’ve seen differing doses and medication names so employ your eagle-eye to avoid any problems. PRN medications and treatments need parameters or indications (e.g., for pain, when systolic pressure is > X).
POCs are not one-size-fits-all documents although, admittedly, a good bit of templated language may be contained in each plan. However, this language must be appropriate for the conditions being treated and the care ordered by the provider. For example, many diabetic patients may have similar goals: to keep their blood sugars within a specified range, to adhere to a diabetic diet, to be able to administer their own insulin, etc.
The quality assurance aspect of reviewing admission documents can’t be overemphasized. Spend time on the front-end, reviewing admission information and making sure your POC is a good blueprint for the care that will be provided and that it meets all accrediting standards and CMS regulations.