Many doctors don’t pay attention to home health care plans

[April 03, 2018] By Lisa Rapaport

(Reuters Health) - Physicians charged with approving treatment plans for skilled home health care often spend no more than a minute reviewing the plans, a study of U.S. doctors suggests.

Researchers surveyed 1,005 physicians who specialize in geriatrics, family or general medicine, or hospice and palliative care. Overall, 720 respondents, or 72 percent, said they had certified at least one plan for skilled home health care in the previous year for a patient covered by Medicare, the U.S. health program for adults 65 and older.

Among the doctors who certified these plans, 47 percent spent less than one minute reviewing the paperwork before signing off on it, researchers report in the Annals of Internal Medicine. Only 21 percent of physicians reported spending two minutes or more.

"The process of care plan certification between skilled home health care and doctors was designed for regulation and payment by (Medicare), and does not appear to foster communication between doctors and the clinicians (nurses, physical therapists) going into patients’ homes," said lead study author Dr. Cynthia Boyd, a researcher at Johns Hopkins University in Baltimore.

Among other problems, care plans are difficult to read due to the font size and format of the report, Boyd said by email. Plus, the plans don’t emphasize the information that is most important for delivering high quality care to patients at home.

"Rather than suggesting physicians spend more time on the form, we think our findings suggest that innovations are needed to foster meaningful communication between skilled home health care and physicians that really helps patients," Boyd said.

Skilled home health care services may be ordered by physicians for homebound patients who need support from nurses, physical therapists or occupational therapists to manage daily tasks and recover from injuries or illnesses.

In 2014 alone, Medicare spent $17.7 billion on skilled home health care services for 3.4 million beneficiaries. One third of Medicare patients don’t receive any physician evaluation or management services during their episodes of skilled home health care.

Physicians typically interacted with multiple skilled home health care agencies by fax or mail, the current study found.

Approximately 80 percent of doctors said they never or only rarely changed an order for skilled home health care services, instead signing off on exactly what was detailed on the paperwork.

Roughly the same proportion of physicians - 78 percent - said they rarely if ever contacted skilled home health care teams to discuss the care plans.

Roughly three-fourths of doctors said the care plans could be improved by adding a brief, easy to read "must know" section with actionable clinical information. About one-third of the doctors also thought creating easier ways to contact skilled home health care staff would help.

Around one-fourth of the doctors also said a bigger font and better layout would make it easier for them to review the paperwork.

The study wasn’t a controlled experiment designed to prove whether or how the amount of time physicians spend reviewing these forms might influence the quality of patient care. Researchers also didn’t assess communications between doctors and home health care providers that might occur outside of the context of certifying care plans.

Still, the survey suggests that many doctors are giving these plans no more than a cursory review, and that there’s plenty of room to improve the process, Boyd said.

Under the current system, patients and families can also play a role in helping to ensure that home health care plans are complete, Boyd added.

"One key thing patients and families can do is to always have an accurate list of all medicines they are taking, and even the actual bottles, and to have this available whenever they are in communication with a health care professional, in person or over the phone," Boyd advised. "Speaking up about what is going well and what isn’t, with both medicines and their ability to care for themselves, to both physicians and the home health care professionals will help all team members ensure the care plan meets the patient’s needs."

SOURCE: http://bit.ly/2wYH0qu Annals of Internal Medicine, online April 2, 2018.

[© 2018 Thomson Reuters. All rights reserved.]

Copyright 2018 Reuters. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.  Thompson Reuters is solely responsible for this content.