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.
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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.
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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.
![](http://archives.lincolndailynews.com/2018/Apr/03/images/ads/current/Applegate_exc_sda_daily_030415.png)
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.
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