Improvements needed in communication between physicians, home health care workers
Nearly half of physicians reported spending less than a minute reviewing a care coordination form before certification, whereas one-fifth reported spending at least two minutes.
The majority of physicians reported spending very little time reviewing or acting on a plan of care for patients who receive Medicare skilled home health care services, according to a nationally representative random sample survey.
The survey was conducted to determine how physicians communicate with home care agencies and use the CMS-485 form, which is typically used for certification of home health plans of care and for interactions between home health care agencies and physicians. Researchers mailed the survey to physicians in the American Medical Association Physician Masterfile who specialized in family or general medicine (excluding adolescent and sports medicine), geriatrics, geriatric psychiatry, internal medicine, or hospice and palliative medicine about time spent reviewing the plan of care and communicating with skilled home health care services. Results were published online April 2 by Annals of Internal Medicine.
The survey response rate was 53%. Of 1,005 respondents who provided patient care, 72% had certified at least one plan of care in the past year. Nearly half (47%) reported spending less than one minute reviewing the CMS-485 form before certification, whereas 21% reported spending at least two minutes. Physicians typically interacted with home care agencies by fax or mail. About 80% rarely or never changed an order on the CMS-485, and 78.3% rarely or never contacted home care clinicians with questions about information. The mean reported ease of contacting the skilled home health care agency was 4.7 (SD, 2.3) on a scale of 1 (easy) to 10 (difficult).
Many of the respondents reported wanting to see changes to the existing mechanism of certification of skilled home health, and provided specific suggestions for enhancing the clinical usefulness of the CMS-485, including increasing the font, presenting orders in terse and clinically useful language for all types of health care clinicians, and highlighting the key clinical information.
“Pertinent clinical information is challenging to glean from the current CMS-485 format, and this speaks to the needs of busy physicians in the ambulatory setting who wish to interactively engage in monitoring and coordinating care of their vulnerable homebound patients receiving [skilled home health care],” the authors wrote.