How to Sabotage a Home Health Agency or Hospice

Wanna bring your home health agency or hospice to it’s knees?  Just don’t file.  It’s that simple.  All the clinical training, strategic and financial planning, marketing efforts and recruiting success amount to nothing in an agency that doesn’t get documentation to the clinical record timely.  You may not believe me but I’ve seen it.   Here are just some of the ways that late filing can ruin you.

1. Surveyors may smile as you bring them notes that have been missing on a clinical record but they don’t really like to wait.  None of them told me this.  I just know.
2. Nurses and therapists, especially those on call, are just guessing at what should be done if care plans are not on charts.  Is that how you would like to be taken care of?
3. Medications errors are easy to accomplish when medication updates are not included in the clinical record.  Most patients don’t really mind taking the wrong medication until they are inadvertently given one that causes a serious reaction.  On the other hand, surveyors and state boards of nursing have been known to take exception.
4. It is virtually impossible to assess OASIS data when the visit notes aren’t in the record to support the data.  Agencies who do not assess OASIS data against clinical visit notes are in for an unpleasant surprise in ADR situations.
5. Hospices are unable to determine if certifications of terminal illness are signed within a 48 hour time frame if no one can find them.
6. No one is able to look at the notes in context and recommend changes to the care plan if the documentation isn’t all together in a clinical record.
7. There are state minimum standards about filing.  7 days is the limit in Louisiana.  That is non-negotiable.  State minimum standards are not suggestions.  Make no mistake.
8. Federal Medicare Home Health and Hospice Conditions of Participation are not mere suggestions, either.  How can you demonstrate compliance to coordination of care, clinical record, or OASIS CoPs if no one knows where to find case conference notes, clinical visit documentation or OASIS assessments?
9. Surveyors do not share their schedule with agencies – or for that matter, consultants.  I have emailed every surveying body I know of alert them that this policy is very inconvenient.  So far, no one has responded.  I will be sure to let you you know when that changes.
10. Complaint surveys happen all the time – even to good agencies.  Just because you do things right doesn’t mean that a disgruntled employee or angry family member won’t call and report you for something.  In my client base, most complaints are unfounded but that never stops the surveyor from finding other deficiencies unrelated to the original complaint.

I can think of a lot more.  However in totally destroying an agency, nothing is more efficient than poor patient outcomes, cash flow problems, bad surveys and Medicare denials.

Or if you aren’t in the mood to have your agency fail, just file.  It can be done by almost anyone with a working knowledge of the alphabet.  There’s even a little song to help you remember where the letters go.  It won’t solve all the problems in an agency but it will certainly be easier to identify the issues and correct them if all the paperwork is where it needs to be.