As anyone experienced in home healthcare can attest, often one of the most challenging aspects of the process of getting patients the care they need is getting physicians to sign off on the orders for home health care. CMS and most private insurers require patients to see a doctor and have a plan for home health certified before beginning to receive care at home, a requirement that has been up for discussion for some time now, in terms of which providers can actually sign off on the orders.

A new study from Johns Hopkins is likely to add fuel to that fire, and garner even more support for new rules allowing nurse practitioners, physicians assistants, and others to sign the orders, also known as CMS-485. According to a nationally representative study conducted by Johns Hopkins and published in the Annals of Medicine, about half of all providers spend less than one minute reviewing home health care plans. Only 21 percent noted that they spend more than two minutes looking at the plans. Given the lack of time spend reviewing plans, it begs the question of whether having physicians sign of on the plans is really accomplishing what it’s designed to do – and at least partially explains why communication and coordination between home health agencies and healthcare providers is often a significant issue.

Reporting the Results

The study, titled “Interactions Between Physicians and Skilled Home Health Care Agencies in the Certification of Medicare Beneficiaries’ Plans of Care: Results of a Nationally Representative Survey,” was published in early April. About 1,000 physicians from the American Medical Association Physician Masterfile specializing in family or general medicine (excluding adolescent and sports medicine), geriatrics, geriatric psychiatry, internal medicine, or hospice and palliative medicine, responded to the mailed survey. Among the key findings from the survey:

• 47 percent spend less than one minute reviewing CMS-485 plans
• 21 percent spent two or more minutes reviewing CMS-485 plans
• 80 percent rarely or never made changes to the CMS-485 prepared by home health agencies
• 78 percent never contacted home health agencies with questions or requests for more information about the plan.
• The majority of physicians use fax or mail to communicate with home health agencies
• Physicians rated the ease of contacting home health agencies an average of 4.7 on a scale of 1 to 10, with 10 being difficult to contact the agency.

The overall conclusion of the researchers is that the CMS-485 does not engage physicians, and does nothing to enhance communication between them and home health agencies. With so much at stake that depends on excellent care coordination between home health and physicians, clearly there is a need to improve in this area.

Why CMS-485 Isn’t Working

Based on the results of the survey, the researchers believe that much of the problem with CMS-485 isn’t necessarily the physician, but the form itself. CMS doesn’t require that agencies use the form, but most opt to in order to avoid potential problems if they were to be audited in the future. From a regulatory standpoint, it’s “safe,” as it’s issued by CMS and covers the key points that would come up during an audit.

However, from a functional standpoint, CMS-485 is really a “just the facts” document. It doesn’t typically provide information that could be used to improve care planning or foster more coordinated care, especially given that most doctors don’t make changes or question the information on the form. Therefore, in many ways, CMS-485 has become little more than a formality when it comes to getting patients the home health services they need. It’s important to note, though, that this particular study did not address physician-agency communication outside of certifying care plans, and many doctors report working with agencies after the care has begun.

Fixing the Problem

With the knowledge that the current protocol isn’t supporting communication and care coordination in the certification of home health plans, the Johns Hopkins researchers plan to conduct a follow up study to get the HHA perspective on care plans and communication with physicians. In the meantime, agencies can take steps now based on the feedback from providers in the survey to make it easier to coordinate care. Some of the ideas presented by physicians include:

• Improving the layout and readability of the care plan form to allow for more detail and an easier time reading it.
• Making it easier to contact the HHA with questions or concerns. Home healthcare software with a physician portal, for example, can help keep the lines of communication open while eliminating the need to rely on fax and mail.
• Redesigning the plan paperwork to include an easy-to-read summary with key information and actionable items.

The next survey is likely to take place this summer, with the results announced in early 2019. Until then, your agency can work on improving communication during the certification process and beyond by implementing some of the suggested improvements. To learn more about how Complia Health’s software products can help, click here.