Are You A Gambler? Are You Willing To Take Vegas Risk With Clinical Documentation Or Realize Less Can Be A Whole Lot More!
Kenyon HomeCare Consulting • March 3, 2021
Let’s think about how documentation has changed over the years in the home health and hospice industry. Many of us remember a one page flow sheet with a small narrative on back where we described exactly what we did in that visit and how the patient/caregiver responded to teaching. We documented things that weren’t “normal” for the patient. Today, our documentation looks a whole lot different and the question is what we gained.
What We Gained:
Access to a whole lot of information is the answer. The introduction to the electronic medical record allows easy access to vast amounts of information at our fingertips. Nurses and therapists can access scanned in documents from the hospital and see all the data from any previous visits. The changes to the care plan can be made immediately and physician’s orders are generated from the visits. There is no waiting to get back to the office to handwrite an order that was taken. You don’t have to wait and fax something off to the doc when you have direct access in software. Supervisors write direct messages to staff about visits while they are being made. These are all positives for use of the technology in providing services.
When More Clinical Documentation Isn’t Better:
Here’s the rub. Now, our care plans are standard. We don’t see a whole lot of variance between those patients who have the same diagnosis. While we would expect some things to mirror each other, there is also a lack of seeing the individuality in the patient’s situation. The same rings true for the documentation. There is so much documentation, that clinicians don’t have the time to truly review previous visits. There is a lot of repeat teaching that results in care plans where specific interventions were never addressed. Meanwhile, we write all goals met on a discharge summary when we never checked to make sure all goals were met. The patient may still need to be discharged, but often we take credit for things not documented.
We also have seen a decline in the clinical note. The clinical note used to be the meat and potatoes of the visit. Any clinician could easily see what was happening with the patient with a clear and concise clinical note including what the plan for the next visit should be. Now, most items which were part of a clinical note are buried in different sections of the assessment. In our efforts to be more thorough, we are documenting a whole lot more while saying less. It is often so cumbersome, that the meat and potatoes end up missing. If you question this premise, then talk to your MACs about the findings of auditing. How many therapy visits were historically denied prior to PDGM? What nursing visits have 6 pages of documentation without clearly showing the clinical need or skill? The answer is a lot and this is why we see states in Review Choice and high denial rates. It’s because the data shows it just isn’t there. Without streamlining your documentation and making sense of what needs documented and where, you might as well be sitting at a blackjack table.
Let Kenyon Homecare Consulting Help With Documentation:
At Kenyon Homecare Consulting, we focus high quality, patient-centered care. This includes Oasis and documentation training. If you would like to streamline your documentation efforts to improve efficiency and accuracy, call us at 206-721-5091 or contact us online to see how we can help you minimize risk and improve documentation efficiency. Register today for our free webinar February 3rd, Unified Care Planning in 2021 and why it should be your best friend moving forward.it and delete this default text and start typing your own or paste your own from a different source.
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Today, this article will look at little different than out typical articles. We all know the costs of losing employees and trying to hire and train new ones. It is exhausting and expensive. So, we think about our wages and benefit packages all the time. What can we do differently that makes people stay? We can’t change the job and we don’t want to keep people that don’t like the work itself. So, how do we acknowledge employees in a way that is valuable to them and that our businesses can afford to do? 5 Things To Consider About Employee Recognition At Your Christmas Party: 1. Years of Service: These can be based on milestone work anniversaries (5, 10, 15 yrs, etc.). If a person has been at your agency 11 years, you pull them up and acknowledge them in the group of employees who have been there at least 10 years up until the time they hit the 15 years landmark. This way longevity is recognized yearly. 2. Special Employee awards: Now, this may be difficult if your staff is very small, but acknowledge the employee who has gone the extra mile in the job they do. Tell the story. The employee needs to know when the employer is proud of the work that has been done. Consider a plaque or certificate. Don’t minimize the value of the employee having them to display. 3. Acknowledge all employees in the mix: Because we are a clinical industry, the administrative staff is often overlooked on day-to-day operations. Ultimately, don’t miss the chance to acknowledge the employee who was able to catch billing errors or collect on a large account. Staff doesn’t like to hear about money, but those types of collections keep Christmas bonuses in place! So, make sure the other staff knows the accomplishments of the finance department or the office manager that every caller loves to speak to. Don't ever forget the IT staff that is on call more than any clinical person in your agency! 4. Letters from the administration: Add a personal note to your staff either collectively or individually depending on the size of your agency. If you are larger, there are employees you don’t often see or get to talk to on a regular basis, so take the time so send a note with that Christmas bonus. 5. Consider the Christmas bonus: Listen, some of you can afford to do substantial monetary bonuses and that is fantastic. However, if you are not in that position, consider something in its place. Maybe small gas cards go with the letter from administration. With the cost of groceries, consider something that helps with the costs of daily living for employees. Big box gift cards in your area will always be used. You may do a lot of these things on a yearly basis to employees. All this being said, it doesn’t mean there aren’t reasons for acknowledgement throughout the year. However, your annual Christmas party is a good way to do it collectively. Between your annual party, write the individual cards to employees when you hear a patient interaction worthy of praise. Or, maybe you buy a gas card for the employee who has picked up extra shifts and always shows up on time. Ultimately, employees will feel valued. You will not regret the time, effort, and energy put into these efforts. Merry Christmas! If you want help with recruitment and retention strategies for your agency, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online today.
When you think in practical terms, what does your ICD 10 coding mean to the clinicians in your agency? It probably isn't as important as you would like. Realistically, your nursing staff cares about hands on patient care. If you want the code itself to be more meaningful, then you need to attach the concepts of patient care to the ICD coding. You may think the code itself goes hand-in-hand with the care, but this is not always true. As a clinician, there are concepts within the nursing care plan that are automatic and some that are instinctual based upon the body system causing the need for care. It's a given that medication, diet, and disease process teaching are going to be in the care plan (or should be). When you get to disease process, our experience shows the clinician doesn't always run deep into the specifics of the disease when it could lead to valuable interventions being included in care. For example, when clinicians do a care plan related to cardiac disease, are the interventions very broad to include all things related to any type of cardiac disease? If you have a patient with right sided heart failure versus left sided heart failure, how many nurses would assess the patient differently? Would your nurses change the frame of mind to look for distended neck veins or anorexia and nausea if the patient had right sided failure? Would they be in the head space of considering whether the patient's appetite changes are more about just having been in the hospital than about potential venous stasis in the abdomen? The point is that although there are certain interventions that would be the same regardless the type of heart failure, picking up on different symptoms and critically thinking through the cause is often missing in the hustle and bustle of the day-to-day. This is not a judgment on the capabilities of the nurses but more about how our nurses are trained to consider care planning and assessment. We have people for ICD 10 coding now. Most nurses are not in the ICD coding manual looking up their own codes anymore because of the specificity that wasn't the same 25 years ago. So, the nurses go out with an H&P from the hospital or doctors office and develop a care plan. It isn't necessarily with the coding in mind. So, we need to get back to basics when it comes to coding and clinical care. We need to train out staff to look harder at the coding. Our coding departments need to have open communication with clinicians and understand the concepts of care planning to understand if things are missing in the care plans. What about your clinical manager's role? Are these things considered when reviewing care plans? What about your record review process? Are your ICD 10 coders nurses that understand care planning and is it part of the coding process to review the care plan? These are things to consider when you look at your clinical practice as well as your coding solution. At Kenyon Homecare Consulting , we have a comprehensive ICD 10 coding department that can provide education to clinicians, accurate ICD 10 coding, care plan and Oasis review. Call us at 206-721-5091 or contact us online to see if we can help you merge the code with the clinical practice in a way to improve your outcomes and your bottom line. We will offer 5 free recodes to any agency that would like us to check the efficacy of their current coding system or talk about becoming your coding solution.