Home Care Therapy: Quality, Documentation and Reimbursement - a Handbook for Physical Therapists, Speech-Language Pathologists, and Occupational Therapists / Edition 1

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Editorial Reviews

Doody's Review Service
Reviewer: Lynn N. McKinnis, PT, OCS (Concordia Care Home Health Agency)
Description: This comprehensive, information-packed handbook is a concise examination of all the aspects of home care therapy promised in the title. The editors, an RN and a PT, each well-accomplished in this field, have expertly brought together all the components necessary to demonstrate how to best provide services to the homebound patient within the present parameters of the healthcare system.
Purpose: The editors' goal is to provide information and resources to enhance the coordination, appropriate utilization, and quality of therapy provided to patients in their homes.
Audience: This book is written for all members of the rehabilitation team, and is not discipline-specific. This does not detract from the value of the book— it is, in fact, its strong point. Only when each member of the rehabilitation team understands the other's role and what each has to offer can early identification of patient needs and cost-effective services be provided.
Features: The book is divided into ten parts. In the first part, the "big picture" of what home care is and how it exists is presented with an overview of the reimbursement, clinical, and operational issues of any home care agency. Part Two is brief, but useful insight to two specialty areas of practice — pediatrics and hospice — is provided. In Part Three the roles of the PT, OT, and SLP are specifically defined, including up-to-date information from each discipline's professional associations' standards of care and guidelines to practice. Assessment tools, interventions, and specialized services of each discipline are outlined. In Part Four the process of obtaining accurate assessments and evaluations of the patient is emphasized. This information serves as the foundation for all care planning and outcome achievement. The correct completion of HCFA Form 485, which encompasses the above, is explained in detail. Part Five is devoted to explaining the role of the OASIS document as used at present. It is well illustrated via a patient case scenario with a correcponding HCFA Form 485 and a corresponding OASIS. Part Six is comprised of numerous specific care guides that help identify the patient's rehabilitation needs. The care guides chosen represent the holistic approach that is evident throughout the book. Correlation of OASIS items are identified where applicable, and this further enhances familiarity with the OASIS tool. Parts Seven through Ten contain information that can be found elsewhere, but their inclusion here makes this book a good singular reference source to keep handy at all times. Included are equipment considerations, wheelchair prescription assessment, personnel job descriptions, competency tools, entire reprints of HCFA's "Coverage of Services" Section for Therapists and "Correct Completion the HCFA Form 485, therapy abbreviation lists, glossary, state licensing board addresses, and a directory of educational resources for clinicians. A minor criticism is the difficult-to-read table of contents, but a detailed index is provided and proves helpful. The small trim size of the book makes it handy to travel along with the clinician, but results in information-crammed pages. Thumbnail border markings would be a helpful addition on future editions.
Assessment: As a veteran PT but a novice to home care, I strongly recommend this book to PTs, OTs, SLPs, RNs, and their specialized assistants on the care team, no matter what their level of experience. The editors are to be congratulated for presenting an excellent cross-discipline learning and teaching resource that will strengthen the home health team and enhance the quality of patient care.
Lynn N. McKinnis
This comprehensive, information-packed handbook is a concise examination of all the aspects of home care therapy promised in the title. The editors, an RN and a PT, each well-accomplished in this field, have expertly brought together all the components necessary to demonstrate how to best provide services to the homebound patient within the present parameters of the healthcare system. The editors' goal is to provide information and resources to enhance the coordination, appropriate utilization, and quality of therapy provided to patients in their homes. This book is written for all members of the rehabilitation team, and is not discipline-specific. This does not detract from the value of the book-- it is, in fact, its strong point. Only when each member of the rehabilitation team understands the other's role and what each has to offer can early identification of patient needs and cost-effective services be provided. The book is divided into ten parts. In the first part, the "big picture" of what home care is and how it exists is presented with an overview of the reimbursement, clinical, and operational issues of any home care agency. Part Two is brief, but useful insight to two specialty areas of practice -- pediatrics and hospice -- is provided. In Part Three the roles of the PT, 0T, and SLP are specifically defined, including up-to-date information from each discipline's professional associations' standards of care and guidelines to practice. Assessment tools, interventions, and specialized services of each discipline are outlined. In Part Four the process of obtaining accurate assessments and evaluations of the patient is emphasized. This information serves as the foundationfor all care planning and outcome achievement. The correct completion of HCFA Form 485, which encompasses the above, is explained in detail. Part Five is devoted to explaining the role of the OASIS document as used at present. It is well illustrated via a patient case scenario with a correcponding HCFA Form 485 and a corresponding OASIS. Part Six is comprised of numerous specific care guides that help identify the patient's rehabilitation needs. The care guides chosen represent the holistic approach that is evident throughout the book. Correlation of OASIS items are identified where applicable, and this further enhances familiarity with the OASIS tool. Parts Seven through Ten contain information that can be found elsewhere, but their inclusion here makes this book a good singular reference source to keep handy at all times. Included are equipment considerations, wheelchair prescription assessment, personnel job descriptions, competency tools, entire reprints of HCFA's "Coverage of Services" Section for Therapists and "Correct Completion the HCFA Form 485, therapy abbreviation lists, glossary, state licensing board addresses, and a directory of educational resources for clinicians. A minor criticism is the difficult-to-read table of contents, but a detailed index is provided and proves helpful. The small trim size of the book makes it handy to travel along with the clinician, but results in information-crammed pages. Thumbnail border markings would be a helpful addition on future editions. As a veteran PT but a novice to home care, I strongly recommend this book to PTs, 0Ts, SLPs, RNs, and their specialized assistants on the care team, no matter what their level of experience. The editors are to be congratulated for presenting an excellent cross-discipline learning and teaching resource that will strengthen the home health team and enhance the quality of patient care.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780964780125
  • Publisher: Marrelli & Associates, Incorporated
  • Publication date: 6/28/1999
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 457
  • Product dimensions: 5.03 (w) x 7.00 (h) x 1.03 (d)

Table of Contents

Acknowledgements iii
Reviewers iv
Preface vi
Guidelines for Use xiii
About the Authors xviii
Part 1 Home Care: An Introduction 1
Home Care: A Working Definition 1
The Big Picture: Four Domains 3
Domain 1 The Reimbursement and Payer Domain 5
Medicare: An Update 5
Home Health Care: Last Vestige of Cost-Based Reimbursement 6
OASIS: Home Care's Newest Regulatory Requirement 7
Medicare: Undergoing Significant Change 8
Medicare Part A 9
Medicare Part B 11
Medicare Changes Pursuant to the BBA of 1997 11
Medicare Risk Health Maintenance Organization (HMO) Programs 13
Compliance: Everyone's Role 13
Strategies for Organizations to Ensure Ongoing Compliance 13
Documentation to Support Covered Care 14
Medicare Requirements for Home Care 15
Homebound: A Major Qualifying Criteria 15
Homebound: Patient Example - Mrs. Smith 16
Roles of Effective Documentation 18
Documentation: An Overview 19
The Important Role of Documentation: A Checklist Approach 20
The Care Process: Assessment and Documentation 21
The Care Process: Intervention and Documentation 21
Documentation Problems: Common Reasons for Payment Denials 22
General Medical Review Problems (or What to Avoid) 23
Specific Therapy Problems 23
Summary 24
Domain 2 The Customer Service and Quality Imperatives 25
Quality 101: An Overview 26
Competency Assessment: Foundation for Excellence 26
Data Management: Increasing Focus 32
Customer Service 33
Who is the Customer? 35
Summary 36
Domain 3 The Patient's Environment of Care: Home (Or the Reason Home Care is So Unique) 37
Patient Example: The Setting Negatively Impacting Care Goals 37
Environmental Safety Considerations: Identifying At-Risk Patients 39
Medical Social Services: Important Role 40
Services of the Medical Social Worker 41
Summary 42
Domain 4 Patient Care Planning and Related Processes 43
Skilled Therapy: The Basic Rules 43
Coverage Versus Scope of Practice Dilemma 45
Physical Therapy Services in Home Care 45
Speech-Language Pathology Services in Home Care 46
Dietitian Services in Home Care 50
Occupational Therapy Services in Home Care 50
Occupational Therapy Coverage: Special Considerations 50
The Role of the Therapist as Case Manager 56
Sources of Data Needed for Holistic Case Management 56
"Therapy Only" Case Considerations 57
Patient Example: Identifying Other Patient Needs 57
Medicare Skilled Nursing Services 58
Managing the Patient's Care: The Care Process 59
11 Patient-Directed Roles of the Effective Case Manager 64
The Case Manager's Role as Supervisor and Educator 65
Home Health Aide Services: Making the Difference for Patients 65
Medicare and Home Health Aide Services 66
Home Health Aide Supervisory Visits: The Law 67
Other Supervisory Activities 67
Team Communications and Care Coordination: Keys to Success 69
Examples of Effective Care Coordination 69
Summary 70
Part 2 Specialty Therapy Practices 71
Pediatries and Therapy: Making A Difference in Young Lives 71
Children Seen in Home Care Therapy Practice 71
ICD-9 Codes for Pediatric Therapy 71
Infection Control and Safety in Children: The Drool Factor 73
Children are Different: 12 Tips for Success 73
Summary 84
Home Hospice Care and the Therapist: Efforts Directed Toward Comfort and Safety 85
Hospice Care: An Introduction 85
Why (or Why Not) Hospice 86
Mr. Walker - A Patient Example 87
Differences: A Review of the Intents of the Programs and Definitions 89
Similarities in the Intersection of the Two Spheres 89
For Both Programs the Quality and Customer Services Imperatives 92
Palliative Care 93
Therapy Coverage and Care Planning Considerations: A Case Study 93
Documentation Problems to Avoid 95
Summary 95
Part 3 The Rehabilitation Team: The Big Picture 96
Practice Standards, Guidelines, and Considerations for PT, SLP and OT from the National Professional Associations 96
Physical Therapy Services 96
Speech-Language Pathology Services 123
Occupational Therapy Services 136
Part 4 Assessment: The Process 154
Referral 154
Scheduling the Assessment 155
The Assessment Visit 155
"Therapy-Only" Case Admissions: Operational Challenge 162
The HCFA Form 485 163
Completing The HCFA Form 485 - A Patient Example: Mrs. Nicholas 169
Assessment Findings 169
Changes to the Conditions of Participation: Impact on the Home Care Admission 170
Patient Outcomes 172
The Comprehensive Assessment: Identifying Patient Needs and Facilitating Outcomes Measurement 174
The Initial Assessment Visit: Timely Initiation of Services 174
Completion of the Comprehensive Assessment 176
The Drug Regimen Review: Models for Meeting Regulatory Intent 176
Updates to the Comprehensive Assessment: Ongoing Assessment and Data Collection 177
Summary 178
Part 5 OASIS: Quality, Reimbursement, and Documentation Considerations With Sample Forms 179
Outcome-Based Quality Improvement: The Big Picture 179
OASIS: Linking Quality and Reimbursement 180
OASIS: The Newest Documentation and Quality Requirement 180
Rules for OASIS Data Collection 181
Documenting the Comprehensive Assessment and OASIS Data Collection - Patient Example Revisited 189
Intent of OASIS Data Collection 205
Competency Assessment: Key to Success for OASIS 206
Summary 214
Part 6 Therapy Care Guides: Focus on Function 215
General Care Guide Summary 217
Specific Functional Care Guides 224
Ambulation 224
Bathing-Tub/Shower Transfers 227
Bed Mobility 230
Car Transfers 233
Dressing 236
Eating/Self-Feeding 239
Emergency Response Needs 242
Functional Communication 245
Grooming 248
Homemaking 251
Kitchen Functioning 255
Laundry 258
Medication Management 261
Money Management 264
Pain Management 267
Toileting 270
Transfers 273
Wheelchair Function 277
Part 7 Optimizing Home Safety 281
Equipment Considerations: Assistive and Adaptive Devices 281
Gait Considerations 281
Bathroom Equipment 283
Equipment for Self-Care 285
Wheelchair Assessment 288
A Home Safety Program: Guidelines and Assessment 291
Part 8 Human Resource Management 294
Competence Assessment 294
Scope of Competency Program 297
Physical Therapist Competence Review/Evaluation Form 299
Speech-Language Pathologist Competence Review/Evaluation Form 301
Occupational Therapist Competence Review/Evaluation Form 303
Job Description Examples 305
Part 9 Medicare Home Health Agency Manual (HCFA Pub.-11) 312
Coverage of Services for Skilled Therapy 312
Completion of the Plan of Care (HCFA Form 485) 319
Part 10 Resources 348
Abbreviation List 348
Glossary of Terms 354
State Licensing Information 382
Directory of Resources 393
Appendix A OASIS (B-1) 416
Appendix B Federal Register: Mandatory Use, Collection, Encoding, and Transmission of Outcomes and Assessment Information Set (OASIS) for Home Health Agencies 435
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