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Johns Hopkins: Most Doctors Spend One Minute Reviewing Home Health Plans

April 3, 2018

Published by Home Health Care News
Amy Baxter

Many physicians only spend about one minute reviewing home health care plans, according to a new study from Johns Hopkins University researchers published in the Annals of Internal Medicine.

That revelation likely isn’t a shock to home health care providers that deal with getting physicians to sign off on care plans. Communication and care coordination are well-known struggles for both sides.

While physicians are required to certify a plan of care for patients who receive Medicare skilled home health care services, the amount of time they actually spend reviewing the paperwork reveals that the current communication streams are lacking quality.

“Our data suggest that the significant majority of physicians spend little time reviewing the plan of care developed by the home health agencies,” Bruce Leff, director of The Center for Transformative Geriatric Research and a professor of medicine at Johns Hopkins, told Home Health Care News.

Part of the problem with the communication is simply the format that the plan of care typically takes. The form, commonly known as the CMS-485, is “not useful or conducive to communicating useful information that could be better used to foster care coordination and care planning,” according to Leff.

Of more than 1,000 respondents in the study, 72% of participants — which included physicians specializing in family or general medicine, geriatrics, geriatric psychiatry, internal medicine, or hospice and palliative medicine — had certified at least one plan of care in the past year.

Nearly half, 47%, said they spent less than one minute reviewing the CMS-485 form before certification; 21% said they spent at least two minutes reviewing the form before certification.

However, most home health care agencies stick with the format because it isn’t likely to lead them astray in terms of an audit later on.

“It’s only a suggestion from CMS, but most agencies use that format because they know that it is a completely safe format to use from a regulatory standpoint,” Leff said.

Once the plan of care is certified, it is also rarely changed. About 80% of respondents said they rarely or never changed an order on the CMS-485, and 78.3% rarely or never contacted the home health care clinicians with questions.

After finding just how little time physicians spend on care plans and communicating with home health care agencies, researchers are planning to look at the issue from the perspective of home health care providers, with a grant from the Alliance for Home Health Quality & Innovation.

“A key thing in the home health care space is to figure out how to [improve] communication, with the majority being agencies that are not integrated with primary care,” Cynthia Boyd, professor at the Johns Hopkins Bloomberg School of Public Health and lead research author, told HHCN. “Addressing it is really important.”

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