A recent study in the Annals of Internal Medicine shed some interesting light on, and evidence of what many in home health have always thought occurred but didn’t have tangible data to confirm. The study revolved around CMS Form 485, The Plan of Care (POC), commonly just referred to as the ‘485’ and how much the physician who signs the document understands it or spends time reviewing the information in it.
The survey conducted earlier this year was sent to almost 2,000 physicians who specialize in internal medicine, family / general practitioner-based practices, psychiatry, and hospice, end of life care. About half of those surveyed responded to the survey. Those that did respond have provided some very interesting insight.
72% of all respondents indicate they have certified at least one plan of care for home health. The big reveal comes with how long physicians spent with the document. Almost half, 47% of physicians, stated they spend less than 1 minute reviewing the plan of care for patients receiving services. Another 21% stated that they spend at least 2 minutes reviewing the POC.
The preferred method of communication by almost 80% of physicians surveyed was through mail or fax. It looks like the adoption and ability to use online portals has yet to catch on. From our own internal information, physicians rarely use the portals available for documentation purposes unless the physician is a medical director for a hospice.
The next set of data provides more understanding of how physicians perceive home health…80% of those who participated in the survey have never changed a home health plan of care. 78% of respondents have never reached out to an agency to seek clarification or to have questions answered. This ties into the fact that if a physician is spending less than a minute reviewing and signing a 485, then the time spent speaking with an agency is very minimal.
What does this all mean for your agency? Well it means that you still must write succinct, accurate, and easily understood plans of care for your patients. Agencies should remember, while the physicians might be rubber stamping documentation, you are ultimately responsible for the care provided to patients and for being in compliance at all times. Surveyors really don’t care that a doctor has only spent seconds signing a form; they want to make sure the agency is doing their job.
However, with the recent increases in home health and physician fraud, should this survey catch the eye of regulators, we could see some action taken towards making changes. The 485 has been updated with minor changes over the years, but has not been overhauled in a very long time. As many in home health know, usually with change things get worse not better, so the current system might be as good as it is going to get.
The full survey is available at the Annals of Medicine.