Home Health & Hospice Week

Will your plan of care’s therapy components stand up to scrutiny?

Home care providers are strategizing about how they’ll handle the change to therapy reimbursement under PDGM. But there are still eight months to go until the new reimbursement system comes in, and agencies had better make sure their current therapy visits can withstand auditors’ focus.

Medicare policies have specific requirements for treatment plans that include therapy, HHH Medicare Administrative Contractor CGS reminds home health agencies in a recent article posted to its website. Among those are that the plan of care “must include measurable therapy treatment goals which pertain directly to the patient’s illness or injury, and the patient’s resultant impairments,” the MAC says.

Example #1: It’s not just physical therapy that needs measurable goals, CGS stresses. A valid occupational therapy goal could be “patient will be able to stand for 8 minutes with walker support to allow for effective clean-up of kitchen after meal preparation in 6 weeks,” CGS offers.

Example #2: For speech-language pathology, a valid goal could be “patient will utilize phonation at the phrase level with 80 percent accuracy for increased volume for speech production in 3 weeks,” CGS says.

Example #3: CGS does offer a PT example as well. “Patient will improve to greater than 25 on the Tinetti balance test to demonstrate lowered risk of falling in 4 weeks,” CGS says.

Bottom line: “Therapy should establish short- and long-term measurable therapy goals and the goals must contain an objectively measurable component with an achievement timeframe/date for each goal,” CGS instructs in the article.

The Home Health Section of the American Physical Therapy Association advises therapists to use the “well-known and widely used” SMART strategy for writing therapy goals. That means goals should be:

• Specific: Target a specific area for improvement
• Measurable: Quantify an indicator of progress
• Achievable: Can the measurable objective be achieved by the person?
• Relevant: Should it be done, why, and what will be the impact?
• Time-oriented: Specify when the result can be achieved.

“Establishing clearly defined, objective goals, is essential to support that the reasonable and necessary criteria have been met,” the APTA Home Health Section says in a goal-writing educational tool.

Note: The CGS article is at www.cgsmedicare.com/hhh/pubs/news/2019/0419/cope12171.html. See the APTA tool at www.homehealthsection.org/resource/collection/357286D6-53EC-4E46-8E1D-5­EF129CB5E2A/Goal-Writing_5-2017.pdf.