Eli's Rehab Report

Don't let a physician's rush leave your records lacking.

Question: Our inpatient hospital rehab facility recently hired a new therapist who says we should not treat patients unless we have a signed physician order that specifically states "treat." Our policy is to begin treatment when we receive a physician's request for a consultation. Is our policy incorrect? Should we force physicians to specify whether they want us to begin treatment?

Answer: "Yes, in the acute care setting, you need the physician's signed order for treatment before you initiate care," says Darlene D'Altorio-Jones, PT, MBA-HCM, a strategist in Rehabilitation Management for MediServe.

The Centers for Medicare & Medicaid Services' conditions of participation clearly state: "Services must be given in accordance with orders of practitioners who are authorized by the medical staff to order the services" (42 CFR 482.56[b]), D'Altorio-Jones points out. Further, you need to incorporate the order in the patient's record, she notes.

Problem: Many physicians have begun writing only "consult" or "eval" on therapy plans of care.

Keyword: "If a doctor orders only an evaluation or only a consultation, therapists still need an order for treatment," D'Altorio-Jones says. That one word is your signal to initiate care -- whether it's "treat" or "treatment" or "eval and treat." Without the keyword, you're out of compliance with the conditions of participation for an acute hospital stay.

Take the headache out of re-educating physicians by updating your evaluation forms to include a check box for treatment followed by a signature line, suggests Colette Fellows, OT, supervisor at Cooley Dickinson Hospital in Northampton, Mass. "We use 'sign here' stickers to help remind docs to sign the form so that we don't have to track them down later," Fellows says.

Relief: "If your facility allows you to accept verbal orders, you can consult with the physician, write the verbal orders and then tag for signature," says D'Altorio-Jones.

But keep in mind that you must check all the guidelines -- state, federal, and payer -- governing your facility before you implement a policy change, D'Altorio-Jones points out.