‘The end result is often poor documentation’

Monday, March 31, 2008

WASHINGTON – Medicare beneficiaries under the care of home health agencies have been putting some therapists and complex rehab providers in a tough bind.
Because Medicare payments to HHAs include wheelchair evaluations, the agencies are more apt to have in-house therapists conduct evaluations than outside therapists. The dilemma, according to industry sources: The therapists who work for HHAs don’t normally specialize in seating and mobility.
“The end result is often poor documentation or no documentation to providers,” said Jody Stogner, a therapist who owns Southeastern Assistive Technology Solutions in Jackson, Miss. “Some providers are doing the documentation themselves and therapists are signing off on it. Obviously, that’s not the way it’s supposed to work.”
Therapists who specialize in seating and mobility estimate that up to 50% of their patients are under HHAs when they get physician referrals to conduct wheelchair evaluations. That’s not a problem if the patients are under a contracted HHA.
It is a problem when they’re not, therapists say. They must then defer to the HHA’s therapist, who may or may not specialize in seating and mobility, or wait until the patient is no longer under the care of an HHA, a process that can take weeks or months.
The Clinician Task Force, a group of 28 therapists who specialize in seating and mobility, brought the issue to Medicare’s attention about a year ago, but the agency told the task force it needed more information, said Co-coordinator Laura Cohen.
“They wanted to know which HHAs couldn’t provide the services, but that would have made it our word against theirs,” she said.
The Clinician Task Force is now trying to determine how to approach Medicare again about the issue.
“There needs to be some kind of resolution,” said Cindi Petito, a therapist who owns Seating Solutions in Jacksonville, Fla.
Ultimately, resolution may lie with the therapy associations (See story page 27). Therapists are calling on them to develop a specialty credential in seating and mobility. If the credential were then recognized by CMS, it would prevent inexperienced therapists from conducting wheelchair evaluations, they say. HME