Home Health agencies should begin now to review processes and be certain that care delivered is “reasonable and necessary” and that each and every visit can withstand scrutiny by auditors/RAC or MAC auditors. Of course, so much of care delivered involves patient teaching. Recently, several colleagues (who are involved in QI) and I were discussing the least supported documented visits we see in home health. We unanimously agreed that visits involving patient teaching seem to be the weakest in documentation. We also realize that if we have noticed this weakness, it is only a matter of time before the MACs and RACs see this also (if they haven’t noticed already).
Visits that are essentially patient teaching oriented must involve teaching that requires the skills of a nurse or therapist. The clinician may also teach the patient about an essentially unskilled service however, it must relate to their illness. Issues can arise if the clinician does not adequately document the connection between the patient’s skill deficit and the patient’s learning need. Additionally, how the clinician addressed the need and the patient’s response is essential.
In the 1980s, Malcolm Knowles (called the father of adult education) identified that successful adult learning involves understanding that:
- Adults want to participate in identifying their needs for learning.
- Adults appreciate a sequence or clear outline of experiences/teachings needed to achieve the desired result.
- Adults learn better in a reduced stress environment with a supportive teacher/facilitator/educator.
- Adults learn better with appropriate learning techniques and instructional methods.
- Adults have improved learning experiences when they have the most appropriate material and resources necessary to produced the planned learning.
- Adults have greater learning success when they are motivated toward measureable desired outcomes.
So, just handing a patient a flyer about medications or diet isn’t necessarily teaching and it frequently doesn’t result in learning. So, in future blogs, let’s look at proven techniques for successful teaching, because reimbursement should be retained for the valuable skill of teaching.
Susan Carmichael
MS, RN, CHCQM, COS-C
Fellow of the American Institute for Healthcare Quality
