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Billing Compliance and Proposed Survey Sanction: Two Looming Issues for the Home Health Industry

Thursday, September 13th, 2012

Issue One: Looking at Statistical  Data

Every time an OASIS is submitted to the state, portions of it may be parsed out to state, regional, and Federal groups such as the HEAT, MAC review groups, and Federal special projects in the DOJ and FBI. That means that when a review letter arrives, it may already be too late. Since we are aware that Predictive Analytics are employed, correct complete data must be submitted.

Predictive Analytics

In home health care, predictive models are being used to exploit patterns found in historical and transactional data to identify risks and opportunities. The present Models capture relationships among many factors to allow assessment of risk or potential risk associated with a particular set of conditions. The relationships should guide clinicians in their care plan decisions as well as care delivery. There are thousands upon thousands of potential OASIS and coding combinations. Because of the patient profiles and patterns retained over the years, comparisons can be made readily. Add HHRGs and service information to the OASIS and diagnostic data and CMS can gather very significant data regarding your agency’s care delivery and outcomes. MANY analytic filters are utilized to screen the data.  The initial round of filters are termed MUEs (Medically Unbelievable Edits). These edits are the first predictors of fraud and can alert the Z-PICs of agencies that should be monitored. Auditors may monitor an agency for years, gathering data, analyzing data and patterns, andreviewing payments. The agency profile is completed.

This data and these pre-probe edits allow Z-PICs to have plenty of time to analyze data and monitor agency behaviors so that when they send a letter, they have already completed their initial audit and arrived at a solid conclusion. 

Since experts state that 75-85% of all agencies are acutely unaware of business operations data and do not have necessary compliance rules built into or a part of their billing practices to protect them from wrongful claim submission, agencies are at risk. Who is auditing your clinical records and care, the ICD-9 coding, and the claim submission? Who is monitoring your data? Do you have clinical and operational benchmarks? In 2009, billing errors were found to have doubled. Be proactive now, because if your compliance rules and program are weak, you could be hearing from the Z-PICs soon.

Issue Two: Look at Clinical Data

CMS has proposed strong regulations establishing hefty intermediate sanctions to be imposed on home health agencies not in compliance with CoPs. Agencies must read the survey regulations carefully, implement precise policies and procedures, and audit utilization of those policies and procedures to be certain they meet processes as intended by the agency compliance program.

Proposed provisions include:

Monetary sanctions of $8500.00-$10,000.00 for condition level deficiencies that place a patient in immediate jeopardy.

Fines of $8500.00 per day for repeat deficiencies

Fines of $2500.00-$5000.00 per day for other deficiencies not placing a patient in jeopardy.

The monetary sanctions can be applied for the number of days the agency is out of compliance and they can be increased or decreased after the application of the penalty. The sanctions may be per day or per instance. They could not be applied simultaneously for the same deficiency. Please go to the CMS website to review the proposed rule.

Monetary sanctions are not the only sanctions that CMS may impose. CMS can chooses to terminate a provider agreement.  If an agency is unable or unwilling to correct deficiencies. Additional alternative or additional sanctions include suspension of payments for new admissions and new episodes of care, temporary management of care, mandated directed inservices and training, as well as the  emporary management of deficient agencies including making personnel changes and providing necessary interventions to assist the agency back into compliance.

The proposed rules would place much more pressure on a home health agency requiring  excellent documentation of care following a careplan that is consistent with  the needs identified in the patient clinical assessment. If outcomes are not achieved because needs were not appropriately identified, visits were missed, or care was not appropriately delivered, or a patient was placed in danger, an agency could face sanctions.

Agencies are expected to audit care, audit data, audit employee performance and be attuned to levels of care delivered to the patients of the agency. Agencies must clearly accept responsibility for care delivery and the outcomes derived from that care. It is clear from the proposed rule that

If the proposed survey sanctions are passed, agencies must be concerned they have excellent processes in place such as a “built-in, self regulating quality assessment and performance improvement system to provide proper care, prevent poor outcomes, control patient injury, enhance quality, promote safety, and avoid risks to patients on a sustainable basis that indicates the ability to meet theCoPs and to ensure patient health and safety ( Fed Register Vol 77 #135, Friday, 7/13/2012 Proposed  Rules, p 41582 col 3). or the financial consequences could be devastating.

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Posted in CMS, HEAT, ICD9-CM Coding, MACs, OASIS-C, Patient Survey, Surveys, Z-PICs | No Comments »

The New Survey Protocols: Are You Ready or How Did You Do?

Tuesday, January 31st, 2012

The CMS new survey protocols have been in effect for over six months. The revised Home Health Agency Survey Protocols and New State Operations Manual are available online. The new survey process is data-driven and patient outcome-oriented with a focus on patient visits and personnel interviews. Though it appears less structured, it is very process-driven.

The new tiered system directs surveyors to focus on quality of care. A detailed list of surveyor probes are provided, outlining questions that may be asked throughout the survey process. Agencies should review the questions outlined for surveyors in order to prepare for the survey process. Preparation for this process will reinforce other patient focused processes. Are you ready? Visit www.cms.gov/Surveycertificationgeninfo/downloads/SCLetter11_11.pdf to read more.

CMS stated surveyors would cite more deficiencies under the new process. After one year, it will be interesting to view the stats.

The Key Focus Areas

Patient Rights

Assessments

Plan of Care

Outcomes and Improvement

Infection Control

The survey process is guided by interpretive guidelines and survey protocols established to provide guidance for surveyors. The surveyor will review the assessment, the medication profile, and physician orders and then evaluate the established plan of care with review of that implementation of the plan of care. Patient and personnel interviews should support the findings of the clinical record.  Prepare personnel for survey interviews so they are familiar with terminology and types of questions they may be asked. Support the interviewees by having them understand that they are the experts in care delivery. They are merely verbalizing the assessment, the care, and the outcomes expected or achieved.

All surveyors are required, by CMS, to utilize these guidelines when evaluating an agency as to compliance with Federal regulation. Remember, the guidelines do not replace regulation and are not allowed to be the basis of any citation, but they provide guidance.  Violations are to be based upon clinical record reviews, interviews with patients, caregivers, and personnel, as well as the agency’s practices in relationship to regulation and agency policies.

“The survey and certification process provides a method for CMS to evaluate HHA compliance with the Conditions of Participation (CoPs), ensuring that patient services provided meet minimum health and safety standards and a basic level of quality. The HHA survey process incorporates an approach that is patient-focused, outcome-oriented and data-driven making it more efficient and effective in assessing, monitoring, and evaluating the quality of care delivered by an HHA…” (Appendix B, p.6).

The surveys are required to have at least one RN on the team.  Surveyors are required to attend the HHA Training Course prior to any survey. They are then required to be in an observational role as part of the training.

Preparing for the Survey

Appoint at least one person, in your agency, to become very familiar with the new survey process. You may want that person to be OASIS certified to readily discuss OASIS conventions. Develop a thorough process-oriented clinical orientation. Be certain all policies and procedures are current and personnel have had the appropriate inservices.

Have a third party or internal coding expert available to answer any questions regarding diagnoses coding conventions, manifestations, and sequencing. A coding audit by an external review agency may give you some peace of mind.

Be certain your clinical lead has reviewed and audited Starts of Care, Resumptions of Care, Recertifications, and Discharges. Be certain the assessments are well documented and the care plans adequately support that proposed Plan of Care.

Be certain the billing (revenue cycle management) audits include the compliance processes that prevent inappropriate billing without a physician order and evidence of all detailed and signed visit notes.

Types of Surveys

The survey process provides for a standard survey, a partial extended survey, and an extended survey. All HHAs must undergo a standard survey.

Initial Certification

The initial certification requires compliance with SS Act 1861(0) (4) as well as 2180 regarding licensing requirements. In addition, follow the guidelines of SS2008 “Early Surveys of New Providers and Suppliers”.

The State Agency (SA) surveyor or the National Accrediting Organization (AO) inclusive of Joint Commission, CHAP, or ACHC with deeming authority conducts the initial certification. At the time of that survey, the HHA must

  • Be operational and have completed the Medicare Enrollment 855A verified by the assigned MAC.
  • Provide nursing and one other therapeutic service (42 CFR 484.14(a).
  • Meet the new capitalization requirements and have completed an OASIS test submission.
  • Have provided care to a minimum of 10 patients requiring SKILLED care.

Standard Survey

This survey is to be a review of the quality of care and services furnished by the HHA as measured by the medical, nursing, and rehabilitative care indicators. The new changes require this survey to review compliance with regulations most related to high-quality patient care. These highest priority standards (regulations) are called Level 1 standards addressing 9 of the 15 CoPs. The thinking is that if the agency is in compliance with these standards, it is in compliance with all CoPs.

Therefore,  “the surveyor can make a determination  that the HHA is in compliance with all CoPs when, after a review of the Level 1 standards, and after completing the required clinical record reviews, home visits, and interviews with patients and HHA staff, he/she does not discover any findings which would support a deficiency citation.”

Partial Extended Survey

This survey occurs when a standard level survey identifies a non compliant Level 1 standard and/or a deficiency practice may exist at a standard or conditional level not examined at the standard survey.  During this survey, the surveyor reviews at a minimum, the Level 2 standards under the same condition which are related to the non compliant Level 1 standards. See Table 1 Level 1 and Level 2 Standards.

Extended Survey

This survey includes a review of all conditions. It may be conducted at any time at the discretion of CMS and is required to be conducted when any conditional level deficiency is identified. The surveyor is required to review all agency policies, procedures, and practices related to the substandard care (one or more condition –level deficiencies).

Recertification Survey

All HHAs are mandated (SS1891) to have a recertification performed no later than 36 months from a previous recertification survey. These surveys are standard unless a Level 1 citation is leveled.

Now, you know the types of surveys. The following chart lists the standard and partially extended surveys with their related priority standards and G-tags. The more you know about the new process, the better prepared you will be for your next survey.

Level 1 and Level 2 Standards Appendix B

Table 1

Conditions                            Standard Survey                Partial Extended Survey

Level 1                                   Level 2

484.10

Patient Rights                          G107, G109                             G101, G108, G111, G114

484.12

Compliance with                     G121                                        G118

Federal, State, Local

Laws

484.14 Organization,               G123, G133, G143,                 G124, G125, G127, G138,

Services and                             G144                                       G139, G150

Administration

484.18 Acceptance                 G157, G158, G159                      G160, G162, G163

Of Patients, Plan of Care,       G164, G165, G166

Medical Supervision

484.30 Skilled                          G170, G172, G173,                     G169, G179

Nursing Services                     G174, G175, G176,

G177

484.32 Therapy                        G186, G187, G188                      G190, G193

484.36 Home Health Aide      G224, G229                               G212, G215, G225, G226, G230

Services                                                                                     G232

484.48 Clinical Records          G236                                        G239

484.55 Comprehensive          G331, G332, G334,                  G339, G341

Assessment of Patients          G445, G336, G337,

G338, G340

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Compliance Q&A: Survey protocols, CoPs, HIPAA, ACOs, and Transitions of Care

Saturday, November 19th, 2011

Questions regarding 2011 Survey protocols

Q. We have several questions re the new survey protocols. What are some of the key differences? What does the pre-survey preparation include?

A. The new survey protocols focus on specific standards within identified conditions that are related to quality care. To identify the care delivered and its relationship to the assessment and plan of care designed, besides reviewing the clinical record, the surveyor will also rely on personnel interviews as well as home visits. The survey is data-driven, patient-focused, and outcome-oriented.

The surveyor is expected to collect data and review State file data, prior survey results, OASIS reports, and agency specific characteristics. (S)he will review outcomes, potentially avoidable events of both active and discharged patients, and make visits for higher risk patents. The new protocols provide specific guidance on citing standard and condition-level deficiencies.

Q. Can you explain the survey levels? How is a standard survey extended?

A. A Standard Survey focuses on Level 1 standards (9 of 15 CoPs) which focus on the delivery of high quality patient care using not only clinical records but inclusive of interviews. If the home health agency is in compliance with all Level 1 standards and there are no identified concerns requiring investigation, the survey will be concluded and form CMS 2567 is issued.

Partial Extended Survey begins/expands when expected outcomes are not met for one or more Level 1 Standards. It requires a review of Level 2 standards. It should be expected that related information would be sought for areas of concern such as agency policies and procedures, personnel competency evaluations, and inservice training

Condition-Level Deficiencies can occur with serious findings related to or not related to Level 1 and 2 standards. Immediate patient jeopardy is always cited at the condition level. All conditions are reviewed.  Refer to the State Operations Manual, Appendix B Guidelines.

Questions re CoPs

Q. What are the required leadership positions stated in the CoPs?

A. The Conditions of Participation cite three administrative positions:  a governing body, an administrator, and a supervising physician or RN.  You may title these three positions whatever  your agency prefers, however the positions must exist and the individuals appointed must perform the duties identified in the CoPs. Be certain job descriptions, policies and procedures, and other necessary documentation clearly define that the positions perform all required designated responsibilities.

Do not forget the delegates required. Be certain that agency policy identifies who will function as the administrative delegate. The agency must also be in compliance with state requirements, which frequently are more stringent. Compare both State and Federal requirements so the agency is in compliance.

Q. Is it true that we must have a realistic end point for intermittent services for a patient who has a chronic diagnosis, such as Alzheimer’s disease?
A.The CMS Publication 100-2, Chapter 7, § 40.1.1,  states  services can be provided “without regard to whether the illness or injury is acute, chronic, terminal, or expected to extend over a long period of time.”

According to the publication, if the patient with a chronic disease is homebound and needs skilled, reasonable, and necessary services that meet the part-time or intermittent requirements, then the agency can provide care.  That documentation must carefully be documented, The agency must be certain there exists an intensive assessment of the patient and their support services with interventions and goals clearly stated.  Carefully delineate the SKILLED need for each visit made. If the patient with Alzheimer’s disease qualifies for Medicare coverage through a need for monthly catheter changes and receives home health aide services 1x per mon, be certain each visit shows progress and document pt/cg response to care.

Up to a maximum of 28 hours per week of skilled nursing care and home health aide services combined completed in less than 8 hours per day or up to 35 hours per week of skilled nursing and home health aide services and subject to review by the fiscal intermediary. Medicare requires supporting evidence of the continued skilled care need. The agency must reflect the need for compliant skilled care through clear documentation.

Questions about ACOs and New Payment Methods

Q. I am hearing about bundled services. Should I be concerned?

A. Home Health Agencies should be aware of potential ACO formation in their respective markets.  Does your agency have a specialty you should be marketing to local hospitals? Some hospitals are looking at the bundled payment options as well as ACOs. Read more at the CMS website but know that the proposed pilot gives participants the opportunities to make choices regarding patients to include, length of episodes of care, whether acute inpatient care should be included, and the target payment to be established. There are a variety of proposed models. Go to www.CMS.hhs.gov to learn more.

Q. I have heard there will be new payment methods. What are they?

A. Select Data will be providing ezine articles in late November and December regarding some of the proposed payment and treatment methods being considered and presently being evaluated. Those may include:

Accountable Care Organizations (ACOs) with Bundled Payments or Shared Savings Programs where the ACO shares risk. There will be various types of risk sharing programs. There may be Value- based Payment plans. Expect to see ACOs lead by hospitals or physician groups. Home Health Agencies will need to show value to become a part of such collaborative formalized groups.  Expect CMS to utilize comparative-effectiveness techniques of evidenced-based practices. Become familiar with the following terms:

ACOs: Integration of providers to assume responsibility for the quality, costs, and outcomes of care.

Total Costs of Care: A reimbursable methodology that is being designed to reduce cost by person by episode.

Predictive Modeling: A methodology to estimate how clients may use services and the related costs based upon variables, prior behavior, and attributes assigned.

Transition of Care: The movement of patients from one health care practitioner or setting to another as the condition and care needs change. Under this model, there will be NO discharge summary. Instead expect a “Transition Summary”. See the next Select Data article: CMS and Transitions of Care.

Questions re Face to Face

Q. Is anyone working to get some help for home health agencies regarding the face-to-face rule?

A. Yes, several state associations as well as NAHC are working to obtain some legislative relief. NAHC has called for 1) exemptions in specific hardship circumstances, 2) a reduction in documentation required, 3) expanded use of telehealth to meet the face to face requirement, 4) protection of home health agencies from denials without fault, 4) allow one physician/NPP to complete the Face to Face and another to certify (CMS has proposed this but is limiting it only to an inpatient physician).

Q. Could you give a summary of key points of the proposed 2012 Home Health PPS Rate Rule?

A. Agencies will need to be efficient as there is a proposed 2.5% inflation update, a 5.06% case mix creep adjustment, and a 3.56% rate reduction for 2012. In addition there is a recalculation of case mix weights proposed that includes elimination of two hypertension codes (401.1 Benign essential hypertension and 401.9 Unspecific essential hypertension). Also, there would be lower therapy episode coding weights. This would include a deceleration of a higher number of visits with a removal of the therapy visit step indicators. There will also be a recalculation of points to clinical and functional scores. Additionally, if an agency failed to complete a successful dry run  in Q3 of 2010 for HHCAHPs, they risk a 2% reduction in payment. (See October, 2011 Select Data ezine for more regarding HHCAHPs).

A few questions regarding HIPAA

Q. Could you give a brief summary of HIPAA HITECH? Can you discuss breach? Can you discuss best practices needed?

A. The American Recovery and Reinvestment Act (ARRA) of 2009 brought changes to HIPAA regulations in three broad areas: breach notifications, business associations, and penalties. It increases enforcement of HIPAA and allocates billions of dollars to invest in the implementation and exchange of health information technology such as the EMR.

Under HITECH, if a breach compromises the privacy and security of the patient’s information and poses a significant risk of financial, reputational, or other harm, patient notification is required.

Five new definitions have been added:

  • Breach Electronic
  • Health Record (HER)
  • National Coordinator
  • Personal Health Record (PHR)
  • Vendor Of PHI

HITECH strengthens the specifics of privacy, significantly increasing penalties, establishing a heightened enforcement scheme and giving state attorney general enforcement authority. Individuals may now be held accountable for wrongful disclosure (HITECH Act section 13409).

If a breach involves 500 or more individuals, the department of HHS should be immediately notified. DHHS began posting names on March 1, 2010. Breaches below 500 must be logged and annually sent to DHHS.

For Business Associates, the Covered Entity must ensure that BAs have implemented the administrative, physical, and technical safeguards of HIPAA security. The CE must also specify that the BA must comply with use and disclosure rules in the HIPPA Privacy Rule. The BA should demonstrate how they will negotiate security/data breach coordination. There should also be an agreement on reporting and dispute resolution.

If the health care organization suspects or knows that a BA has committed a material breach or violation of the agreement, “the health care organization is in violation of the business associate rules unless it takes reasonable steps to cure the breach or end the violation {45CFR 164.504 (e)(1)(ii)” (Decision Health, HIPAA, 2010).

Penalties include a Tiered System for assessing both the level and penalty for each violation. There is a cap of $50,000 per violation and 1.5 million for the calendar year for the same type of violation.

Health care organizations should have in place policies that address various levels of violation, such as failing to sign off a computer terminal when not attended, sharing passwords, assessing a patient record without legitimate reason, releasing data for personal gain, and intentionally destroying or altering data.

Use Best Practices for:

Authentication: pre-boot and intricate passwords

Access: Need to know basis on approved devices

Retention: Destroy if not needed

Encryption: Laptops, notebooks, desktops, email, and social networks

For some peace of mind, have a written information security program, an active HIPAA privacy program, and a living Corporate Compliance Program.

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Posted in ACO, Best Practice Intervention Practice, CMS, CMS Guidelines, Compliance, Face to Face Encounters, HIPAA, HIPPA HITECH, Home Health, Medicare, Patient Survey, Surveys | No Comments »

OBQM/Chart Audits and the New Survey Protocols: Tweaking and Streamlining Process for Real Improvement

Tuesday, October 25th, 2011

From Outcome-Based Quality Improvement (OBQI) refresher training to Total Quality Management Agency Programs, the home health agency of today needs to define the level of programs needed to operationally and financially drive  success. The home health agency needs OASIS stop, logic, and congruence edits to prompt clinicians and flag incongruence between M questions. But, that is just the start. The OASIS integrated assessment sets the stage for the plan of care created. From the plan comes the visits and they must support that plan and drive to expected outcomes.

Perhaps your firm would benefit from a third party quality clinical chart audit. Your Professional Advisory Committee, Board of Directors, and you may well see the merit of an independent view of clinical processes and care. Noting strengths and determining opportunities for improvement before a survey makes sense. Are you spending too much time and money internally for chart reviews? What does happen after those reviews? Do you educate personnel? How do you know if that education was successful?

Clinical chart audits can assist you to remedy issues, provide education and training, and improve efficiencies. Clinical audits can assist to streamline processes, determine areas of risk, and assist to improve the bottom line.  Clinical audits can assist to identify quality customer service and improve patient care.

“Identifying ways that an outcome-based corporate culture fully extends to both internal and external customers is the responsibility of leadership. Developing and using simple tools can aid in the process. Once systems are implemented, maintaining a true commitment to TQM becomes a powerful challenge. But, to the persevering leader, the rewards of quality customer service can go hand in hand with a positive bottom line” (Carmichael, 2005)*

The new survey protocols mandate an outcome–oriented survey process, therefore, know that the surveyor will continue evaluating, per CMS, “the quality of care and services furnished by the agency as measured by indicators of medical, nursing, and rehabilitative care.” In addition, the new process will emphasize the clinical record of assessment and care, agency personnel interviews, and home visits. The new regulations provide clear guidance for expanding the survey, if needed.

Besides Process and Chart reviews, agencies should routinely use the Surveyor Worksheets to review agency data filed with the state, look at diagnoses and expected outcomes, monitor potentially avoidable event outcomes, and be certain there is adequate documentation for case mix indicators.

An evaluation of Level 1 indicators (see Select Data University April, 2011 article on New Survey Protocols, Survey Protocol Worksheets) includes standards under skilled nursing and therapies. If the agency is in compliance with Level 1 standards and no additional issues or concerns are identified, the survey is completed. If the expected outcomes are not met for one or more Level 1 standards, then the survey expands to become a partially extended survey.

At the very minimum, compliance with Level 2 standards is evaluated if deficiencies were identified with Level 1 standards. This is the partially extended survey. Be aware that surveyors may review additional non Level 1 or 2 standards under the same conditions during the partially extended survey at their discretion. (State Operations Manual, SOM, Appendix B). In an extended survey, all conditions will be reviewed. Appendix B and Survey Protocols provide specific recommendations for: citing condition-level deficiencies, extending the survey, and related conditions for further survey.

Now, more than ever, a thorough assessment must drive discipline specific care plans that drive the overall POC with every visit skilled and enhancing the process toward expected outcomes. Clinical record reviews, clinical interviews, and home visits drive the survey process. Documentation is essential. Good documentation starts with a thorough assessment. That assessment should be specific. Does your assessment tool set the stage for success? Is it detailed enough to gather data to allow the highest level of coding specificity? Does it cue the clinician with requests for detail to support a case mix diagnosis that may be assigned?

It is simple in the guidelines; a good POC starts with a solid clinically integrated OASIS assessment. That assessment drives the discipline specific care plan and those plans contribute to the overall POC. That POC has diagnoses present that require substantiation in the clinical record and the expertise of master coders. That very record supports the diagnoses sequences chosen. The visits can stand alone as to skill but reflect that they are a part of an individualized skilled plan of care.

Documentation takes time and thought. Clinicians are busy and require assistance and support. Consider a third party coding entity. Also consider an OASIS data collection service that was created by clinicians.  The system should be reflective of what you expect and of what your clinicians need.

The new survey protocols are data driven. Agency leaders need real data daily, weekly, monthly to monitor clinical performance and patient care outcomes.

The Surveyors have the data when they arrive. Do you?

*Carmichael, S (2005). Total quality management and outcomes based quality improvement: revisiting the basics. In Home Health Care Management and Practice (17)(2),119-124

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Posted in Best Practice Intervention Practice, CMS Guidelines, Compliance, Home Health, ICD9-CM Coding, Legislation, OASIS-C, OBQI, Patient Survey, Surveys | No Comments »

Adult Learning Principles: Influencing Patient Outcomes through Education

Monday, July 25th, 2011

Understanding the Principles of Adult Learning can assist clinicians to improve patient learning and can result in improved clinical and quality patient outcomes. The brain governs more than memory alone. The brain and mind allow humans to cope with stimuli, creativity, immune responses, language, reasoning, planning, analyzing, and dreaming. It allows the human to feel a myriad of emotions, store experiences, while shaping the capacity to alter behavior and thinking through awareness expansion and critical reflection. The brain is, according to Caine, 2009) biologically designed to learn and learning is a matter of building rich neural networks, but how? Each individual learns a bit differently than their neighbor yet there are 12 strong underlying principles:

  1. All learning is physiological
  2. The brain/mind is social
  3. The search for meaning is innate
  4. The search for meaning occurs through patterning
  5. Emotions are critical to patterning
  6. The brain/mind processes parts and wholes simultaneously
  7. Learning involves both focused attention and peripheral perception
  8. Learning always involves conscious and unconscious processes
  9. There are at least two approaches to memory

10.  Learning is developmental

11.  Complex learning is enhanced by challenge and inhibited by threat associated with helplessness

12.  Each brain is uniquely organized

(Caine, Caine, McClintic, and Klimek, 2009 and Caine and Caine, 1994)

The principles assist us, as clinicians, leaders, managers, to understand that there are several different processes involved. Yet, we all tend to print up some teaching materials and have the nurses leave them with the patient “for reinforcement”. Many people believe, “If I told you, you have had education”.

The best selling education books, Tellin’ ain’t Trainin’ (Stolovitch, 2011) and Sit and Get Won’t Grow Dendrites (Tate, 2004) help us to better understand Brain-Compatible strategies. Some patients may learn well with the written word, while others are spatial and auditory learners.

Future Select Data articles will explore the constructs further but here is one sample activity.

If a patient treatment has changed or is being compared or contrasted, consider using a Venn Diagram. Draw two circles that have an overlapping center like below:

Information that is overlapping in the center is that information that is alike. The information outside that space identifies differences.

A spider chart with the new treatment or new topic in the center of a circle should be drawn. Then draw “spider-like” lines coming out of the circles. These can be goals to be achieved. As the patient articulates each goal they desire to achieve, linking it to the treatment or med in the center of the chart dramatically diagrams the importance of that treatment or medication.

A pie chart can be used to classify the careplan components. Breakdowns can make the plan seem more manageable. Each component or “piece” of the pie can appear to be managed at a setting, much like a tasty lemon pie.

We will look at this topic with more depth in the future. There is a PowerPoint Presentation on the topic of Learning and Brain Compatibility that is based on the Twelve Adult Learning Principles. This presentation was presented at two state association conferences and it could be shared with clinicians.

Having trouble downloading Learning and Brain Compatibility PowerPoint?

right click on the link > Then choose “Save Target As” > “Save”

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