What is the CAHPS Program?

The Consumer Assessment of Healthcare Providers and Systems is designed to develop and support the use of comprehensive standardized surveys that ask customers and beneficiaries to report on and evaluate the care they received. The program is funded by and administered by the US Agency for Healthcare Research and Quality (AHRQ). For over a decade CAHPS has established principles that include identifying and supporting consumer information, adherence to scientific testing principles, comparability of data, as well as maintaining products in the public domain. (CMS, AHRQ, CAHPS).

CAHPS surveys are standardized per AHRQ in the following manner:

The Instrument is standardized in such a fashion that anyone administering the survey can ask the questions in the same way.

The protocol is standardized in that it adopts the same approach to “drawing the sample, communicating with potential respondents, and collecting the data.”

The analysis is developed in a way to minimize variations in how vendors process and interpret survey results.

The reporting uses a well-tested approach that reflects best practices in reporting.

How is CAHPS Data Utilized?

Health care monitoring agencies, such as State regulatory agencies and Quality Improvement Agencies (QIOs) use CAHPS data coupled with quality measure data to evaluate agency performance. Since 1999, the National Center for Quality Assurance (NCQA) has required CAHPS data from health plans that are seeking accreditation or when they submit data as part of the Health Plan-Employer Data and Information Set (HEDIS). Behavioral health organizations must use CAHPS data along with their ECHO survey when they are seeking accreditation. PPOs must have CAHPS survey findings completed routinely as part of their accreditation process through URAC.

The CAHPS standardized surveys are expanding into new areas of healthcare but CAHPS is not new to the business of surveys. CAHPS Health Plan Surveys are designed to be heterogeneous in population coverage.

Per CMS, CAHPS Emphasis is on Consumers and Patients

CMS believes that “consumers and patients are the best and/or only source regarding care.” They also state that CAHPS surveys do not attempt to collect information that can be gathered more effectively through other means. This overall program has been a successful collaboration of public and private research organizations that includes RAND, Yale School of Public Health, and the American Institute for Research. Together, the private and public groups are known as the CAHPS Consortium. Together, they have been instrumental in developing and testing ways organizations can use CAHPS data for quality improvement.

Can an Agency Improve their Scores Through Better Practice?

Yes, an agency not only can influence later scores, they should be aggressive in doing so. Reward clinicians when a positive comment is known. In the same regard, keep track of negative comments. Help the clinician who is perceived as lacking in customer service attributes. Review facts such as sitting with a patient for 1-2 minutes creates an image of spending time and not being in a hurry. Taking time to ask about a grandchild or a pet conveys sensitivity and caring. Sometimes, a busy very qualified clinician can have behaviors misunderstood.

Be certain that clinicians understand that research supports the fact that patients want at least a day’s notice of a visit. Timely notification scores decline if the clinician does not establish or remind the patient of the visit at least one day in advance.

Find creative ways to help patients remember their education. When I once visited a home to survey care, the patient showed the picture of the blue ribbon she had received for correctly learning how to properly administer her meds. She and her nurse had  a fun time discussing the fact that she had always wanted a blue ribbon. “Now, I have one,” she stated.” And later she challenged me. “Ask me anything about those meds,”

Patients who are visual learners may appreciate a journal to take notes or may appreciate printed information they can underline with colored markers. The important point is learning how they have learned in the past.

Return phone calls promptly (within 10-15 minutes) to obtain high scores on timeliness of response to questions.

The First HHCAHPS Letters of Non-Compliance have been Received

Over 1300 agencies have received letters notifying them that they have not satisfied the requirement for participation in HHCAHPS. As a result, these agencies are slated to have a 2% market-basket reduction in 2012. That 2% will be in addition to the 3.5% payment cut proposed by CMS for that year. In a time of fragile bottom lines, a 5.5% reduction can be onerous.

So, what should the agencies do if they receive the letter of non-compliance and they believe it was sent in error? Consider appeal! Be prompt. The letter of non-compliance has a 30 day life span for appeal. Do not miss it. Verify with your vendor that the required data was submitted timely. Ask for proof of transmission.

Many agencies that received the letters reported to NAHC that submission of data occurred. Obtain proof from your vendor of the dry run and the ongoing data submissions. Data submission guidance can be found at https://homehealthcahps.org/HHAGuidanceforDataSubRept.pdf

Some agencies believe CMS may have a glitch in the reporting system. Take no chances. Obtain proof from your vendor of submission and preserve your rights by filing the timely appeal. Be proactive. The old adage, “not to decide is to decide… is true” Decide and Act.

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The belief is that “bundled payments can help align incentives for providers to partner and work closely together across specialties and settings…” (CMS, 8/23/2011).

The CMS Innovation Center http://www.innovations.cms.gov has made available the Request for Application (RFA) for three retrospective models. The application is due November 4, 2011. To apply: http://www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html

Specific questions can be directed to BundledPayments@cms.hhs.gov

Per CMS, research and prior demonstration projects have shown that using a bundled payment initiative for patients with coronary artery bypass graph surgery saved CMS $42.5 million, roughly 10% of expected costs. The research was conducted at hospitals in Atlanta, Columbus, Ann Arbor, and Boston.

Bundled payments are just one part of a wide-ranging effort to improve healthcare yet reduce the cost of that care. The Accountable Care Organizations are another strategy being encouraged.

These strategies are not new. Many organizations have recognized the fragmentation that occurs in healthcare delivery. Recently, the National Quality Strategy launched a Partnership for Patients uniting physicians, nurses, other healthcare professionals as well as unions, the State and the Federal Government to offer ways to prevent hospital readmissions and improve transition between levels of care. CMS announced an investment intended over $1 billion to help drive these changes. CMS also announced their intent to invest over $50 billion over 10 years in like projects.

It appears that innovative projects to decrease fragmentation in care could be rewarded. If you have ideas, why not apply for the RFA?

To read the Affordable Care Act, go to www.HealthCare.gov/news/factsheets/deliverysystem07272011a.html

While Home Health Agencies were focusing on new CY 2011 regulations and plenty of changes, leaders need to remember that there was the change to Version 5010 for handling electronic claims. CMS will still accept Version 4010 claims until January 1, 2012. CMS expects that software vendors have been conducting internal testing so testing of the new version is now externally underway and full Level II compliance is completed by December 31, 2011.

To make this process as well as the transition to ICD-10 easier, the Coordination and Maintenance Committee has proposed ICD-9-CM coding changes be frozen, effective October 1, 2011.

“Recognizing the ICD-9-CM as a dynamic statistical tool that must be flexible to meet expanding classification needs, the ICD-9-CM Coordination and Maintenance Committee was created as a forum for proposals to update ICD-9-CM.  A representative from the National Center for Health Statistics (NCHS) and one from the Centers for Medicare and Medicaid Services (CMS) co-chair the ICD-9-CM Coordination and Maintenance Committee meetings.  Responsibility for maintenance of the ICD-9-CM is divided between the two agencies, with classification of diagnoses (volumes 1 and 2) by NCHS and of procedures (volume 3) by CMS”. (http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm).

The ICD-9-CM Coordination and Maintenance Committee’s role is advisory.  All final decisions are made by the Director of NCHS and the Administrator of CMS.  Final decisions are made after the December meeting and become effective October 1 of the following year. Official code revision packages, which are referred to as addenda, are available from this site.

The transition to ICD-10 is a major change for the industry. To better effect that transition as well as the Version 5010 to handle electronic claims, the ICD-9-CM Coordination and Maintenance Committee has proposed and accepted a partial freeze at a recent meeting. This freeze identifies:

• The last regular annual updates to ICD-9-CM and ICD-10-CM would be made October 1, 2011
• Limited updates to ICD-10 October 1, 2013 (ICD-10-CM is expected to be fully in use in Home Health by 2013)
• Full regular updates to ICD-10 to be reinstituted October 1, 2014

Agencies need to be certain billing software vendors are in full testing for Version 5010 and are planning for ICD-10-CM. CMS reminds everyone that ICD-10-CM is far more comprehensive than ICD-9-CM and preparation should be underway now.  (www.cms.gov/ICD10).

What are the Differences between ICD-9-CM and ICD-10-CM?

ICD-9-CM:
17 chapters and V and E code chapters
13,000 disease codes plus V and E codes
3,000 procedure codes in Volume 3
3-5 digits in disease codes
Essentially numeric system
Codes usually do not indicate timing encounter
No differentiation between left/right

ICD-10-CM:
21 chapters- V and E codes in disease chapters
68,000 disease codes, including V and E codes
87,000 procedures codes in ICD-10-PCS
3-7 digits in disease codes
Alphanumeric system
Codes specify initial and subsequent encounters
Differentiates between the right and left
Expertise in anatomy, physiology, and diagnostics will be a must

Third Party Coding experts should already be actively into their plan for additional education of their coding teams. Some, like Select Data, have been stepping up training sessions and will be offering ongoing Anatomy, Physiology, and Diagnostic seminars to refresh and maintain currency among their credentialed experts. It may look like ICD-10 is far away but, an additional 55,000 diagnostic codes, an additional 84,000 procedure codes, and increased coding specificity to the 7^th digit means increased risk for payment and more importantly, increased risk for payment retention. If your payment retention has been in question, can the MACs, RACs, or Z-PICs be far behind? Could you survive what is coming with what you have right now?

We can choose from 71 sports drinks, 385 cereal brands, and 405 types of candy bars.  But, until recently, a hard working diligent home health nurse (visiting 5-6 patients a day, who live many miles apart, and have at least 8 diagnoses and take an average of 15 medications each) had to complete an OASIS assessment tool only on paper OR only on a laptop, depending on where she worked. Hey, what about an iPAD?

What about choice?

One nurse knows she can complete an assessment more quickly and accurately if she uses paper. Why? Because that is how she learned as a child. To try to be faster on a laptop will be more difficult as she is a “digital immigrant”. Our children and grandones are “digital natives”. Without social networking and an MP3 player, they are lost.  They need/like technology to feel a part of their group.

Many in my age group (very mature…and wise J) believe that technology should be used carefully as it could pose a barrier toward relationship development and establishing patient trust. We feel connectivity being near and around people. In homecare we know we are frequently visiting older persons and many of them are suspicious or less comfortable having data entered into a laptop while in their very home.

Now, just when one begins to slip into a stereotypical belief pattern, let me share a few statistics. The fastest growing group of internet users are ages70-75. Over 45% of seniors in this age group are now online. While social networking and blogging are very popular among the 18-44 year olds, a fully 74% of internet users age 64 + send and receive email routinely. We have clients whose patients want emails, not phone call reminders of clinician visits.

The beauty of home health care is that it is comprised of clinicians in their 20s to their 80s. Yes, I know of an agency with an excellent 82 year old MSW. She is quite the motivator.

I like both paper and technology. I am faster when I use paper to complete an assessment. I love both of my laptops and my iPAD and my iPhone and I read on them all. But, if I need to scrutinize a contract, I will print it out so I can read it ON PAPER. No kidding! That is how I learned way back when and it is my trusted reading medium to this day.

The Agency Leader

And what about the agency leader who needs to recruit and retain competent experienced clinicians? In both very rural and very urban areas this can be a challenge.  As a contractor, it can be very painful to work for many agencies and try to use everyones’ special device or forms. Could the contractor be more efficient and prompter if (s)he could use their own laptop to complete the documentation? As a leader, it can be a problem in getting assessments in on time. Most of the therapists will tell you, it is because of the paperwork and frequently, it’s the device.

In my dream world as a prior home health agency leader (11 offices in three states), I wanted my OASIS Assessment tools available on line so ANY and ALL of the agency clinicians could complete them (with their favorite laptop if they wanted to) or I would give them a laptop or a notebook or a tablet. Whatever made them more comfortable and thus more efficient was one of my goals. In my dream world I also wanted a great electronic paper tool that could “scrape” OASIS data, electronically capture orders and goals on a careplan and move them to the POC. Did I mention that in my dream world, orders and goals were updated electronically on my smart paper progress notes, so I did not need to have a series of data entry processes that invariably slowed the information availability down? Also, I have believed clinicians need to see progress on the orders and goals no matter if on paper or laptop. The progress of each goal should directly relate to the visit note documentation. Because in the perfect world, if there is congruence between the goal and the visit note, the RACs, MACs, and Z-Pics must find some other target of insufficient documentation.

In my dream world one nurse could use paper, another a laptop, the therapist could now use an iPAD to collect data from one patient because the data would all be deposited in one smart EMR. Easy data collection. Easy viewing of the data. Easy access and monitoring.

Finally, a compliant system

It has always been intriguing to me that an agency invests thousands for a software program and cannot use it for every clinician. So, some clinicians must use paper that invariably awaits the frenzied data entry/receptionist clerk to enter it into the system. Right from the start, the agency is out of compliance. The conduit for safety and communication becomes the overworked clinical supervisor who must convey information to disciplines and share what occurred on visits.  So, now the agency has two to three systems. One is on the laptop, one is the paper that has info that must be added to the software program, and what about all of the other extraneous pieces of paper like H&Ps, transfer and referral forms from other levels of care? No wonder the MAC and RAC auditors are having a field day.

In our real world, my dream world has now become a reality. I am not one to use this blog for sales (we are educationally oriented) but, having the ability to collect data any way you like is so very exciting. To not be tied to those expensive computer updates that must go on and on and on each and every computer or require everyone to have the same type of hardware or won’t allow paper. Worse yet, have a way to get “other” paper, like the H&Ps, consents, lab reports, psych work sheets, dietary supplement sheets, extra teaching tools etc into an EMR is so important.

To offer a clinical data capture system that allows you to choose, your choice, has been needed in this industry and will resolve so many efficiency and clinician retention issues.  We tell our clinicians they must become more efficient. Now, we can actually show them how. We can offer them a choice on their desired medium.  In order to enable this level of flexibility requires a very smart EMR or data repository. And, what if you have an existing MIS/billing system? No problem.  LEVERAGE IT!

Collect your data your way, YourChoice and solve those operational and data collection headaches. Use SmartScribe EMR to collect ALL of your data and reports. Leverage your existing MIS/billing system. Get the clinical, patient, operational, and business results you deserve not what you have had to settle for. I love working with this team. They solve real problems for clinicians and leaders like you and me.

ABN, HHABN, and the Notice of Medicare Non-Coverage, aka Expedited Determination Notice:
http://www.cms.gov/BNI/

Abt Associates- “Analysis of Home Health Case-Mix Change 2000-2008:
www.cms.gov/center/hha.asp

Billing in Home Health- Chapter 10 Medicare Claims Processing Manual:
www.cms.hhs.gov/manuals

CASPER Reports:
http://www.cms.gov/HomeHealthQualityInits/16_HHQIOASISOBQI.asp

CMS new URL-
www.cms.gov

CMS Sponsored Calls:
http://www.cms.gov/HomeHealthQualityInits/02_CMSSponsoredCalls.asp#TopOfPage

CMS Website Wheel:
http://www.cms.gov/MLNProducts/02_Catalog.asp

CMS ICD9-CM Coding Guidelines:
http://www.cms.gov/ICD9ProviderDiagnosticCodes/

CMS Interpretive Guidelines:
http://www.cms.gov/GuidanceforLawsAndRegulations/06_HHAs.asp

Conditions of Participation (CoPs):
http://www.cms.gov/CFCsAndCoPs/12_homehealth.asp#TopOfPage

CY2011 HHPPS Proposed Rule:
http://edocket.access.gpo.gov/2010pdf/2010-17753.pdf

False Claims Act:
http://www.cms.gov/smdl/downloads/SMD032207Att2.pdf

Food and Drug Association Safety Communications:
www.CMS.gov/Drugs/DrugSafety/PostmarketdrugSafetyInformationfor PatientsandProviders/ucm204882.htm

GROUPER effective October 1, 2010:
www.cms.gov/homehealthpps/05_casemixgroupersoftware.asp/

HHCAHPs:
Proposed PPS Rule
http://edocket.access.gpo.gov/2009/pdf/R9-18587.pdf
CAHPs Survey
https://www.homehealthcahps.org

Home Health Quality Improvement National Campaign (free resources):
www.homehealthquality.org/hh/about/default.asp
http://www.cms.gov/HomeHealthQualityInits/Downloads/HHQIOBQIManual.pdf

Medicare Administrative Contractors (MACs):
http://www.cms.gov/GuidanceforLawsAndRegulations/06_HHAs.asp

MAC Protest: www.palmettogba.com/palmetto/providers/providers.nsf/DocsCatHome/Jurisdiction%2011%20Pa520A%20B
Medicare Learning Network (MLN): Web-based training courses:
www.cms.hhs.gov/MLNProducts/downloads/NPIBooklet.pdf

Medicaid Integrity Contractors (MICs):
http://www.cms.gov/ProviderAudits/Downloads/mipmicontractors.pdf

New York Compliance Program for hints of what may be coming nationally: www.omig.state.ny.us/data/images/stories/provider_compliance/adopted_regulations_521.pdf

OASIS-C:
http://www.cms.gov/HomeHealthQualityInits/12_HHQIOASISDataSet.asp#TopOfPage

Office of Civil Rights (OCR): HIPAA:
http://www.hhs.gov/ocr/office/index.html

OIG 194 page report:
www.oig.hhs.gov/publications/docs/compendium/compendium2010.pdf

Physician certification Limitation of Liability Language, CMS Publication 100-4, Chapter 30, 10
www.cms.hhs.gov/manuals/downloads/clm104c30.pdf

Potentially Avoidable Event Report (Formerly, the Adverse Events Report):
www.cms.gov/HomeHealth QualityInits/18_HHQIOASISOBQM.asp

Quality Measures- HHQI Home Health Quality Measures
www.cms.gov/HomeHealthQualityInits/10_HHQIQualityMeasures.asp
http://www.cms.gov/HomeHealthQualityInits/15_PBQIProcessMeasures.asp#TopOfPage

Recovery Audit Contractors (RACs):
http://www.cms.gov/rac/

Red Flags Rule:
http://www.ftc.gov/opa/2008/10/redflags.shtm

Zone Z-PICs:
http://www.cms.gov/manuals/downloads/pim83c04.pdf

Wound, Ostomy, Continence Nurses (WOCN)
http://www.wocn.org/

An organized plan with expected outcomes is being mandated in this contemporary health industry. There is a need for information directed toward diagnosis, prognosis and disease prevention. Traditional sources; such as textbooks no longer meet the fast paced knowledge accumulation of today. Time treating patients has become expensive and limited. Current up to date, tested knowledge is vital to maintain diagnostic/practitioner skills and quality outcomes.

There are specific steps recommended to achieve evidenced-based practices:
1. Select a topic or a clinical question is asked:
Problem-focused such as identified through Quality improvement, benchmarking, and recurrent data
Knowledge-focused, based on research from conferences or journals
2. Form a Team
3. Have a well defined process for evidence retrieval . A common paradigm used today is PICO; a) who is the Population, b) what is the intended Intervention, c) is there a Comparison intervention or Control group, d) what is the desired outcome.
4. Classify the literature as either conceptual (theory and clinical articles) or data driven (systemic research reviews). The data is derived from clinical trials, meta analysis, and national rated articles.
5. The information should then be interpreted and critically evaluated as to application, validity, and expected outcome. Apply the evidence.
6. The decision to change practice considers the relevance of the evidence and the consistency in research findings, looking for ways to improve or modify the application. Qualitative research is being used more frequently in this regard.

To further encourage evidence based practice in home health care, CMS is seeking standardized tools to be used in the OASIS C Integrated Assessment. These tools, such as the Braden and Norton used for skin integrity assessment are readily recognizable, not only in home health but, in other levels of care in health care. Thus, if the patient is transferred to another care level, a reliability of skin assessment can be maintained because the tool is a recognizable standardized instrument.

Evidenced-based processes are also being encouraged because the patient population is requiring more from their health care practitioners, having increased knowledge, empowerment, and access to information, and expecting predictable outcomes from care.

Evidenced – based practice is not a new concept. It is documented in Daniel 1:6 in the Bible where “controlled trials” were used in comparing dietary benefits for families. In the 1700s, James Lind used randomized trials to show that scurvy could be prevented by citrus fruit. In the 1800s, Semmelweis studied the transmittal of puerperal fever, an infection occurring in females post partum. Semmelweis was able to document that physicians and medical students would perform aurtopsies, and in the same clothing (dirty aprons and all), frequently, merely wiping their bloody hands on their aprons, then perform gynecologic examinations on the new mothers. By instituting hand washing with chloride of lime prior to examining the females, the infection rate dropped over 80%. Evidence-based practice is soundly grounded in research.

The Agency for Healthcare Research and Quality, the National Guideline Clearinghouse, and the Evidence-based Medicine Resource Center are just a few organizations involved with the practices of EBP. Discipline specific associations impacting medicine, nursing, and the rehabilitation oriented therapies are also actively involved in research.

Evidence-based practice in nursing is seen with a new model called Guided Care Nursing (GON) being researched in Maryland, to examine seven chronic care interventions, including disease management, patient self management, case management, lifestyle modification and geriatric management. The nurses involved in the program have completed a specific educational program that looked to enhance their skills in these areas. Predictive modeling software was used to identify patients for the study. The study has been so positive further clinical trials have been funded..

Researchers at the University of California San Francisco Medical Center have undertaken a prospective study to look at incongruencies in practice standards across specific disease lines.

Evidence Based Practice is now being applied in the health care education and training setting. Data has been evaluated on over 109 medical schools in the country.

Government has a strong belief that evidence based practice will positively impact both on the quality and financial outcomes in health care. It is an exciting time in health care. It is truly the time for strong data driven practice.

Susan Carmichael
MS, RN, CHCQM, COS-C
Fellow of the American Institute for Healthcare Quality

In 1999, the Institute of Medicine (IOM) recommended adverse event reporting, first in the acute care setting and then to other health care delivery systems. An adverse event is defined as “an injury caused by medical management rather than by the underlying disease or condition of the patient” (IOM, November, 1999).  Systems failure remains the number one reason for medical error. Types of errors include medication, accidents/falls, and pressure wounds. Causes of error and adverse events include complex patients with complex problems (multiple diagnoses and co-morbidities, multiple medications), complex information management, and the complexities of being human (emotions, support systems, and resistance to change). The IOM encouraged improved data collection and analysis and improved systems.

By 2005, various studies reflected that the IOM goals had not been met (Leape and Berwick, JAMA, 2005). This fact encouraged various organizations, including the Joint Commission to revise and update performance standards including National Patient Safety Goals to more aggressively encourage safety and prevent adverse events. CHAP encouraged improved infection control processes by clinicians in the home. In 2010, CMS, through OASIS C, is driving evidenced-based processes. Home Health Agencies are charged to screen patients for risk in skin condition, depression, pain, falls. SOB, depression, and anxiety are considered very strong risk predictors for outcomes. In the near future, outcomes are expected to be tied to referral potential and payment reality.

Evidenced-based processes are advanced by standardized assessment tools. These measureable assessment tools are enhanced when used in conjunction with well captured patient data. That means completing an OASIS data set thoroughly and accurately. Changes in OASIS coupled with impending RAC audits should be an impetus to agency leadership to effect powerful change and/or review in their organization. Clinical accountability for timely documentation, attending educational sessions, and case conferences are essential to maintaining skill sets and excelling to achieve improved patient outcomes. Streamlining processes becomes vital.

Clinicians require a thorough knowledge of how to answer each of the OASIS M question. As adult learners, they will naturally want a better understanding of the big picture conceptual changes and how the new evidence tools will drive care quality. They may ask for more education as to how to assign risk. This is where algorithms and protocols play a part in quality care. Agencies need to establish “next steps” in care; a falls risk score of 10 may trigger a physical therapy referral or weekend hospital discharges may mean an admission to home care is completed that same day instead of the agency routine policy of “within 24 hours”.

OASIS C has the potential to measurably improve clinical excellence and increase consumer value but, assisting clinicians to embrace the change can still be challenging. One facet to review regarding clinician efficiency and accuracy is having the right tools. Having a tool designed by home care clinicians that flows through a head to toe assessment, that triggers clinician care planning, that allows for additional screening tools to be available is essential. Also, consider providing coding support for the clinician.  We all know that for the average home health agency, the home health nurse is an excellent clinical generalist, not having the luxury to specialize in one diagnostic area. (And many nurses state that is one reason they enjoy homehealth). But in the area of coding, providing coding expertise is an essential part of risk management.

OASIS C may be the impetus for transformational change for the industry. It has morphed from a mere data collection tool to a process oriented tool that requires the clinician to create a highly comprehensive client/patient-centered plan of care with a diagnosis code table of contents and evidenced –based care with expected outcomes. In the very near future, those outcomes are expected to be linked to patient/client satisfaction ratings and agency reimbursement. CMS is well on its way to expanding processes that have publicly reported measures solidly supported with evidenced – based practices. Those practices begin with tools to aid the clinician in gathering accurate data…efficiently.

Susan Carmichael
MS, RN, CHCQM, COS-C
Fellow of the American Institute for Healthcare Quality

So much of successful therapy requires healthy displacement of internalized anger. The RN therapist frequently uses words, supportive counseling, or cognitive restructuring action plans. The OT leans toward activities. Adults enjoy activities, especially when they build ego strength or divert or displace hostility in a more acceptable manner. Plus, did you ever notice that it is sometimes easier (and sometimes safer) to talk when active? OTs can assist with stress management, anger/conflict management, basic living skills, relaxation strategies, and grief counseling. They are usually comfortable using the mini-mental status exam and the geriatric mood assessment. Of course, the team must agree on which tools will be used and be certain all members are proficient in their use to reduce inter-rater reliability issues and promote optimal effectiveness. Both RNs and OTs model relationship skills with patients and families to promote patient goal achievement. Both disciplines model interpersonal and communication skills and respond effectively to conflict and complex issues in coordinating services. So, when you are considering your home health psych team, consider OT. They add another dynamic dimension.

Susan Carmichael
MS, RN, CHCQM, COS-C
Fellow of the American Institute for Healthcare Quality