Survey suggests physicians and Medicare skilled home health care clinicians lack interaction

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. About 80% of physicians seldom or never communicated with skilled home health care (SHHC) clinicians about information on the Centers for Medicare & Medicaid Services form 485 (CMS-485) or made modifications to any orders on the form.

2. Almost half of physicians spend no more than one minute reading the CMS-485 prior to certifying the plan of care.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Care coordination is an important part of SHHC services for Medicare recipients. The SHHC clinician uses the CMS-485 to communicate with physicians regarding a plan of care for the Medicare recipient that the physician must certify. The authors of this study surveyed physicians in order to analyze how physicians work with SHHC agencies and utilize the CMS-485 to coordinate care for patients getting SHHC.  The authors found that the CMS-485 does not engage physicians on a meaningful level.  Almost half of physicians spent no more than one minute reading the form prior to certification. About 80% of physicians seldom or never communicated with clinicians from SHHC about the CMS-485 or made modifications to any orders on the CMS-485.  These findings suggest that a better method of communication for care coordination between physicians and SHHC clinicians is needed.

A strength of the study is that it used a nationally representative random sample.  Limitations of the study included the use of data that was self-reported, and a response rate of 53%.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Home health care: nurse–physician communication, patient severity, and hospital readmission

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In-Depth [survey]: Researchers sampled 2 000 physicians at random from the American Medical Association Physician Masterfile.  Residents were not included.  Physicians meeting inclusion criteria were specialists in family or general medicine, hospice and palliative medicine, internal medicine, geriatrics, or geriatric psychiatry.  Using the Dillman tailored design method, a 25-question survey was mailed to physicians during June 2014.  After three mailings, 1 044 of 1 968 survey recipients (53%) had responded.  Respondents who did not provide direct patient care or did not answer the question were excluded.  Of the 1 005 physicians who reported providing direct patient care, 72% had certified 1 or more plan of care within the last 12 months.  Many physicians (47%) spent no more than 1 minute reading the CMS-485 prior to certification, and 21% spent 2 minutes or more.  Many physicians never (22.4%) or rarely (55.8%) contacted SHHC clinicians regarding information on the form.  In addition, many physicians never (24.2%) or rarely (55.3%) modified any orders on the form.  Many physicians supported various ideas regarding how to improve the CMS-485, including a new layout, larger font, making crucial actionable clinical information more easily read, making it easier to contact SHHC staff, and improving the delivery method for receipt and return of the form.

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