Caring, Comprehension, and Coding: Webinar Speaker Seeks To Boost Confidence, Ease Worries
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Physicians and other post-acute/long-term care (PALTC) practitioners want to do the right thing, but keeping up with changing rules and regulations within the industry can be challenging. In an upcoming Society webinar, “Malpractice in Nursing Homes/Legal Aspects in Nursing Home Care,” on October 25, Society Past-President Jonathan Evans, MD, MPH, CMD, will share updates of regulations that govern physician practice and what is expected of practitioners and facilities. He will also explain how understanding all of this can help prevent malpractice/legal worries and woes.
Regulations change over time and new rules come into play. “As practitioners, we contract with Medicare and Medicaid; and when those contracts come up for renewal, the terms may change. The recently revised Requirements of Participation are an example of such a change,” Dr. Evans says. He will help his audience understand what the new Requirements of Participation mean to them and what revisions impact them and how. He will also talk about issues that are always challenging for practitioners—billing and coding and ordering therapy services. “If you understand the rules, it’s easier to do the right thing,” he says.
When it comes to coding, many practitioners worry about using the right codes and not over coding. Dr. Evans will seek to ease some of their fears. “Documentation is critical. Each code represents a package of services, and the services you provide need to match medical necessity in frequency and intensity,” Dr. Evans says. As for ordering therapy services, he says, “Facilities have gotten into trouble when they’ve provided therapy services of an intensity that is later criticized as being too high or for a duration that isn’t deemed medically necessary. The goals of treatment need to be reasonable and appropriate.” It has to do with the baseline level of functioning, he suggests. If the patient could walk 10 feet before he/she went into the hospital, a rehab goal of getting the person to walk 10 feet is reasonable. A goal of getting them to walk 50 feet might not be. Again, documentation is key.
A major cause of lawsuits and complaints has to do with surprises—the difference between what someone expects and what they get, Dr. Evans notes. He says, “In our field, people often sue for emotional reasons. A common theme of lawsuits is when there is a bad outcome and people feel ignored or dismissed.” The key to minimizing this is good communication with patients and families. It is important, he says, not to appear to blame patients for problems they didn’t cause or feel that they didn’t cause.
Dr. Evans has always had a great passion for making patients feel cared about and respected. With his big heart and deep compassion for others, it shouldn’t surprise anyone to learn that before he became a physician, Dr. Evans worked briefly as a clown. “I was a card-carrying member of Clowns of America. I worked with some retired circus clowns and performed at children’s parties and other events.” He adds, “My motivation was the same as it is now—to help people feel better.” He notes, “The makeup I wore as a clown was similar to the white coat I wear as a physician. People respond to these costumes in a trusting way; and I realized early on that I wanted to earn that trust.” Working as a clown, he adds, “I also learned that people needed things in health care settings that they weren’t getting from practitioners. There is always something we can do to help people feel better.”