We are working towards transitioning our EMR and the implementation team is suggesting that our various Complimentary Therapists - Healing Touch, Music and Massage Therapies do not require "visit frequencies" like RNs, MSWs, etc. They have set up those discipline interventions and visit frequencies go on the POC which the Hospice Medical Director signs every 2 weeks during IDG meetings. I see this practice as raising concerns when we are surveyed by MDH. Do you have any recommendations?
Responses:
Depending on your software provider, I would assume this is referencing “mandatory/default” frequencies. Seeing as complementary therapies are not medicare required would allow this to be accurate. I would recommend verification of definition to your EMR vendor first. I have not seen a software that doesn’t generate frequencies (as ordered by physician) for any and all disciplines, so specificity of this question needs further explanation
I agree…. Massage, music doesn’t require a MD order, but many software programs require a frequency as referenced in the care plan. It does allow for a more accurate internal audit of services. According to the COP’s you can use a range if your EMR can accommodate this. I hope you have this flexibility. Interpretive Guidelines §418.56(c)(2)
The use of visit ranges in the patient plan of care should follow these parameters:
• The plan of care may include a range of visits and ’provide as needed’ orders for visit frequencies to ensure the most appropriate level of service is provided to the patient.
• A range of visits is acceptable as long as it continues to meet the identified needs of the patient/family.
• Visit ranges with small intervals are acceptable (i.e., 1-3 visits/week; 2-4
visits/week) but ranges that include “0” as a frequency are not allowed.
• The IDG may exceed the number of visits in the range to address patient/family’s
needs. There should be documentation in the record to support the need for the extra visit(s).
If the patient requires frequent use of PRN visits, the plan of care should be updated to include the need for additional visits. The complementary therapy visit frequencies in the Plan of Care as an intervention, not specifically an order for visit frequencies. The hospice program I currently work with adds them as orders for visits. I’ve worked with these hospice programs during their MDH state & Federal survey and neither was cited.
