Improve relationship with physician office staff

Ask for preferences before signatures

All you need is a signature. The challenge is tracking down the physician, getting him or her to review your plan of care, and getting the document back into your records within the time frame allowed by Medicare.

Hospice and home health agencies of all sizes struggle with this issue, but it is an ongoing issue for all, admits Trish Tulloch, RN, BSN, MSN, HCS-D, senior consultant for RBC Limited, a Staatsburg, NY-based home health consulting company. "Home health nurses talk with physicians by telephone to update medications or adjust plans of care, but the phone calls only result in interim orders," she says. "A signed form acknowledging the change or approving the plan of care is necessary."

To make it easy for physicians, Tulloch recommends a standard form that includes current diagnosis, medications, and other information you need the physician to approve. "I like having a standard form that faxes easily, so it can be returned to the home health agency quickly," she says.

A personal relationship with physician office staff members also is important, says Denise Cook, RN, quality assurance and quality improvement coordinator for South Davis Home Health in Bountiful, UT. Because the majority of forms that require physician signature are mailed, a mail log is maintained to show when the forms were mailed and to indicate if the form has been returned, she says. "If a form doesn't come back in a timely manner, our staff members follow up with the physician's office staff," she says.

Some physicians who are typically slow to return forms will have their forms hand-delivered to their office, points out Cook. "Most of our physicians are close to our office, so it is not a burden to hand-deliver the forms, and the personal visit establishes a rapport with the physician and the physician's office staff," she explains. "We take the forms in a folder that is clearly marked as home health, and we ask the physician when we should return for the signed forms," she says. The physician places the signed forms back in the folder, and the home health staff member returns on the designated day. "Physicians are more likely to pay attention to the form and not set it aside if they know that someone will be back to pick it up," she explains.

Patricia Burke, RN, director of clinical services and operations for Caritas Home Care in Norwood, MA, says, "We always check to see how the physician wants us to send forms for his or her signature." Physicians may express a preference for faxed forms or mailed forms, she says. "We also ask if they want us to hold everything for several days or a week and send a batch of forms at one time," Burke adds.

It is also important to designate one person to be responsible for follow-up with physician offices, says Burke. "We have a 95% return rate within 30 days, and I believe that part of the reason is the personal relationship that our health information manager that handles this responsibility has developed with the different office staffs," she says. If follow-up is necessary, the agency staff person knows who to call, Burke adds.

One feature of her agency's software system that has not yet been used is the ability for physicians who are tied into the health care network to view forms and sign them online, says Burke. "This is a feature we would like to test for use in the future," she says.