Case managers must encourage compliance

Agencies won’t keep noncompliant patients

This is to put you on notice that if your Medicare patients are noncompliant, they might be discharged from home care. Noncompliant patients may include those who are not following their special diets or their doctor’s plan of care.

Noncompliant patients also may include those who claim to be homebound but are still able to attend church each week. (For additional information about how case managers can boost compliance, see Case Management Advisor, June 1998, pp. 93- 100; 105.)

Home health agencies must often make difficult choices about these types of patients, says Michael Walker, administrator of Contin uing Care Home Health Services in Harrisonburg, VA.

Physicians are notified

Clients often must make difficult decisions, Walker says. "The agency is left with the choice of trying to abide by Medicare’s strict regulations or meeting the client’s needs. What we see happening more and more is where someone may better be served in an outpatient facility; or when they need to be seen by a doctor, they stay at home and think home care will take care of them for as long as possible."

Continuing Care Home Health Services addresses this issue with a policy that includes notifying physicians when a noncompliance issue arises. Home care employees document all communication with the physician and with patients.

Then the agency contacts the patients and gives a reason and date when services will be terminated. This is followed up with a letter. The agency also may give patients information about other home care agencies or community resources that could help.