Longitudinal Charting in Home Health Care

Home health agencies have had longitudinal charting looming like a shadow over their operations. On one hand, implementing a longitudinal charting methodology makes it easier to track care activities in more nuanced and specialized ways, leading to potential quality and transparency improvements within an agency. On the other, the extra time and attention that goes into documentation with a longitudinal chart methodology can be intimidating for agencies already facing regulatory challenges and pressures.

According to a Home Health Tech Report article, agencies have faced significant pressure around ADR requests and even handling Probe and Educate processes. In some cases, agencies have also had to contend with a ZPIC pre-payment review. These types of challenges have left agencies maintaining typical check-box charting procedures, something that is becoming problematic.

Moving Beyond Check Boxes
The news source explained that CMS is increasingly expecting longitudinal charting when they analyze home health agency operations. This represents a major problem for agencies for one simple reason – longitudinal charting has long been recommended, but rarely been enforced. Initial CMS guidelines favoring longitudinal charting go back to 2015, but it hasn’t been putting pressure on agencies to adapt. That’s changing. As a result, agencies now may be facing pressure to adopt new charting methodologies, but be forced to do so without the usual notice and adjustment period that comes with regulatory changes.

All told, the issue has become so acute that an agency using check-box charting methodologies may be much more likely to end up facing a ZPIC investigation than those using longitudinal charts, the report said. Because of this, organizations should begin adapting their charting procedures immediately to apply longitudinal principles to operations. This means not leaving vague notes about patients. The CMS recommends avoiding such language as “Patient tolerated treatment well” because it does not describe the care strategy and situation thoroughly. Instead, the CMS wants charts to follow the follow criteria:

“Clinical notes should be written such that they adequately describe the reaction of a patient to his/her skilled care. Clinical notes should also provide a clear picture of the treatment, as well as ‘next steps’ to be taken,” CMS documentation cited by Home Care Tech Report stated.

At their core, care notes should build on one another, demonstrate the medical justification for practices taking place, and establish how procedures fit within care strategies. Documenting care in greater detail doesn’t have to be a huge time burden. Instead, strategic health IT innovation can lay the groundwork for efficiency.

Using health IT innovation to enable longitudinal charting
Research from The American College of Obstetricians and Gynecologists published in full by New York City High Tech pointed out that organizations that focus on health care IT advances position themselves for improvements across a variety of areas of operation. These include:

  • Patient adherence monitoring
  • Treatment plan recommendations
  • Reminders and alerts for patients and physicians
  • Longitudinal charting of risk factors

In many care settings, the complexity of documenting and distributing data makes charting methodologies problematic. Implementing advanced electronic health record systems can help agencies streamline data entry procedures and allow care providers to more easily share information with stakeholders. When combined, these capabilities allow home health providers to apply longitudinal charting without putting as great a burden on staff, allowing the potential care gains of the documentation method to shine through. As agencies consider the urgency of adopting longitudinal charting, they must also think about how they can use technological innovation to smooth the transition.

CMS is taking a hard look at your home health clinical documentation. And with the new CoPs coming, this type of scrutiny will only continue to grow. firstHOMECARE with CAREpliance care planning technology ensures consistent clinical documentation, reducing your risk of incompliance, audits, denials, and takebacks. No home health agency should document without it. Contact us to schedule a personalized demonstration for your agency today.

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