A long-established outcome measure for home health, the Timely Initiation of Care Outcome Measure, seems to have some uncertainty surrounding it that we’d like to clear up.
The Timely Initiation of Care Outcome Measure is determined using the dates recorded in the OASIS document. The calculation starts with the facility discharge date. However, if the referral date occurs after the discharge date, the referral date will be used instead, following the guidelines outlined in the official manual regarding valid referrals.
A valid referral requires confirmation of a physician who will oversee the patient’s care and sign orders for home health services. Therefore, the referral date should reflect the day this physician’s commitment to the patient’s care is officially confirmed.
The survey issue that has arisen includes the requirement that if a referral is received, even over the weekend, the Start of Care must be initiated within two days, and the patient must be seen. Efforts must also be made to contact the physician and confirm their commitment to overseeing the patient’s home health care, regardless of the day.
Surveyors are not considering the referral requirement or physician confirmation when assessing timely initiation of care for a survey deficiency. If a referral is received over the weekend, efforts must be made to contact the physician or ensure someone in their office can assist in confirming the patient’s admission to home health.
One allowable exception is when a physician issues an order specifying a Start of Care date for the patient. In this case, the 48-hour window is calculated from the designated date. However, if the specified Start of Care date cannot be met, an additional order from the physician is required to make any changes to the originally ordered date.
To clarify, the outcome measure considers the facility discharge date and the referral date. If the referral date is later, which is usually the case, it will be used. However, if a physician has explicitly specified a Start of Care date, that designated date will be used for the Timely Initiation of Care calculation.
For survey purposes, the date used will be either the documented referral receipt date or a specifically designated Start of Care date. This means that if a physician assigns a Start of Care date for Monday, you would not receive a deficiency for not seeing the patient within two days of receiving the referral on a Friday night, Saturday, or similar timeframe.
It is essential to understand that surveyors expect a patient to be seen within 48 hours of receiving a referral unless a physician has provided a specific Start of Care date. Your organization must have processes in place to ensure timely contact and confirmation with physicians for all referrals. This is crucial to avoid citations and to ensure that your outcome measure is accurately and effectively calculated for both your organization and your patients.
Healthcare Provider Solutions is here to support you with any survey-related concerns or outcome measure calculations you may need assistance with. If you require assistance, please reach out to us.
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