Supervisory visits

[metalRN]

Hello,

I work at a small rural home health agency. For patients with aides, the RN usually sees the patient every other week for a supervisory visit.

My question is, what if the sup visit is due, and the patient is out of town? What are the Medicare guidelines? Do you get the visit as soon as the patient returns, even though it is past the 14 days? How does your agency handle this?

Thanks!

[KateRN1]

Why is the patient out of town? I would be questioning homebound status as well as the need for a HHA if the patient is out of town long enough to prevent a supervisory visit.

[cathrn64]

I agree, if the pt can go out of town, why is homecare still in? Is this a private pay pt? If it is I would check with your supervisor At one time I worked for an agency that did private duty pt's, which than wouldn't have to be homebound. Illinois rules state the supervisory visit needs to be every 14 days

[metalRN]

The patient is out of town for an MD appointment. He is most definitely homebound, has dialysis 3x per week, and is an amputee.

So if a sup visit is due, but pt is out of town for MD appt, then what?

[KateRN1]

How long is the patient out of town? If you can't get in to do a sup visit, then how is the aide getting in to be suped? Do it as soon as the patient comes back and document very carefully that patient's absence.

[Lacie, BSN, RN]

If pt out of town we DC. What if he needs care while out of town? Then what. We D/C then readmit on return. Yes sometimes homebound patients will go to family homes for a week or so to tie up loose ends most of the time. But we never put anyone on a "hold" status. If vacation or a cruise definitely DC and we dont readmit unless they are definitely homebound

[KateRN1]

We definitely don't d/c for a patient who is out of town for a dr's appt. We have lots of folks who go 150+ miles to the VA hospital and stay overnight, or several nights, for testing and appointments. We may have missed visits, but they are documented accurately as missed d/t physician appointment. It's not a hold status, but not seen as any different than if the patient was seeing a local dr.

[jnette, ASN, EMT-I]

Ditto ! :)

[CFitzRN, ADN]

Every other WEEK?? Holy cannoli. I'm a Clinical Supervisor and I see our patients with HHAs every 60 days. I think we have about 65 CNA (Medicaid) cases. I can barely keep up with THESE ones! My visits are fairly extensive though, so I can only do about 5 per day. I have to spend time in the office doing case mgmt and paperwork, follow up calls, etc, so I average about 1.5 days of sups per week. That's out of only 3 days worked per week (they can't afford me full-time)...

[metalRN]

Every other WEEK?? Holy cannoli. I'm a Clinical Supervisor and I see our patients with HHAs every 60 days. I think we have about 65 CNA (Medicaid) cases. I can barely keep up with THESE ones! My visits are fairly extensive though, so I can only do about 5 per day. I have to spend time in the office doing case mgmt and paperwork, follow up calls, etc, so I average about 1.5 days of sups per week. That's out of only 3 days worked per week (they can't afford me full-time)...

Medicare regulations state a sup visit must be done every 14 days, so who does these visits? Another RN? I feel for you with 65 patients... I usually have a caseload of 25-30 patients that I'm case manager for, and that gets difficult with all the sups (HHA and wounds), recerts and admissions.

[HmarieD]

Any way you can do the sup visit early? The CoPs just state that the SV must be no less frequently than every two weeks. You would be in compliance if they were done more frequently.

[CFitzRN, ADN]

Oh, that's the difference. We are not a medicare agency - only medicaid. And since our clients have DSS case managers, we, as the agency of the HHA, only have to do sups every 90 days per state law. We do every 60 though by choice. If I go over a few days, I'm still okay because state law mandates no less than every 90. Despite the fact that these clients have a DSS case worker, I find I do a LOT of case management anyway.