What to do when the agency is beyond the help of a QA?

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I was asked to review some charts and begin a QA department for a Home Health Agency. They have not had any QA at all prior to my arrival.

Frankly, I have done this before, and maybe I am burned out, but it is such a mess that there is nothing I can do for them. I have seen situations like this before and walked away, however, that was in a better economic environment. I have told agencies before that there was nothing I could do for them. Maybe I am giving up too soon, but this is a real disaster.

The entire agency needs to be rebuilt from the ground up. The Director has no clue about the content of their policies.

I need the job and it will be hard to find another one in the area I live in, but this is beyond my ability. I don't know anyone who would take on such a situation. (This includes other QA and consultants.) I have previously done electronic charts for QA and coding for agencies when the consulting firm would not send any more staff into the building, so I have seen some very difficult situations.

To make matters worse, the Director is burned out, has an angry attitude and is very vocal about her own situation. I do not blame her. If I were in her shoes I would have been gone a long time ago. This makes it very difficult to work with her towards solutions to the serious problems they are facing.

I am seeing this as a turning point for me. I do not ever want to do QA again. The problems in this agency are so serious that I can't even look at the work in front of me.

Any suggestions would be appreciated, keeping in mind that finding another job is very difficult where I live.

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Specializes in Functional Medicine, Holistic Nutrition.

I know this was posted several months ago- Did you resolve the issue? Is it very common to come across agencies that have no QA/QI? I work in home health and I can't imagine this...my agency has a very active QI department and I am still appalled by what I see on a daily basis during chart reviews...

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I know this was posted several months ago- Did you resolve the issue? Is it very common to come across agencies that have no QA/QI? I work in home health and I can't imagine this...my agency has a very active QI department and I am still appalled by what I see on a daily basis during chart reviews...

I'm still plugging away at this, but it is one step forward, 3 steps back.

If the QA is appalled by what is seen on a daily basis during chart reviews, what chance does the agency have to survive audits and changing reimbursement qualifications? I just don't see any way for this agency to survive. One RAC audit and they will be gone.

The owners listen to me and agree and then do the opposite.

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Specializes in Long term care-geriatrics.

You need to do inservice training to try to get the nurses to understand what the problem is. Once they have had training per your expectations, then you need to look at terminating a person who is not willing to change. I know you don't want to terminate someone, but if they continue to fail your expectations, which are the expectations of passing an audit, the person needs to leave. Good luck.

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You need to do inservice training to try to get the nurses to understand what the problem is. Once they have had training per your expectations, then you need to look at terminating a person who is not willing to change. I know you don't want to terminate someone, but if they continue to fail your expectations, which are the expectations of passing an audit, the person needs to leave. Good luck.

We had one "untrainable" nurse who is now gone. All staff have had extensive inservices and training. Most of our cases are PT. The owner is the PT. That is the problem. The nurses won't stay because the referrals are mostly noncompliant, substance abuse and in the worst neighborhoods.

Too many problems. Time to move on. Thanks for the luck.

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Specializes in Long term care-geriatrics.

So most of the type of patients you have are physical therapy patients? A physical therapy person owns the home health company. As long as the nurses are documenting that the patients are noncomplient and they continue to try to teach the patients that their behavior is inappropriate then there should be no problems. All of these problems need to be care planned and be clear. There is only so much that the nurses can do. The director of nursing probably feels like she is swimming up stream. Again good luck

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The last 2 DONs left. They just hired another one. I turned down the job at least 20 times.

Medicare has issues with noncompliance and reimbursement.

Doctors are sending weird referrals. For example Wound as a diagnosis. When we see the patient there is no wound at all and they send in therapy. ADRs and RAC audits will find all of this mess.

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