Distinguishing the Origins and Causes of Problematic Transitions
MDS 3.0 Insider; http://www.hcpro.com; 7/26/13

Distinguishing the Origins and Causes of Problematic Transitions MDS 3.0 Insider; http://www.hcpro.com; 7/26/13 Great communication between suppliers builds the likelihood that a person will get essential consideration and training to address his or her issues amid the move from doctor's facility to long term care office (LTCF) (or the other way around). Truth be told, deficient correspondence has been recorded as a central point for doctor's facility readmissions. Healing centers point the finger at LTCFs and LTCFs, reprimand clinics for deficient correspondence and absence of data. In some cases both sides confuse the Health Insurance Portability and Accountability Act rules, trusting the other party is not qualified for the patient's therapeutic data. This further confounds a troublesome circumstance.

LTCF concerns At the point when data is missing, LTCF medical caretakers experience issues checking the inhabitant's condition. Numerous LTCFs get inhabitants with:

Incomplete or missing findings

No history and physical or release outline

No advance mandate data or code status

Missing or deficient solution records

No stop dates for time-restricted requests, for example, anti-infection agents

Missing lab and x-ray test comes about; no notice of noteworthy tests with results pending

No directions for unique systems, for example, complex health care devices or wound care

Lack of directions and data for subsequent arrangements, lab tests, and x-rays

Orders that are doubtful for the LTCF setting

New contaminations and/or pressure ulcers

Physician concerns

Another issue is that a hospitalist (a physician whose practice is devoted to treating patients in a hospital setting) or other specialist may care for the resident in the hospital. The treating physician has little or no contact with the facility attending. There is often no hand-off from one physician to another. Written records, discharge summaries, and diagnostic testing are often not sent to the attending physician who cares for the resident in the facility. Other issues include:

The insurance may require a change of physician.

The insurer may require hospital discharge before the person is ready.

The medical director or other facility physician accepts the resident from another setting and is not familiar with the person’s needs; little to no information is sent with the resident.

The resident has dementia and/or is a poor historian. The attending physician is not familiar with the resident or her history.

The physician phones a prescription to the pharmacy, such as a schedule II drug. The pharmacist advises the physician to fax the order. The physician is not in the office and has no access to a fax.

Physicians are paid more for caring for patients in the hospital. They fear their bills will be denied if they visit a LTCF resident more than once in 30 days. ?The federal regulations specify that nursing home patients must be seen by a physician at least once (not only once) every 30 days for the first 90 days, then every 60 days thereafter.

Medicare does not limit physician visits to nursing facility residents as long as the visit is reasonable and necessary.

At times, some fiscal intermediaries have imposed arbitrary limits on payment for physician visits. A 2001 Institute of Medicine (IOM) report recommended removal of “arbitrary limits set by fiscal intermediaries on the number of [nursing home] visits.” They noted that Medicare (and Medicaid) regulations for physicians’ services in nursing homes should allow the number and type of services provided to be based on each resident’s medical needs and the severity of their illness.

It is easier for physicians to care for hospital patients. The doctor has a wide variety of diagnostics immediately available. He or she can make rounds and see a number of patients fairly quickly. ?Physicians are available 24 hours a day in the hospital to care for unstable patients and emergencies.




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


Feb 3, 2008

The Interdisciplinary Team; The Role of the Psychiatrist

by Dr. Leo J. Borrell, featured in Assisted Living Consult for November/December 2006. A HealthCom Media Publication