Cynthia M. Boyd, MD, MPH; Bruce Leff, MD; Julia Bellantoni, BS; Navpreet Rana, DO; Jennifer L. Wolff, PhD; David L. Roth, PhD; Kim Carl, RN; Orla C. Sheehan, MD, PhD
Acknowledgment: The authors thank Jon Tilburt, MD, MPH, for his advice on physician surveys and Debbie Statom for her invaluable help with survey administration.
Financial Support: Dr. Boyd was supported by the Paul Beeson Career Development Award Program: National Institute on Aging 1K23AG032910, the American Federation for Aging Research, the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation, and an anonymous donor. Dr. Wolff was supported by National Institute of Mental Health grant K01MH082885. Dr. Rana was supported by the University of New England College of Osteopathic Medicine Peter Morgane Fellowship. The study was also supported by the Johns Hopkins Bayview Center for Innovative Medicine.
Disclosures: Several members of the research team have been developing an informatics tool, based in part on the survey results reported in this article, to improve communication between their institution's nonprofit home health care agency and primary care physicians. This related work received funding from the National Institutes of Health. Dr. Boyd reports a grant from the National Institute on Aging Roybal Center outside the submitted work. Dr. Leff reports personal fees from Landmark Health and other support from Honor outside the submitted work and is a member of the Board of Directors of the Alliance for Home Health Quality and Innovation, the Board of Directors of the American Academy of Home Care Medicine, and the Editorial Board of Annals of Internal Medicine. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2219.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Boyd (e-mail, firstname.lastname@example.org). Data set: Not available. Requests to reuse the data would need to be approved by the Institutional Review Board at Johns Hopkins University.
Requests for Single Reprints: Cynthia M. Boyd, MD, MPH, Center for Transformative Geriatric Research, 5200 Eastern Avenue, MFL 7th Floor Center Tower, Baltimore, MD 21224; e-mail, email@example.com.
Current Author Addresses: Dr. Boyd: Center for Transformative Geriatric Research, 5200 Eastern Avenue, MFL 7th Floor Center Tower, Baltimore, MD 21224.
Dr. Leff: Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, Center for Transformative Geriatric Research, 5200 Eastern Avenue, Mason F. Lord Building, Center Tower, Suite 700, Baltimore, MD 21224.
Ms. Bellantoni: Office of Student Affairs, Duke University Medical Center, Box 3005, Durham, NC 27710.
Dr. Rana: Guthrie Robert Packer Hospital, Department of General Surgery, 1 Guthrie Square, Sayre, PA 18840.
Dr. Wolff: Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 692, Baltimore, MD 21205-1996.
Dr. Roth: Johns Hopkins Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, 2024 East Monument Street, Suite 2-700, Baltimore, MD 21205-2223.
Ms. Carl: Johns Hopkins Home Care Group, 5901 Holabird Avenue A, Baltimore, MD 21224.
Dr. Sheehan: Johns Hopkins Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, 5200 Eastern Avenue, Mason F. Lord Building, Center Tower, Suite 700, Baltimore, MD 21224.
Author Contributions: Conception and design: C.M. Boyd, B. Leff, N. Rana, J.L. Wolff, K. Carl, O.C. Sheehan.
Analysis and interpretation of the data: C.M. Boyd, B. Leff, J. Bellantoni, J.L. Wolff, O.C. Sheehan.
Drafting of the article: C.M. Boyd, B. Leff, J. Bellantoni, N. Rana, O.C. Sheehan.
Critical revision of the article for important intellectual content: B. Leff, N. Rana, J.L. Wolff, D.L. Roth, K. Carl, O.C. Sheehan.
Final approval of the article: C.M. Boyd, B. Leff, J. Bellantoni, N. Rana, J.L. Wolff, D.L. Roth, K. Carl, O.C. Sheehan.
Provision of study materials or patients: C.M. Boyd, N. Rana.
Statistical expertise: D.L. Roth.
Obtaining of funding: C.M. Boyd, N. Rana, D.L. Roth.
Administrative, technical, or logistic support: B. Leff, J.L. Wolff.
Collection and assembly of data: C.M. Boyd, B. Leff, J. Bellantoni, N. Rana, O.C. Sheehan.
Physicians are required to certify a plan of care for patients who receive Medicare skilled home health care (SHHC) services. The Centers for Medicare & Medicaid Services form 485 (CMS-485) is typically used for certification of SHHC plans of care and for interactions between SHHC agencies and physicians. Little is known about how physicians use the CMS-485 or their perceptions of its usefulness with respect to coordinating care with SHHC agencies.
To determine how physicians interact with SHHC agencies and use the CMS-485 in care coordination for patients receiving SHHC services.
Nationally representative random sample.
Physicians from the American Medical Association Physician Masterfile specializing in family or general medicine (excluding adolescent and sports medicine), geriatrics, geriatric psychiatry, internal medicine, or hospice and palliative medicine.
Time spent reviewing the plan of care and experiences with making changes and communicating with SHHC clinicians.
The response rate after 3 mailings was 53% (1044 of 1968). Of 1005 respondents who provided patient care, 72% had certified at least 1 plan of care in the past year. Nearly half (47%) reported spending less than 1 minute reviewing the CMS-485 before certification, whereas 21% reported spending at least 2 minutes. Physicians typically interacted with multiple SHHC agencies by fax or mail. Approximately 80% rarely or never changed an order on the CMS-485, and 78.3% rarely or never contacted SHHC clinicians with questions about information. The mean reported ease of contacting the SHHC agency was 4.7 (SD, 2.3) on a scale of 1 (easy) to 10 (difficult).
Self-reported data and 53% response rate.
The CMS-485 does not meaningfully engage physicians. Physicians spend little time reviewing or acting on the SHHC plan of care. Strategies to enhance meaningful communication between SHHC agencies and physicians are needed.
National Institute on Aging and National Institute of Mental Health.
Boyd CM, Leff B, Bellantoni J, et al. Interactions Between Physicians and Skilled Home Health Care Agencies in the Certification of Medicare Beneficiaries' Plans of Care: Results of a Nationally Representative Survey. Ann Intern Med. 2018;168:695–701. [Epub ahead of print 3 April 2018]. doi: https://doi.org/10.7326/M17-2219
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Published: Ann Intern Med. 2018;168(10):695-701.
Published at www.annals.org on 3 April 2018
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