Namaste Home Health Protocol/101
6000 E Evans Ave, Suite 2-400
Denver, CO 80222
(303) 730-3578
Documentation: Pointcare/HomeCareHomeBased, EVV included in tablet, SOLI signature required
Billing: Alpine Kinnser
***Please email scheduling@Namaste-Health.com for scheduling requests or assistance with plotting visits. Agency goals are to decrease rehospitalization, document 80% of the information in the tablet while with the patient for accuracy, great communication - so please call the agency for POC approvals after every eval or SOC, for request to recert etc. This agency will only accept COVID vaccine cards and medical exemptions.
CONTACTS:
Scheduling: "Namaste-Scheduling" <scheduling@Namaste-Health.com> Please email this group with any scheduling requests. Group: Jessica DiGiacomo, Chelsea Knight, Jacynta Myers
Records: "Namaste Medical Records-DL" <Records@namaste-health.com> Please use this for any uploads to patient chart or requests for records, Group: Jacynta Myers
Office: "Namaste-Office-DL" <office@namaste-health.com> Please use this for any supply/equipment needs for bag and patient care, Group: Jacob Short, Yuliya Veen
Orders or clinical needs: You can email courtney.whitt@namaste-health.com or tiger text on your tablet is secure if you don't have a secure email or 7203576081 (work #) or 9704020377 (personal #). If no text or email options feel free to contact the office at 303.730.3578
Namaste COVID 19 Patient Guide
Namaste Admission Support Documents
Namaste COVID Teaching Disease Management Guide
Namaste HH Admission Combined Documents
Example Documentation/Narrative Note Expectations:
PT SOC:
PT IS A 75 YO MALE REFERRED TO HHPT S/P PLANNED SURGERY FOR R INGUINAL HERNIA REPAIR ON 9/10/21. PATIENT WAS DISCHARGED FROM HOSPITAL TO INPATIENT REHAB SECONDARY TO POST OP WEAKNESS AND INSTABILITY. PATIENT WAS DISCHARGED HOME FROM REHAB WHERE HE LIVES WITH ROOMMATE. ONCE IN HOME, ALL PATIENT'S NEEDS ARE MET ON MAIN LEVEL. PATIENT REPORTS HE IS FEARFUL OF FALLING ON STEPS TO ENTER/EXIT HOME AND FEELS LIKE HE IS MORE FORGETFUL THAN BEFORE SURGERY. PATIENT HAS FWW BUT IS NOT USING AT TIME OF EVALUATION, REINFORCED USE SECONDARY TO INCREASED FALL RISK AND FURNITURE GRABBING IN HOME. PATIENT DEMOS INCREASED INSTABILITY AND POOR INSIGHT INTO DEFICITS, REQUIRES SIGNIFICANT CUEING FOR SAFETY AND STABILITY WITH NEGOTIATION OF HOME ENVIRONMENT. PT HAS FOLLOW UP WITH SURGEON ON 11/4/21 AND HAD STAPLES TAKEN OUT EARLIER THIS WEEK. PLOF: INDEPENDENT WITHOUT AD IN HOME, DID NOT DRIVE, MANAGED OWN MEDS AND ADLS WITHOUT ASSIST OR EQUIPMENT, PT RECEIVES MEALS THROUGH PROJECT ANGEL HEART. PMH: DM II, B INGUINAL HERNIA, HLD, MEMORY LOSS.
PATIENT VERBALLY CONSENTED TO PHYSICAL THERAPY EVALUATION AND ALL CONSENTS SIGNED APPROPRIATELY BY PATIENT.
PATIENT IS CURRENTLY LIVING IN HOUSE WITH 5 STEPS TO ENTER WITHOUT RAILINGS. PATIENT HAS ROOMMATE WHO LIVES ON LOWER LEVEL, ALL NEEDS MET ON MAIN FLOOR. PT LIVES IN CLUTTERED ENVIRONMENT, HAS PROJECT ANGEL HEART ASSISTING WITH MEALS.
EQUIPMENT: FWW, RECOMMENDED: TUB TRANSFER BENCH, SPC, AND HHS - EQUIPMENT RESOURCES PROVIDED.
DYSPNEA WITH MINIMAL EXERTION ON ROOM AIR. PT REQUIRES FREQUENT SEATED REST BREAKS WITH ACTIVITY TODAY AND CUEING FOR BREATHING WITH MOVEMENT.
PAIN: PT DENIES REPORT OF PAIN TODAY, STATES SURGICAL PAIN COMES AND GOES BUT HAS IMPROVED SIGNIFICANTLY SINCE GETTING STAPLES OUT.
MEDICATION REVIEW: REVIEWED EACH MED, DOSAGE, AND INDICATION. PT IS TAKING AS PRESCRIBED WITH NEW INSTRUCTIONS FOLLOWING VISIT WITH PCP. NO ISSUES NOTED.
SKIN ASSESSMENT: NO SKIN BREAKDOWN NOTED WITH ASSESSMENT, SURGICAL INCISION CLEAN AND HEALING WITH PRIMARY INTENT.
PATIENT PRESENTS WITH DECREASED STRENGTH AND ENDURANCE, COMPROMISED BALANCE, AND UNSTEADY GAIT. PT REQUIRES CLOSE CGA TO MIN A FOR SAFETY WITH ALL TESTING AND ACTIVITY TODAY. PT COMPLETED 30 SEC SIT TO STAND WITH SCORE OF 3, INDICATING REDUCED STRENGTH. PT PRESENTS WITH TUG SCORE 35 SEC, TINETTI SCORE OF 13/28, AND BERG SCORE OF 22/56 ALL INDICATING A HIGH RISK OF FALLS. PATIENT'S MAIN GOAL IS TO IMPROVE BALANCE. PATIENT WILL BENEFIT FROM SKILLED PHYSICAL THERAPY FOR STRETCHING/STRENGTHENING HEP TO ADDRESS MUSCULAR IMBALANCES, TRANSFER TRAINING TO REDUCE NEED FOR ASSIST, BALANCE TRAINING TO REDUCE RISK OF FALLS, ENERGY CONSERVATION TRAINING TO IMPROVE ENDURANCE, AND GAIT TRAINING TO IMPROVE POSTURAL ALIGNMENT AND WEIGHT SHIFTING AND ALLOW PATIENT TO SAFELY NAVIGATE HOME ENVIRONMENT.
PATIENT WAS EDUCATED ON CALL ME FIRST CAMPAIGN AND IS AGREEABLE TO COMMUNICATING WITH CLINICIANS APPROPRIATELY.
PT POC 1WK1 2WK3 1WK3
OT 1WK1
ST 1WK1
ADD ON MSW
PT EVAL:
PT 85 YEAR OLD MALE WHO FELL AT HOME ON 9/5/21, WAS EXAMINED MULTIPLE TIMES WITH NO INJURY DETECTED UNTIL 10/4/21 PT THEN UNDERWENT R HIP HEMIARTHROPLASTY
PT LIVES ALONE IN OWN HOME WHERE HE WAS MOD INDEPENDENT TO INDEPENDENT WITH BASIC ADL, LIGHT IADL, TRANSFERS AND MOBILITY WITH THE USE OF DME AS NEEDED, DRIVING AUTO AND ACTIVE IN THE COMMUNITY PRIOR TO THIS EVENT PT DAUGHTERS ARE NOW TAKING TURNS STAYING WITH HIM DURING RECUPERATION THERE IS ONE FLIGHT OF STAIRS TO ACCESS UPSTAIRS BEDROOM AND SHOWER WHICH PT IS ABLE TO MANAGE WITH MIN ASSISTANCE 2 STEPS TO ENTER THE HOME THROUGH THE GARAGE
BARTHEL 20 FUNCTIONAL REACH 3 KATZ 0/6
PMH SIGNIFICANT FOR HLD, HTN, ARTHRITIS, CATARACTS, GLAUCOMA
PT IS WBAT
RECOMMENDED PT USE FWW AT ALL TIMES, SIT TO SHOWER, INSTALLATION OF GRAB BARS IN SHOWER, USE OF COMMODE SAFETY FRAME, REMOVAL OF THROW RUGS AND CLUTTER WITH PT AND DAUGHTER VERBALIZING GOOD UNDERSTANDING AND AGREEMENT
EDUCATED PT AND DAUGHTER ON HOW TO OBTAIN RECOMMENDED DME FROM WALMART OR WALGREENS, DENVER ASSISTANCE LEAGUE, AMAZON.COM, EDUCATED ON USE OF DISPATCH HEALTH FOR URGENT CARE NEEDS IN THE HOME WITH BOTH VERBALIZING GOOD UNDERSTANDING
OT EVAL, FREQUENCY AND DURATION OF VISITS AND PROPOSED OUTCOMES WITH PT AND DAUGHTER VERBALIZING GOOD UNDERSTANDING AND AGREEMENT WITH PLAN
CURRENTLY PT PRESENTS WITH DECREASED INDEPENDENCE ADL AND IADL, DECREASED SAFETY TRANSFERS AND MOBILITY, DECREASED UE STRENGTH AND DECREASED HOME SAFETY PT WOULD BENEFIT FROM OT INTERVENTION TO INCREASE INDEPENDENCE AND SAFETY IN ALL AREAS WHILE REDUCING FALL RISK AS WELL AS CAREGIVER BURDEN AND STRAIN TO ACHIEVE MAX INDEPENDENCE POSSIBLE WHILE REMAINING IN HIS OWN HOME ENVIRONMENT
OT 1W4 FOR ADL TRAINING, TRANSFER AND MOBILITY TRAINING, THER EX WITH HEP TRAINING ALONG WITH HOME SAFETY AND CAREGIVER TRAINING
Protocol:
Documentation: PointCare tablets given by agency, Soli signature required, Alpine Kinnser for billing. (All documentation needs to be submitted same day as visit, evals and SOCs can be submitted up to 48hrs after the visit for VO purposes). Telehealth is utilized by this company, but must be approved by the agency first.
SOC
· SOC pack can be picked up at the main office; paperwork required as below and is mainly located in the tablet for patient signature, and a hard copy for the patient in the SOC pack:
1. Emergency preparedness
2. Admission consent
3. Agency disclosure
4. *** Any delay or rescheduling of SOC visit, please call this agency immediately for communication :
· Tablet – add MD order for VO within evaluation and plot your visits on the calendar; if no VO is obtained same day – write no VO obtained, “VM left for MA awaiting call back” and plot your visits per the frequency you are suggesting in the POC using the calendar in the physician order tab of the eval or SOC.
1. Once VO is obtained, simply go to medical records, features > physician orders and add the VO, plot the visits for PT11/OT11/ST11 (if a PT/OT will treat), PA11/COTA11 (if a PTA/COTA will treat).
2. Then complete the “Physician Communication Note” under communication of features.
3. Sometimes this agency will go ahead and plot the visits to your tablet, even if you are waiting on the VO to complete ‘missed visits due to no orders’ to show their attempts to see the patient.
· Tablet – your narrative note within the SOC should be copied and pasted into a ‘narrative note’ after completion and after each daily note for communication to the therapy team to include PMH, PLOF, assistive device, subjective, assessments, and plan.
· FREQUENCY:
1. CALL the office and speak to a clinical supervisor immediately after each evaluation with the POC to prevent a LUPA.
2. Schedule visits for the entire cert; to prevent additional supplemental orders.
§ LUPA can occur in the first 30 days, and again in the second 30 days.
§ LUPA prevention – at least 6 combined visits in the first 30 days (PT/OT/ST) & at least 4 combined completed visits in the second 30 days combined (PT/OT/ST). (Example: 2w4, 1w4 for PT)
§ You have automatic permission to re-evaluate for this company.
EVALUATION GUIDELINES
· Evaluations must be completed within 5 days of the SOC; delay orders are required for evaluations completed after the 5 day window and must be entered as a new physician order.
· Once you receive the VO, please plot your visits on the calendar. If you do not receive orders day of the evaluation, you will submit the note and add a new physician order thereafter, as well as plotting your visits with your additional physician communication note under features. Plot your visits for a PTA or COTA if applicable as COTA11, PA11, with the discharge plotted to the supervising therapist PT19 or OT19 for discipline discharge and PT18 or OT18 for final discipline discharge OASIS.
· ***If you notice that your plotted visits are not on your tablet at time of next scheduled visit with the patient, please contact their office and the appropriate scheduler. Call and ask for a clinical supervisor if your email is not answered and the visit is still not on your tab at time of the patient visit.***`
· FREQUENCY:
1. CALL the office and speak to a clinical supervisor immediately after each evaluation with the POC to prevent a LUPA.
2. Schedule visits for the entire cert; to prevent additional supplemental orders.
§ LUPA can occur in the first 30 days, and again in the second 30 days.
§ LUPA prevention – at least 6 combined visits in the first 30 days (PT/OT/ST) & at least 4 combined completed visits in the second 30 days combined (PT/OT/ST). (Example: 2w4, 1w4 for PT)
§ You have automatic permission to re-evaluate for this company.
INSURANCE SPECIFIC GUIDELINES
· Recertifications are allowed with this company, but must be approved before completing.
· Frequencies are determined by clinical supervisors per PDGM changes within the company. When in question, always call to speak to a clinical supervisor.
REFUSAL OF EVALUATION
· Communication note on the chart in the tablet is key, notification to the agency, and non-admit in the Soli app, complete comm note in ATS Kinnser and delete scheduled SOC or eval.
EVALUATION PAPERWORK
· Standardized Testing – TUG, Barthel, DGI, Functional reach, Cognition testing
· Verbal Orders – enter these in as new orders on the tablet
DAILY NOTES
· Must be 30mins minimum face to face with patient
· Copy/paste your narrative note and insert into a “narrative note” under medical records for others to view your notes.
MISSED VISITS
· Indicate reason for missed visit in the tablet; MD is automatically notified of your missed visit through the tablet.
DISCHARGES
The Final Discipline (can add these documents to Pointcare by sending them to scheduling@Namaste-Health.com
o OASIS
o HEP
o DC instructions
o NOMNC (signed at least 48hrs prior)/paper copy and electronic copy in the tablet
o DC summary under ‘narrative note’ in the tablet under features
o Narrative note with summary copy/pasted
· Regular Discharges – still require NOMNC after each discipline. Narrative note with DC summary is also required.
· Transfers (patient went to hospital) – notify agency office ASAP by phone once you know the following: (what hospital, day of admission and reasons for the admission). If you complete a transfer OASIS, please bill in Alpine Kinnser to ensure proper pay and billing. The only time you should Discharge following a transfer to the hospital, is if the patient is still in the hospital at the end of the 60 day certification period. The last discipline in completes the Transfer OASIS.
· ROCs – agency will notify ATS Task force when patient is prepared for ROC.
