Patient treatment plan quality can never rise above the accuracy of the assessment on which it is based.
Unfortunately, many of the electronic health records systems now available in the marketplace frequently fail to collect vital information on patients during the admissions and treatment process.
As a result, the quality of the treatment planning throughout the course of treatment measured against national accreditation criteria is substandard, so treatment fails to address key issues that should have been addressed. Often, these are issues that when not addressed, function as relapse triggers.
The ACG Team believes that treatment is unlikely to be successful if the patient treatment planning process is missing major elements while also lacking an ability of measuring how treatment services are performing. Too many organizations are claiming successful results without the performance data and summary reports to back up these claims. There really are no shortcuts to quality patient treatment planning. Measurement has to be built into daily operation and treatment performance and staff have to be trained in quality monitoring.
Of the hundreds of patient records our Team members have reviewed, it is safe to say that the vast majority of these data do not meet current national standards. As experienced CARF surveyors it is frequently hard to tell whether the treatment provided is successful in changing the patient’s behavior. In many cases, the counselors’ have developed a standardized list of what it is they are going to do during the patient’s treatment and how many sessions the patient will sit through! So does this type of anecdotal documentation suggest that if the patient can sit long enough, he or she is a treatment success? Absolutely not.
When reviewing patient treatment records for compliance with national accreditation it is often impossible to match a patient’s “individualized” treatment plan with what is actually going on in the counseling process.
Progress notes often fail to address the treatment plan objectives in any measurable fashion.
Addiction treatment program CEO’s should understand that the future reimbursement structures are changing rapidly and that 3rd party payers are expecting to pay for “outcome reliable” care that is worth the cost of services being provided. We should remember that by establishing a chronic care model for treatment of addictions and co-occurring disorders that is cost-effective and which demonstrates value is the wave of the future.
This growing payer-driven element of quality measurement of provider performance will have predictable consequences, which includes having to measure, communicate and report results of treatment outcomes to consumers and payers. The implications of this growing trend is that 3rd party payers are calling for a fundamental realignment of clinical staff training that includes both the need for clinical expertise, understanding Managed Care criteria and Customer service as priorities. There is also an implied need for an organization-wide approach to performance measurement.
These future changes will require providers: to build individualized patient treatment plans, the ability to report in real time, provide daily patient progress updates, have variable lengths of stay, and operate performance oriented reimbursement systems.
