Get your contract ducks in a row
Get your contract ducks in a row
Are your contract agreements in good order?
It is an area where surveyors from the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, continue to find problems: contracting with outside agencies and individuals to do work for your organization. Whether it is an infusion therapist, a dietitian, or a durable medical equipment company, you must meet certain criteria to score well on that part of your survey.
"There are really two areas where we repeatedly see problems," says Maryanne Popovich, RN, MPH, director of home care accreditation services at the Joint Commission. "People don’t include information on the role of the contracted party, and they forget to include the required documentation."
These two standards are outlined in LD.7, located on pages 316 to 318 of your standards manual. Along with the roles and documentation, the standard says agreements should include information on:
• the nature, scope, and type of care and services to be provided;
• the responsibility of the contractor to comply with applicable organization policies and personnel qualifications;
• the procedures for determining charges and reimbursement;
• the term of the agreement and conditions for renewal or termination.
There are additional requirements for Medicare-certified agencies and hospices.
"Everyone remembers to include information about payment," Popovich adds. "But they forget to outline the role a contracted person has in admissions, assessments, care planning, supervision, scheduling, and discharge planning."
Audits and checklists
The best way to ensure you meet the standard, she advises, is to pull out your contracts and do an audit. "Check to see what you are getting in there, and make a checklist of the things you have forgotten." Be sure to amend any contracts you have in use that do not include the required elements. "Make sure both parties sign the amendment, too," adds Popovich.
Making a checklist is something that Janet Clyde, organizational development manager at the Oakland, CA-based Pathways Hospice & Home Health did before her last survey. "It was really short, though, and when the surveyor left, she said it was a good concept, but should be expanded."
Clyde took that advice and has developed a more complete list, which was being put to the test during her latest survey at press time. (See checklist, at right.) The list includes the five items that all agreements with outside service providers must contain, and 13 other items that only agreements with subcontractors must include.
It wasn’t just the surveyor’s comments that led Clyde to develop the list, she says. She also heard rumors that Operation Restore Trust the government effort to uncover Medicare fraud and abuse wanted to see contract language indicating that contractors who get more than $10,000 from an agency are willing to have their books open to scrutiny.
Clyde added an item on that topic, as well as one on patient confidentiality.
Experience over 14 years also prodded Clyde to action. "I remember when I first started this, I was so happy just to get any contract that I didn’t care what was in it," she admits. "Asking for changes or additions was hard." Many of her original contracts didn’t include the basics, like the address of the party with whom the agreement was being made.
Clyde has gone even further. Each contractor has a folder. On one side are the checklist and a current copy of the person’s or organization’s license, accreditation, and proof of liability insurance. On the other side is a copy of the latest quality assurance work done by the person or organization, such as results from the last patient satisfaction survey.
"Maybe it seems like it’s going overboard," admits Clyde, "but I want to be sure everything is covered for the Joint Commission or whoever. You never know when some surveyor will come in unannounced. I don’t want to get dinged."
Clyde likes to use her own agreements, but says that when she works with national companies, they often want to substitute their contracts. "That’s fine, as long as I can read it," she says. When it lacks something her checklist requires, she asks to use her language as an addendum.
Addenda are a smart way to ensure complete agreements, says Elizabeth Hogue, JD, an attorney in practice in the Washington, DC, area who specializes in home health. However, don’t use those addenda to outline specific job duties with your staff. "That can be dangerous," says Hogue. "If you ever want to change the duties, or if you leave something out, you have to rewrite your agreement to do so." The best contracts are flexible, she says.
Popovich agrees. "We aren’t looking for a contract that specifies what nursing services are," says Popovich. "We want information on who can do what, not what will be done."
General is better in this case, she says. "A job description adds too much detail for our purposes. We want this to be a document that anyone can execute, not just an attorney."
After her current survey, Clyde will revise her checklist again. She already knows she wants to add a statement about non-discrimination. And there are things she will clarify further, too. "I want to make sure that they either participate in some quality assurance themselves, or are willing to be part of ours," says Clyde. "It’s not enough for outside staff to be licensed. They have to meet our standards. We often forget that when these contracted people are out there, they are us. People don’t think, Oh, here’s the subcontractor from Pathway.’ They think, Here comes the Pathway person.’ We can’t forget that, and we have to make sure that when they serve our patients, they meet our standards."
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