I’m sharing eight strategies for easier reassessments. Most of us probably find that reassessments can be time-consuming and even stressful. And we all have to do them. Medicare requires a reassessment every 30 days, and most insurances follow Medicare’s guidelines. Even if we’re not continuing therapy, we still have to reassess at discharge.
I’ve found that my workload and stress level have decreased by being organized, spreading the work across two or more sessions, and using point-of-service documentation skills.
Free DIRECT download: 8 strategies for easier reassessments (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- Reassessments show that therapy is helping but there’s more to do.
- Get organized.
- Spread the work out.
- Use point-of-service documentation.
- Putting it all together for an easier reassessment.
- Tips for me?
- Related Eat, Speak, & Think posts.
Reassessments show that therapy is helping but there’s more to do
My goal with a reassessment is to show that therapy has been helpful but that my patient still has deficits that are causing problems. Basically, I’m justifying the need for continued therapy and making a plan for the next set of visits.
Reassessment outline
Luckily, I’m not solely relying on assessment data to make my case. My reassessment note includes the following headings:
- Current Level of Function.
- Objective Tests and Measures Performed and Compared to Previous.
- Progress Towards Goals and Modification of Goals.
- Rationale for Continued Therapy and Assessment of Effectiveness of Therapy.
I make my case for continuing therapy through my narrative in the first and last sections, the reassessment data, and the report on progress towards the goals.
Choosing reassessment measures
For each patient, I decide whether to re-administer an entire test or only select certain sub-tests. Again, I try to select measures that show that my patient has made progress but still has deficits.
I make my decision based on a number of factors, including:
- My patient’s stamina and interest in testing.
- How impaired they are. If they’re very impaired or minimally impaired, I often select sub-tests.
- The length of the test.
- The availability of relevant questionnaires or rating scales.
Links to assessment tools
I think that the more assessment materials we have access to, the better. I’m not in a position to definitively judge the psychometric properties and theoretical soundness of various assessment materials, but I’m more than happy to share resources that are freely available.
- 9 free swallow assessment tools.
- 18 free assessment tools for cognition. (Look at the comments for more links.)
- How to assess pragmatic skills in adults with brain injury. (Seven conversation tasks and two rating scales.)
- 3 versions of the Clock Drawing Test for cognition.
Get organized
Don’t be taken by surprise; plan ahead!
It’s a bad feeling to walk into a session only to realize it’s time for a reassessment. Especially if your test materials are back at the office!
If this has happened to you, then you might want to come up with a system to avoid surprises. Here are a couple of options:
- Mark reassessment visits in your EMR, if possible. In McKesson, reassessment visits are highlighted.
- When you do the initial evaluation, flip ahead four weeks and pencil in a reminder.
- As you document each visit, take a peek at how many visits you have left. You should be preparing your patient for reassessment or discharge, anyway.
Organize the materials you’ll need
After being hit with one-too-many surprise reassessments, I’ve started carrying selected assessment materials with me. Just in case!
I’ve also started planning for each week during the previous Friday. When I have a reassessment due, I take a moment to look at the initial evaluation and make a note of any assessment materials I’ll need. I just jot a quick note at the top of my schedule for that day.
Spread the work out
Update progress towards goals at each session
Many clinicians in my company comment on their patient’s progress towards each short term goal during each session. We copy and paste their short term goals from session to session, and then edit the commentary and data at each visit, trying to reflect the skill we bring as well.
Updating the short term goals at each visit has many benefits:
- Ensures therapy activities are directly related to the written goals.
- Helps you keep track of progress towards goals.
- Allows you to modify goals if it becomes obvious your patient isn’t going to reach them.
- If your patient misses their reassessment visit, you can more easily annotate the previous visit to be their reassessment.
- Makes writing up the reassessment visit easier. No need to comb back through all the visit notes hunting for data.
Mark short term goals “MET” in the previous session
Often, many of my short term goals can be marked “MET” in the session prior to the reassessment visit. When this is the case, I include the data and my skill in the commentary.
Then during the reassessment visit, I simply copy and paste with the work already done.
I almost always have one short term goal that hasn’t been met until the day of the reassessment.
Start the reassessment early
You can do a reassessment before 30 days pass, for any reason that you feel is appropriate. During the initial evaluation, when I enter my orders, I mark the next-to-last visit as the reassessment visit. This reminds me to start the reassessment early.
Starting the reassessment early offers several advantages.
- Allows you to spread reassessment tasks across two sessions, especially helpful for language and cognitive-communication impairments.
- Offers your patient a second chance in case they’re not feeling well the week of your reassessment.
- Provides time for you to discuss reassessment results and goals for the next time-period with your patient.
- Allows you to do additional testing based on the reassessment results and patient’s goals, if needed to justify additional intervention.
And if your patient cancels the last visit on your plan of care, you’ll have an easier time annotating the prior visit as a reassessment as you’ll have some real assessment data to use.
When I document the visit, I write up the assessment results in the format that I’ll use for the reassessment visit note using the heading ” Objective Tests and Measures Performed and Compared to Previous.” I write in “to be determined” for anything left open for the next session.
Begin writing up the narrative early
I make a point of starting to include the reassessment verbiage in the session(s) leading up to the reassessment visit. I’ll ask my patient and their family for updates on any improvement they’re noticing in day-to-day activities, as well as problems they’re noticing.
This information will ultimately go into the Current Level of Function section of the reassessment visit, but I simply write it in a notes section until then.
Use point-of-service documentation
In my mind, point of service documentation includes more than simply typing up the visit note during the session.
For instance, it can include scoring assessments, documenting phone calls to the doctor or other team members, or writing up recommendations to leave with the patient.
Basically, any writing I do on behalf of the patient is a candidate for doing during the session.
Score assessments during the session
Many of the test measures I use don’t take too long to score, so I try to do that during the session. Giving patients feedback immediately after they’ve finished the test is a good way to open a discussion about what specific things they’d like to work on going forward. Or for confirming discharge at the next session, if their goals are met.
Most of my patients are actively interested in learning how they did on the test. Others are content to let me score the tests. I may have some task for them to do while I’m scoring the test. Sometimes, my patient has no patience for that, or I have to get going for my next visit.
So I don’t always leave them home with the assessment scored (especially aphasia tests!), but when I do, it’s a good feeling!
Work on the visit note in small chunks during the visit
As I’m doing my session, I’m using my point-of-service documentation skills to slowly fill in the visit note as I do for each routine visit.
When I start the reassessment early, I copy and paste the assessment data from the initial assessment into the visit note. Then I begin updating the format to provide space for the reassessment data.
This makes it easy to copy and paste into the reassessment visit note, and all I’ll have to do is update with anything new.
Putting it all together for an easier reassessment
On the day of the reassessment, I finish testing, if it wasn’t completed at the previous visit. I usually have something to finish up. If possible, I’ll score the test immediately.
My patient, their family, and I discuss what they’d like to accomplish over the next few sessions or weeks. We complete the paperwork, and I call the doctor. And then we often finish with a therapeutic activity.
During the session, I begin copying and pasting the information from the previous session into my reassessment note:
- Current Level of Function.
- I copy the information from the previous note and update it.
- Objective Tests and Measures Performed and Compared to Previous.
- I copy the test results from the previous notes and update it.
- Each set of data includes the date it was collected.
- Progress Towards Goals and Modification of Goals.
- I copy the short term goals from the previous note and update them, writing new goals as needed.
- Ideally most of the goals were marked “MET” in the previous session.
- Rationale for Continued Therapy and Assessment of Effectiveness of Therapy.
- I write a quick summary of how my patient has improved as a result of therapy, and how their deficits are still affecting safety, participation, independence, and/or caregiver burden.
- I include a statement to make clear that without continued therapy, my patient is likely to have XYZ problems but with continued therapy, my patient is likely to improve in meaningful ways.
I’ve never finished a reassessment visit note in the patient’s home, but I often get at least big pieces of it done. I find that every little bit helps!
Tips for me?
I’ve found that following these strategies has led to easier reassessments. I have some wiggle room in case something goes wrong, I’ve spread the work out over two or more sessions, and I have less work to do for the reassessment note.
Even so, I’d love to someday actually be able to complete reassessment notes in the patient’s home.
If you have tips for me, I’d love to hear them!
Free DIRECT download: 8 strategies for easier reassessments (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Related Eat, Speak, & Think posts
- Is home health paperwork really that bad?
- 5 ways I improved work-life balance as a home health SLP.
- Organize the materials you carry to save time as a home health SLP.
- 7 tips to benefit your home health patients and minimize your workload.
- Use your planner to lighten your home health workload.
- A message of hope to the struggling SLP.
Featured image by Nik MacMillan on Unsplash.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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