When Does the Week Start?
Here's a quick question that came up this past week. Maybe this is something that few ever think about, but it was one that really made me think. I'm not sure if there are any specific regulations covering this issue, but maybe there should be.
Anyway, a new Part B person was evaluated by therapy on a Wednesday. The orders were written for treatments three times per week. In order to capture a RUG score, MDS wanted this person treated Wednesday, Thursday and Friday of that week. This was fine, as the order allowed for three treatments for that week. However, they also wanted this person seen for treatments the following week on Monday and Tuesday. This is where the question comes up.
For this person, when does a week start and end? Is there a designation of a Sunday to Saturday week? Or would you establish their week as normally done with a Part A person, day one is always the day of eval and the days begin counting from there. In other words, for a Part A person if the eval occurred on a Wednesday, then day 7 (or the completion of week 1) would be the next week Tuesday, correct? If this same "formula" is applied to the Part B person, then seeing them on the following Monday and Tuesday would be five treatments in the same week by my deduction. But is there a difference in how the weeks are established for Part A and Part B patients?
Yes, I have run into this problem before. It is solved by simply discussing the treatment plan with the MDS office prior to writing the treatment orders. If a RUG level can be captured by obtaining five consecutive treatments then the order can be written for five times the first week, then decrease to three times the following week(s).
My real problem with this is that the evaluating therapist didn't think this person could tolerate therapy five days a week, therefore the order for three times a week. And even though the weekend was in there to allow this person to rest for two days between these five consecutive treatments, that left a gap of at least five days where they would only receive one more treatment. Makes me wonder if any gains the person made in week one would be lost during the scheduling gap in week two.
Until next time, hope all your thoughts are good-
Tim