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What exactly is the Interdisciplinary Team Conference supposed to do?

Written by: Bob Habasevich, PT on Monday, March 5, 2012 Posted in: Inpatient Rehab

To be clear, let’s review the Medicare requirements for Interdisciplinary Team Care and Coordination.  The current Medicare publication, Inpatient Rehabilitation Therapy Services: Complying with Documentation Requirements, provides a convenient summary of expectations.

…The purpose of the interdisciplinary team is to foster frequent, structured, and documented communication among disciplines to establish, prioritize and achieve treatment goals.

Team conferences must be held once a week; seven consecutive calendar days that begin the day of admission.

Document participation by professionals from each of the following disciplines (each of whom must have current knowledge of the patient as documented in the IRF medical record):
A rehabilitation physician with specialized training and experience in rehabilitation services;
A registered nurse with specialized training or experience in rehabilitation;
A social worker or a case manager (or both); and
A licensed or certified therapist from each discipline involved in treating the patient.

The weekly interdisciplinary team meeting must be led by a rehabilitation physician who is

Streamline interdisciplinary care across your facility

responsible for making the final decisions regarding the patient’s treatment in the IRF. The physician must document concurrence with all decisions made by the interdisciplinary team. Documentation must include the name and professional designation of each interdisciplinary team member in attendance.

The periodic interdisciplinary team conferences must focus on:
Assessing the patient’s progress toward rehabilitation goals;
Considering possible resolutions to any problems that could impede the patient’s progress toward the goals;
Reassessing the validity of the rehabilitation goals previously established; and
Monitoring and revising the treatment plan, as needed.

With these expectations in mind, how does anyone answer the question, “how effective is the team?” Passing an audit or survey review for evidence of team management is not much more than providing documentation that the team meeting happened and signatory attestation is in evidence.  But was the team meeting effective?  What value did it provide and at what cost?  Every manager and clinician asks these question but few have quantified answers.  In the current environment of driving cost and waste out of the delivery system the weekly meeting must be challenged for its value in doing more than documenting occurrence.

Assessment of effectiveness should start with clarifying and defining expectations.

A quick response to the following checklist may provide some insights to the organization’s clinical and operational culture:

  Y N
1 The team is knowledgeable about the purpose of the team conference and their respective roles on the team.
2 Team members are provided with a great deal of feedback regarding their performance.
3 Team members are encouraged to work for the common good of the organization.
4 There are many complaints, and morale is low on the team.
5 Team members don’t understand the decisions that are made, or don’t agree with them.
6 Meetings are inefficient and there is a lot of role overlap.
7 Team members are focused on patient goals, and understand how their role contributes to achievement.
8 Team members are competent and qualified to perform as required by role expectation.
9 The team understands what it needs to accomplish and has the resources needed to be successful.
10 Conflict between or disregard for other disciplines is a pervasive issue that doesn’t seem to get better.
11 Team accomplishments are not celebrated and members are not sure what is expected of them.
12 Professional or discipline objectives take priority over team functions or goals.
13 Working relationships across disciplines or functions are uncoordinated or duplicated.
14 The team leader has ultimate authority for all decisions and exercises same in resolving conflicts

What the team and team conference is supposed to do is probably best answered by asking the team itself.  Their responses will provide evidence for planning the next step. Opinions and the checklist are not a substitute for a formal team performance assessment but will give indication if expectations of team performance are common to all and can uncover areas of improvement that will help you become a better team member and team builder.