The Sherpa can guide us to medical necessity, skilled services and patient involvement!

Two of the toughest concepts for even the best nurses and therapists to deeply understand and document have recently become even more critical and will continue to be among the most important concepts in health care in the future. I’m referring to balancing true patient involvement with providing skilled care based on medical necessity. Clinicians and agencies who can master these concepts, make them the center of all their encounters and document them well will be the leaders of the industry in the future, impress the regulators and will have the best outcomes. These concepts are complex, but they can be easily understood and remembered through a simple metaphor: the Sherpa.

No westerner, even the celebrated Sir Edmund Hillary, has ever reached the summit of Mt. Everest without the help of a Sherpa (Himalayan mountain guide). The Sherpas have the unique skills, expertise, training, knowledge of the mountain and environment, and experience to help thousands of people conquer Everest and other tough mountains. They show their clients exactly what to do, and they know when to encourage them to press on, when to slow down and when to stop in place. They know when to revise the plan. Does that sound familiar? Consider Medicare’s definition of skilled services: services that require the skills of a clinician to be safe and effective, due to the inherent complexity of the service, the condition of the patient and accepted professional standards. Combine that with the expectation that we constantly reassess the effectiveness of our interventions and revise the plan when needed, it becomes clear - our clinicians are Sherpas leading patients to summits they could not reach on their own. They are (medically) necessary guides!

However, the Sherpa can’t climb the mountain for the climber. The climber still as to do the work. The climber must pay attention, receive, understand and implement the education. This represents true patient involvement. We can’t just rely on handouts without training and passive, superficial “patient education.” Our clients must be deeply involved in the planning process, fully understand and integrate the training, and take every step up that mountain. Our clients and the mountain climbers need the clinicians/Sherpa, but they have to actually do it themselves.

I’m not sure what the documentation requirements are for Sherpas, but I suspect we might have a tougher mountain to climb than they do in that regard. By teaching our clinicians to document what they did as skilled, professional guides and describing what obstacles they helped the client overcome; detailing the steps the patient performed, the training they integrated and how they progressed each step of the way and tying this together, we can tell a compelling story that’s easy to understand and appreciate. Our clients and our clinicians make an amazing team, and clinicians must proudly document their individual and joint achievements. The Sherpa metaphor is a great daily reminder of how to do that.