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In our continuing series on the technical requirements of the January 1, 2010, updates to the regulations for Inpatient Rehabilitation Facilities (IRFs), this article will address the requirements for the Interdisciplinary Team Meeting or Conference.[1]

Why a Team Meeting?

Medicare considers an IRF stay reasonable and necessary only if the documentation in the patient’s medical record indicates the patient has complex needs that require an interdisciplinary team approach to the delivery of the patient’s care and services—and the team includes specialists in the treatment of the rehabilitation patient. The Interdisciplinary Team Meeting (ITM) allows the members of the treatment team to coordinate care and to document the communication among all members of the team related to the patient’s plan of care and treatment goals. There is an expectation that the rehabilitation physician leads the conference and appropriate members of the treatment team are in attendance.

During the team meeting, the participants will address the patient’s needs, progress, goals, barriers to goal achievement, and changes in the plan of care required to meet the patient’s needs. The meeting provides an opportunity for all members of the treatment team to coordinate rehabilitation care to best meet the needs of the patient.

Frequency of the Conference

The ITM must be held at least once per week during the course of the patient’s stay in the IRF. CMS defines a “week” as a seven-consecutive-day period that begins with the date of admission. A standing weekly team meeting will meet this requirement and Medicare has clarified that a patient who is admitted after the weekly team meeting may have their initial team conference at the time of the next standing meeting. This could technically be the eighth day of the patient’s stay in the IRF. For example, if the standing team meeting is at 10:00 a.m. on Wednesday, those patients who are admitted after 10:00 a.m. on Wednesday would be considered to be compliant if they were scheduled for their first team meeting on the following Wednesday at 10:00 a.m.

Required Attendees

The key participants in the ITM are: (1) a rehabilitation physician; (2) a registered nurse with specialized training or experience in rehabilitation; (3) a social worker or case manager; and (4) a licensed or certified therapist from each therapy discipline involved in treating the patient.

The rehabilitation physician—not a physician’s assistant, nurse practitioner, or medical resident—is expected to be present and to lead the team meeting. The staff members representing their individual discipline must have current knowledge of the patient. While we believe that it is a “best practice” for this to be the same professional responsible for the patient’s program on a day-to-day basis, Medicare does not make this a requirement. 

CMS has provided clarification that while a licensed vocational or practical nurse, a physical therapist assistant, or a certified occupational therapist assistant may attend the ITM, the scope of practice for these individuals does not include the ability to perform assessment, modify the care plan, and establish treatment goals which are core functions of the ITM. For this reason, a registered nurse with specialized training in rehabilitation must represent rehabilitation nursing at the ITM and, likewise, a therapist from each discipline involved in the care must be present at the meeting even when an assistant is present.

Telephonic participation in the meeting is permitted provided that the specific reasons the attendee was not physically present are well documented and the record reflects the required level of participation in the meeting. At minimum, documentation of conference attendance must include the names and professional designations of those who participated in the meeting. Many organizations fulfill this requirement by capturing signatures of those attending, although capturing signatures is not specifically required by Medicare.

Other healthcare professionals may attend the meeting as appropriate to assure the patient’s rehabilitation needs are met.

Content and Documentation Requirements

The primary focus of the ITM includes assessment of the patient’s progress toward treatment goals, identification of any barriers to goal achievement, reassessment of patient needs and goals, and progressing and revising the treatment plan. Discussion about these issues as well as discharge planning and other factors that impact the patient’s treatment and progress should be documented in the ITM notes. When barriers to goal achievement exist, the documentation should demonstrate adjustments to the plan of care and goals consistent with the patient’s needs and potential. As previously noted, the documentation must also include the names and professional designations of those in attendance.

Common Issues

In our experience, we find organizations have difficulty in two common areas:

  • Attendance by Required Personnel:
    Because of the time commitment for team meeting attendance we sometimes find the registered nurse or one of the required therapists is not in attendance, or was in attendance but the attendance was not documented. Organizations should establish a procedure to assure the individual who records the meeting assures all in attendance are listed in the meeting notes or appropriately sign the attendance record.
  • Documentation of Collaboration and Coordination:
    When barriers arise that slow or limit goal achievement, the organization should clearly document the barriers and what changes in the plan of care have been made to address those barriers. When completing chart audits, we often note that the patient has medical, behavioral, or resource issues that have occurred in the week prior to the conference, and impact their care. Yet, these issues are not documented as having been addressed at the team meeting. Some examples from our record reviews include:
    • Problem – Patient was unable to participate in three hours of therapy a minimum of five times per week due to fatigue after dialysis. The team meeting documentation did not demonstrate collaboration to overcome this barrier. There was no documentation of the patient’s limited participation and no discussion that the limitation was likely due to fatigue after treatment.
      Solution – Team members should discuss potential solutions including switching the patient to a 15 hour per week treatment program to allow for meeting the patient’s needs while on dialysis. The solution should be documented and plan of care modifications made. When a change in the plan of care is made as a result of discussion at the ITM, it supports the patient’s interdisciplinary needs.
    • Problem – The patient being reviewed was discontinued from Speech Therapy as the patient had achieved baseline functioning. Physical and Occupational Therapy increase treatment time to assure the patient receives the required three hours of therapy on five of seven days. While the patient’s progress in therapies suggests the patient is ready for more focus on functional and mobility tasks and the increased time in PT and OT is warranted, there is no documentation that supports why the time in these disciplines has increased. Speech Therapy does not attend the ITM immediately following the discharge from services and there is no notation in the ITM note of why ST has signed off the case and why PT and OT have modified their respective plans of care.
      Solution – When ST signs off the case, there should be corresponding notes by PT and OT detailing what changes will occur in the treatment plan and the reasons for the changes. This might be that the patient is ready for higher-level functional activities or increasing tolerance to certain activities. We would recommend Speech and Language Therapy attend the meeting immediately following or coinciding with the discharge from Speech and Language Therapy. The team meeting notes should document the patient’s attainment of Speech goals, address revised or increased goals for mobility, and specify the changes in the plan of care to achieve these goals.

Tips for Success

As with all of the technical requirements, organizations that have standardized processes that are routinely followed will have greater compliance. Industry “best practices” include:

  • Standing “team meetings” on a set day of the week and time of day;
  • Team Meeting Documentation Templates—paper or electronic—that cue for the required elements of content;
  • A Team Meeting Coordinator—often the Case Manager—who verifies all team members are present and have signed the attendance sheet or have had attendance validated in the notes.

Coming next: Therapy Service Requirements

About the Author

Angela M. Phillips, PT, is president and chief executive officer of Images & Associates. A graduate of the University of Pennsylvania School of Allied Health Professions, she has more than 35 years of experience as a consultant, healthcare executive, hospital administrator, educator, and clinician. Ms. Phillips is one of the nation’s leading consultants assisting Inpatient Rehabilitation Facilities in operating effectively under the Medicare Prospective Payment System (PPS) and in addressing key issues related to compliance for therapy services across all venues.

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[1] Note: Medicare uses both the terms “interdisciplinary team conference” and “interdisciplinary team meeting” to refer to the team meeting.


Angela Phillips, PT

Angela M. Phillips, PT, is President & Chief Executive Officer of Images & Associates. A graduate of the University of Pennsylvania, School of Allied Health Professions, she has almost 45 years of experience as a consultant, healthcare executive, hospital administrator, educator, and clinician. Ms. Phillips is one of the nation’s leading consultants assisting Inpatient Rehabilitation Facilities in operating effectively under the Medicare Prospective Payment System (PPS) and in addressing key issues related to compliance.

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