Live Discharges Handle with - Hospice · PDF fileLive Discharges Handle with Care ......

LiveDischargeswww.hospicefundamentals.com
November4,2011
HospiceFundamentalsSubscriberAudioconference(c)HospiceFundamentals2011AllRightsReserved 1
LiveDischarges
HandlewithCare
CharleneRoss,MBA,MSN,RNConsultant/EducatorHospiceFundamentals
November4,2011
WhatYouWillLearn
Thedifferenttypesoflivedischargesandhowtodistinguishtheprocesses
TheroleofthehospiceleadershipandtheIDGinproperlymanagingandreducinglivedischarges
HowyourhospicecanuselivedischargedatainyourQAPIprogram

November4,2011
TodaysMaterial
SpecifictotherequirementsfoundintheMedicareHospiceBenefit
TITLE42PUBLICHEALTHPART418HOSPICECARESubpartBEligibility,ElectionandDurationofBenefits
ApplytobeneficiariesreceivingcareundertheHospiceMedicare Benefit
Dontforgettocheckyourstaterules!!!
THEREGULATIONS

November4,2011
SubpartBEligibility,ElectionandDurationofBenefits
418.26Dischargefromhospicecare
418.28Revokingtheelectionofhospicecare
418.30Changeofhospiceprovider
An HMB Admission Requires A Yes from Two Parties
Hospice Makes
the Decision to
Admit
Yes #1
BeneficiaryMakes
theDecision to
Elect
Yes #2
Admission+ =

November4,2011
An HMB Discharge, Revocation or Transfer Only Requires One Yes
Hospice Makes
the Decision toDischarge
BeneficiaryMakes
theDecision toRevoke or
Transfer
End of CareOR =
HospiceMedicareBenefitDischargeHistory
FromtheinceptionoftheMedicareHospiceBenefit,CMSfearedthathospiceswoulddischargeabeneficiarywhosecarebecameveryexpensive
Forthatreason,veryfewsituationswarrantdischarge

November4,2011
20.2.1 HospiceDischarge
OnceahospicechoosestoadmitaMedicarebeneficiary,itmaynotautomaticallyorroutinelydischargethebeneficiaryatitsdiscretion,evenifthecarepromisestobecostlyorinconvenient,ortheStateallowsfordischargeunderStaterequirements.
MedicareBenefitPolicyManualChapter9
20.2.1 HospiceDischarge
Theelectionofthehospicebenefitisthebeneficiaryschoiceratherthanthehospiceschoice,andthehospicecannotrevokethebeneficiaryselection.Neithershouldthehospicerequestnordemandthatthepatientrevokehis/herelection.
MedicareBenefitPolicyManualChapter9

November4,2011
418.26DischargefromHospiceCare
Only3allowablereasonsahospicemaydischarge apatientfromitscare
1. Patientmovesoutofthehospicesserviceareaortransferstoanotherhospice;
2. Nolongerterminallyill;or3. Dischargeforcause
Priortodischargingapatientforanyofthesereasons
Hospicemustobtainawrittenphysiciansdischargeorderfromthehospicephysician
Attendingphysicianshouldbeconsultedbeforedischargeandhisorherreviewanddecisionincludedinthedischargenote

November4,2011
Musthaveindischargeplanningprocessinplaceintheeventapatientsconditionstabilizesorcannolongerbecertifiedasterminallyill
Itmustinclude planningforanynecessaryfamilycounseling, patienteducation orotherservices
418.26DischargefromHospiceCareNoLongerTerminallyIll
CMSnotesDischargeisnotexpectedtobetheresultofasinglemomentthatdoesnotallowtimeforsomepostdischargeplanning
WhenIDGisfollowingtheirpatient,andifthereareindicationsofimprovementintheindividualsconditionsuchthatthepatientmaysoonnolongerbeeligible,thendischargeplanningshouldbegin
Dischargeplanningisexpectedtobeaprocess,andplanningshouldbeginbeforethedischargedate

November4,2011
418.26 DischargefromHospiceCareNoLongerTerminallyIll
Hospiceissues NoticeofMedicareProviderNonCoverage/GenericNoticenolessthan48hoursbeforedischarge
Requirementsandprocessfoundat
http://www.cms.gov/BNI/06_FFSEDNotices.asp
418.26DischargefromHospiceCareForCause
Thehospicemustdothefollowingbeforeitseekstodischargeapatientforcause
Advisethepatientthatadischargeforcauseisbeingconsidered
Makeaseriousefforttoresolvetheproblem(s)presentedbythepatientsbehaviororsituation
Ascertainthatthepatientsproposeddischargeisnotduetothepatientsuseofnecessaryhospiceservices
Documenttheproblem(s)andeffortsmadetoresolvetheproblem(s)andenterthisdocumentationintoitsmedicalrecords

November4,2011
PotentialReasonsforCause
Threateningbehaviortostaffthatcantbemanagedafterrepeatedattempts
Patientconsistentlyrefusestoallowthehospicetovisitordelivercare
PatientcontinuestoleavetheserviceareamakingitimpossibletodelivercareormanagethePlanofCare
418.28RevokingtheElectionofHospiceCare
Apatientmayrevoke theirelectionofthehospicebenefitatanytimebyfilingasignedstatementandthedatetherevocationistobeeffectivewhichcanbenoearlierthanthedatetherevocationismade

November4,2011
ImportantPoints Revocation
Canonlybedonebythepatientorhis/herrepresentative
Mustbedoneinwritingnoaccommodationforaverbalrevocation
Cannotbackdatearevocation Ahospicemayneverrevokeapatient
ImportantPoints Revocation
Ahospicehasaresponsibilitytocounselthebeneficiaryontheavailabilityofrevocation
Beneficiarydoesnothavetoprovideareasonforrevocation
Hospicedocumentationshouldincludethecircumstancesaroundtherevocation
Righttoreelect

November4,2011
418.30ChangeofDesignatedHospice
Apatientmaychangeortransfer hospicesonceinabenefitperiodbyfilingastatementwiththecurrentandnewhospiceandtheeffectivedateofthechange/transfer
Iftransferringtoanewhospiceoutoftheservicearea,stronglyconsiderdischarging
Cannottransferhospicesagaininthesameperiod Mustrevokefromthecurrenthospiceandelectwiththe
newhospiceorincasepatientleavestheserviceareaitcouldbeadischargebythehospice
InEitherCaseCoordinatecloselywithotherhospiceto
Promotecontinuityofcare Minimizebillingnightmares

November4,2011
LiveDischargesWhoTakesAction
NHPCONationalHospiceSummary

November4,2011
WhereDoYouStand?
Captureandanalyzenumberoflivedischargesonongoingbasisby Category Team Ifnecessary,individualclinician
Howdotheycomparetobenchmarkfigures?
MANAGINGLIVEDISCHARGES

November4,2011
UnplannedHospitalAdmissions
Hospicesarerequiredtoprovidegeneralinpatientcareforpaincontrolorothersymptommanagementthatcannotbeeffectivelymanagedinothersettings
Patientrights Comprehensiveassessment Planofcaremustincludeallservicesnecessaryforthepalliationandmanagementoftheterminalillnessandrelatedconditions
UnplannedHospitalAdmissions Handlinghospitaladmissionsafterthefact
Unrelatedtoterminaldiagnosis Relatedtoterminaldiagnosis
Contractedhospital Noncontractedhospital
Ifapatientishospitalized,youareresponsibleforcounselingthemonhis/heroptiontorevokeandanyadvantagesordisadvantagesofthisdecision

November4,2011
ThinkofrevocationsasSERVICEDELIVERYFAILURES
Revocations
WhatcantheIDGdotoreducerevocations Youhavepromisedtoworkwiththepatientandfamily
throughtheendoflife Comprehensiveassessments,communicationandcare
planning Haveanescalationprocessinplacewhereleadershipis
notifiedimmediatelyofanydiscussionofrevocation Takenecessarysteps
Understandthereasonfortherevocation Attempttocorrectanyactualorperceivedserviceissues

November4,2011
UnplannedHospitalAdmissionsGetAheadoftheProblem
Reviewallunplannedhospitaladmissionsforapastperiodlookingfortrends Withinfirstweekofhospiceadmission Afterasymptomcrisis Whenoutoftownfamilyarrives
Reviewyourafterhoursactivity Workwit

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