live discharges handle with - hospice · pdf filelive discharges handle with care ......
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LiveDischargeswww.hospicefundamentals.com
November4,2011
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LiveDischarges
HandlewithCare
CharleneRoss,MBA,MSN,RNConsultant/EducatorHospiceFundamentals
November4,2011
WhatYouWillLearn
Thedifferenttypesoflivedischargesandhowtodistinguishtheprocesses
TheroleofthehospiceleadershipandtheIDGinproperlymanagingandreducinglivedischarges
HowyourhospicecanuselivedischargedatainyourQAPIprogram
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November4,2011
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TodaysMaterial
SpecifictotherequirementsfoundintheMedicareHospiceBenefit
TITLE42PUBLICHEALTHPART418HOSPICECARESubpartBEligibility,ElectionandDurationofBenefits
ApplytobeneficiariesreceivingcareundertheHospiceMedicare Benefit
Dontforgettocheckyourstaterules!!!
THEREGULATIONS
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November4,2011
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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+ =
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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
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20.2.1 HospiceDischarge
OnceahospicechoosestoadmitaMedicarebeneficiary,itmaynotautomaticallyorroutinelydischargethebeneficiaryatitsdiscretion,evenifthecarepromisestobecostlyorinconvenient,ortheStateallowsfordischargeunderStaterequirements.
MedicareBenefitPolicyManualChapter9
20.2.1 HospiceDischarge
Theelectionofthehospicebenefitisthebeneficiaryschoiceratherthanthehospiceschoice,andthehospicecannotrevokethebeneficiaryselection.Neithershouldthehospicerequestnordemandthatthepatientrevokehis/herelection.
MedicareBenefitPolicyManualChapter9
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418.26DischargefromHospiceCare
Only3allowablereasonsahospicemaydischarge apatientfromitscare
1. Patientmovesoutofthehospicesserviceareaortransferstoanotherhospice;
2. Nolongerterminallyill;or3. Dischargeforcause
418.26DischargefromHospiceCare
Priortodischargingapatientforanyofthesereasons
Hospicemustobtainawrittenphysiciansdischargeorderfromthehospicephysician
Attendingphysicianshouldbeconsultedbeforedischargeandhisorherreviewanddecisionincludedinthedischargenote
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418.26DischargefromHospiceCare
Musthaveindischargeplanningprocessinplaceintheeventapatientsconditionstabilizesorcannolongerbecertifiedasterminallyill
Itmustinclude planningforanynecessaryfamilycounseling, patienteducation orotherservices
418.26DischargefromHospiceCareNoLongerTerminallyIll
CMSnotesDischargeisnotexpectedtobetheresultofasinglemomentthatdoesnotallowtimeforsomepostdischargeplanning
WhenIDGisfollowingtheirpatient,andifthereareindicationsofimprovementintheindividualsconditionsuchthatthepatientmaysoonnolongerbeeligible,thendischargeplanningshouldbegin
Dischargeplanningisexpectedtobeaprocess,andplanningshouldbeginbeforethedischargedate
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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
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PotentialReasonsforCause
Threateningbehaviortostaffthatcantbemanagedafterrepeatedattempts
Patientconsistentlyrefusestoallowthehospicetovisitordelivercare
PatientcontinuestoleavetheserviceareamakingitimpossibletodelivercareormanagethePlanofCare
418.28RevokingtheElectionofHospiceCare
Apatientmayrevoke theirelectionofthehospicebenefitatanytimebyfilingasignedstatementandthedatetherevocationistobeeffectivewhichcanbenoearlierthanthedatetherevocationismade
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ImportantPoints Revocation
Canonlybedonebythepatientorhis/herrepresentative
Mustbedoneinwritingnoaccommodationforaverbalrevocation
Cannotbackdatearevocation Ahospicemayneverrevokeapatient
ImportantPoints Revocation
Ahospicehasaresponsibilitytocounselthebeneficiaryontheavailabilityofrevocation
Beneficiarydoesnothavetoprovideareasonforrevocation
Hospicedocumentationshouldincludethecircumstancesaroundtherevocation
Righttoreelect
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418.30ChangeofDesignatedHospice
Apatientmaychangeortransfer hospicesonceinabenefitperiodbyfilingastatementwiththecurrentandnewhospiceandtheeffectivedateofthechange/transfer
Iftransferringtoanewhospiceoutoftheservicearea,stronglyconsiderdischarging
Cannottransferhospicesagaininthesameperiod Mustrevokefromthecurrenthospiceandelectwiththe
newhospiceorincasepatientleavestheserviceareaitcouldbeadischargebythehospice
InEitherCaseCoordinatecloselywithotherhospiceto
Promotecontinuityofcare Minimizebillingnightmares
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LiveDischargesWhoTakesAction
NHPCONationalHospiceSummary
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WhereDoYouStand?
Captureandanalyzenumberoflivedischargesonongoingbasisby Category Team Ifnecessary,individualclinician
Howdotheycomparetobenchmarkfigures?
MANAGINGLIVEDISCHARGES
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UnplannedHospitalAdmissions
Hospicesarerequiredtoprovidegeneralinpatientcareforpaincontrolorothersymptommanagementthatcannotbeeffectivelymanagedinothersettings
Patientrights Comprehensiveassessment Planofcaremustincludeallservicesnecessaryforthepalliationandmanagementoftheterminalillnessandrelatedconditions
UnplannedHospitalAdmissions Handlinghospitaladmissionsafterthefact
Unrelatedtoterminaldiagnosis Relatedtoterminaldiagnosis
Contractedhospital Noncontractedhospital
Ifapatientishospitalized,youareresponsibleforcounselingthemonhis/heroptiontorevokeandanyadvantagesordisadvantagesofthisdecision
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ThinkofrevocationsasSERVICEDELIVERYFAILURES
Revocations
WhatcantheIDGdotoreducerevocations Youhavepromisedtoworkwiththepatientandfamily
throughtheendoflife Comprehensiveassessments,communicationandcare
planning Haveanescalationprocessinplacewhereleadershipis
notifiedimmediatelyofanydiscussionofrevocation Takenecessarysteps
Understandthereasonfortherevocation Attempttocorrectanyactualorperceivedserviceissues
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UnplannedHospitalAdmissionsGetAheadoftheProblem
Reviewallunplannedhospitaladmissionsforapastperiodlookingfortrends Withinfirstweekofhospiceadmission Afterasymptomcrisis Whenoutoftownfamilyarrives
Reviewyourafterhoursactivity Workwit