Hospice and Palliative Care Handbook: Quality, Compliance, and Reimbursement

by Tina M. Marrelli

Overview

The goal of the fourth edition of this book is to help hospice clinicians, team members, and managers meet numerous quality, coverage, and reimbursement standards and requirements for success in daily practice, operations, and documentation. All these components are needed to meet the coverage requirements of the Medicare Hospice Benefit and provide skillful and compassionate hospice care.

Part 1-Hospice Care: An Overview of Quality and Compassionate Care. This part provides the foundational information needed to understand hospice and hospice within the confines of the larger healthcare system. Simply put, hospice, a type of palliative care, is the model for quality, compassionate care for people facing a life-limiting illness or injury. This model and special care is explained in this opening part.

Part 2-Documentation: An Important Driver for Care and Coverage. This part focuses on the numerous and important roles that documentation plays in the provision of care as well as quality and reimbursement components related to hospice care. This part provides the fundamentals as well as why documentation is the key to care coverage, compliance, and quality for hospice patients and organizations.

Part 3-Planning, Managing, and Coordinating Hospice Care. Hospice care is individualized care provided by the interdisciplinary group for each patient and the patient's family. This part clearly explains hospice care planning and the ongoing process for success.

Part 4-Hospice Diagnoses and Guidelines for Care. Prior parts of this book address that the Medicare Hospice Benefit is prognosis-based, which means that the patient must have a limited life expectancy and the hospice is responsible for caring for and covering all costs for the terminal or primary diagnosis and all diagnoses that contribute to the terminal prognosis. In this part, the guidelines for care or care problems are specific topics or diagnoses that are organized alphabetically for easy identification and retrieval of needed information. This information can

then be individualized for your hospice patient/family and used throughout care and care planning as well as in the clinical record. This information can even serve as a basis for a common glossary in team meetings, discussions, and ongoing care planning communications. This part was formatted and designed for easy review for care and care planning and related activities. The hospice diagnoses or care guidelines are generally formatted in the same manner across all sections/diagnoses topics, as follows:

• General Considerations
• Eligibility Considerations
• Potential Diagnoses ICD-10-CM Diagnostic Coding
• Safety Considerations
• Skills and Services Identified
• Patient, Family, and Caregiver Educational Needs
• Tips for Supporting Quality, Safety, Eligibility, and Reimbursement
• Quality Metrics

Product Details

ISBN-13:	9781646480852
Publisher:	Sigma
Publication date:	06/01/2023
Edition description:	Fourth
Pages:	326
Sales rank:	681,851
Product dimensions:	5.40(w) x 8.40(h) x 0.00(d)

About the Author

Tina M. Marrelli, MSN, MA, RN, FAANTina Marrelli is the author of numerous books, including Home Care Nursing: Surviving in an Ever-Changing Care Environment, her book directed toward caregivers, a sometimes undervalued person on the healthcare team; A Guide for Caregiving: What's Next? Planning for Safety, Quality, and Compassionate Care for Your Loved One and Yourself!; Handbook of Home Health Standards: Quality, Documentation and Reimbursement (2018); and The Nurse Manager's Survival Guide.Tina has a long-term relationship with hospice and hospice colleagues. Medicare did not recognize hospices or pay for hospice care until 1982. In the early years of hospice, both the staff at CMS and the leaders of the early hospices worked to make sense of the law and the population it served, working together to develop the kind of hospice care that is now identified with the name. She was an early participant and remembers those heady days. For the more "experienced" readers, you might recall Tom Hoyer of HCFA (now CMS) fame. Tom was termed the "hospice czar" and was a driving force for positive change. This means that at that time, hospice was primarily volunteer. It was pretty much grassroots and mission-driven to try to change and improve end-of-life care for patients and to support their loved ones. This all sounds common sense now, but looking back, it was not. At that time, Tina was the Director of a systems-based nonprofit Home Care and Hospice in Annapolis, Mary- land (USA), and it was the first hospice to receive TJC accreditation. So she has always embraced the hospice philosophy and model and (still) wonders why the rest of the healthcare system does not also embrace family and friend caregivers.Tina attended Duke University School of Nursing, where she received her undergraduate degree in nursing. She also has a master's degree in health administration and in nursing. Tina has worked in hospitals, nursing homes, and public health. She has practiced as a visiting nurse and man- aged in-home care and hospice for many years.Tina is the Chief Clinical Officer for Innovative Caregiving Solutions, LLC, an innovative e-caregiving technology (www.e-caregiving.com). Finally, caregiving and caregivers (loved ones, friends, partners, and others) are being recognized for their important contributions, knowl- edge, and roles. She is an international healthcare consultant, specializing in home care, hospice, and community-based models of care. Tina and her team of specialized consultants have been practicing in the home care and hospice environments for more than 20 years. Tina is a founding member of the International Home Care Nurses Organization (www.IHCNO.org), which was developed "to support a vibrant worldwide network of nurses to promote excellence in providing opti- mal care to patients living at home wherever they live in the world." The IHCNO was started with a small but "mighty" group of nursing leaders. She has been the editor of three peer-reviewed publications-most recently for Home Healthcare Nurse (now Home Healthcare Now), and she is an Editor Emeritus. Tina also serves on the editorial boards of the Journal of Community Health Nursing and The American Nurse.

Table of Contents

About the Author vii

Reviewers ix

Foreword xvii

Preface xix

Introduction xxi

1 Hospice Care: An Overview of Quality and Compassionate Care 1

History of Hospice 2

Hospice and Hospice Growth 3

Hospice in the Care Continuum: Where Does It Fit? 5

What Is a Terminal Illness from a Hospice Perspective? 5

Where Is Hospice Care Provided? 6

The Hospice Interdisciplinary Group: Who Are They? 6

Interdisciplinary Roles 7

Hospice "Core" Services 8

Hospice "Noncore" Services 13

Hospice Reimbursement 15

Medicare Hospice Benefit 15

Components of the Medicare Hospice Benefit 20

Revocation/Change of Provider/Discharge 28

Revocation of the Medicare Hospice Benefit-The Patient's Right to Revocation 28

Change of Hospice Provider-Another Patient Right 28

Discharge from Hospice 29

The Four Levels of Hospice Care 30

Medicare Hospice Quality: What Is It? 32

Hospice Quality Reporting to CMS: Linking Quality to Payment 34

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey 35

CMS Hospice Compare-The Public Display of Quality Measures and Other Hospice Data 36

Defining Hospice Nursing 37

Hallmarks of Effective Hospice Care 38

Differences in Goals Between Home Health and Hospice Nursing 42

Skills and Knowledge Needed for Hospice Care 42

Hospice Orientation: Considerations for Success 46

Hospice Orientation Considerations 48

Defining the Hospice Orientation 49

Competency Assessment and Validation 49

Organizational Orientation Topics 50

Trends in Hospice Care: Staying Apprised and Engaged 55

Length of Stay 55

Live Discharge 56

Hospice Data 56

Advance Care Planning 57

Summary 58

References 58

2 Documentation: An Important Driver for Care and Coverage 61

Hospice Documentation: Why Is the Clinical Record So Important? 61

Increased Scrutiny of Hospice Services 62

The Emphasis on Quality Assessment and Performance Improvement (QAPI) 63

The Emphasis on Standardization of Care, Policies and Procedures, and Processes 64

Recognition and Empowerment of the Nursing Profession and the Nursing Shortage 64

Emphasis on Effectiveness and Efficiency in All Healthcare Settings 66

Importance of the Hospice Patient Record 67

Documentation: The Key to Care, Coverage, Compliance, and Quality 69

Hospice Documentation: The Fundamentals 70

Documentation Tips for Paper-Based Documentation 70

Documentation Tips for Electronic Health Records 72

Documentation Quality and Value Considerations 73

Documentation Strategies 74

Focused Documentation 74

Compariative Documentation 75

Inconsistent and Insufficient Documentation Considerations 76

Accurate and Objective Documentation 77

Hospice Documentation Resources 78

Local Coverage Determinations 78

Symptom and Functionality Measurement Scales 79

Supporting Eligibility and Terminal Prognosis 80

Decline, Terminal Plateaus, and Chronic Status Considerations 80

Summary 83

References 84

3 Planning, Managing, and Coordinating Care 85

The Hospice Initial and Comprehensive Assessment 85

Initial Assessment 85

Comprehensive Assessment 86

The Hospice Plan of Care and Coordination of Care 89

Review of the Plan of Care 93

Medication Management 93

Controlled Drug Management and Disposal 95

Patient Death 97

Care Planning and IDG Cultural Competency 98

Case Study: Eligibility and the Plan of Care 98

Case Study: Frequency and Intensity of Services 101

Summary 102

References 103

4 Hospice Diagnoses and Guidelines for Care 105

Common Symptoms in the Last days of Life (Active Dying) 108

Staging Scales 110

Guidelines for Hospice Care 111

Volunteer(s) 111

Dietitian/Nutritional Counseling 111

Occupational Therapist 111

Physical Therapy 112

Bereavement Counselor 112

Complementary Therapies 112

Alzheimer's Disease and Other Dementias Care 113

1 General Considerations 113

2 Eligibility Considerations 113

3 Potential Diagnoses ICD-10-CM Diagnostic Coding 114

4 Safety Considerations 115

5 Skills and Services Identified 116

6 Patient, Family, and Caregiver Educational Needs 124

7 Tips for Supporting Quality, Safety, and Eligibility 124

8 Quality Metrics 127

Bedbound, Coma, and Skin Care 128

1 General Considerations 128

2 Eligibility Considerations 128

3 Potential Diagnoses ICD-10-CM Diagnostic Coding 129

4 Safety Considerations 130

5 Skills and Services Identified 131

6 Patient, Family, and Caregiver Educational Needs 139

7 Tips for Quality, Safety, Eligibility, and Reimbursement 140

8 Quality Metrics 142

Cancer 143

1 General Considerations 143

2 Eligibility Considerations 143

3 Potential Diagnoses ICD-10-CM Diagnostic Coding 144

4 Safety Considerations 145

5 Skills and Services Identified 146

6 Patient, Family, and Caregiver Educational Needs 154

7 Tips for Quality, Safety, Eligibility, and Reimbursement 155

8 Quality Metrics 158

Cardiac and Cerebrovascular Accident (Stroke) Care 159

1 General Considerations 159

2 Eligibility Considerations 159

3 Potential Diagnoses ICD-10-CM Diagnostic Coding 160

4 Safety Considerations 162

5 Skills and Services Identified 163

6 Patient, Family, and Caregiver Educational Needs 170

7 Tips for Quality, Safety, Eligibility, and Reimbursement 171

8 Quality Metrics 174

Liver Disease Care 175

1 General Considerations 175

2 Eligibility Considerations 175

3 Potential Diagnoses ICD-10-CM Diagnostic Coding 176

4 Safety Considerations 176

5 Skills and Services Identified 177

6 Patient, Family, and Caregiver Educational Needs 185

7 Tips for Supporting Quality, Safety, and Eligibility 185

8 Quality Metrics 188

Neurologic Disease Care 189

1 General Considerations 189

2 Eligibility Considerations 189

3 Potential Diagnoses ICD-10-CM Diagnostic Coding 190

4 Safety Considerations 191

5 Skills and Services Identified 191

6 Patient, Family, and Caregiver Educational Needs 199

7 Tips for Quality, Safety, Eligibility, and Reimbursement 200

8 Quality Metrics 203

Pulmonary Care 204

1 General Considerations 204

2 Eligibility Considerations 204

3 Potential Diagnoses ICD-10-CM Diagnostic Coding 205

4 Safety Considerations 205

5 Skills and Services Identified 206

6 Patient, Family, and Caregiver Educational Needs 214

7 Tips for Quality, Safety, Eligibility, and Reimbursement 215

8 Quality Metrics 217

Renal Disease Care 218

1 General Considerations 218

2 Eligibility Considerations 218

3 Potential Diagnoses ICD-10-CM Diagnostic Coding 219

4 Safety Considerations 219

5 Skills and Services Identified 220

6 Patient, Family, and Caregiver Educational Needs 227

7 Tips for Supporting Quality, Safety, and Eligibility 228

8 Quality Metrics 231

References 232

A Hospice Conditions of Participation: Subpart B-Eligibility, Election, and Duration of Benefits 233

B Hospice Conditions of Participation: Subpart F-Covered Services 245

C State Hospice and Palliative Care Organizations 251

D Resources 261

Index 263