medicare hospice benefits and more presented by: xxxxx
TRANSCRIPT
Medicare Hospice Benefits and More
Presented by: XXXXX
Introductions
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Objectives• Overview of the TRUE project• Explore triggering events for a hospice
referral• Explore strategies for communication with
primary physician about a hospice referral• Describe the Medicare hospice benefit and
services
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Stratis Project Team
Stratis Health Staff• Janelle Shearer, RN, MA, CPHQ, Program
Manager• Laura Grangaard, MPH, Research Analyst
Subject Matter Experts• Barry Baines, MD• Lores Vlaminck, RN, BSN, MA, CHPN
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Local Project Hospice Lead(s)• Insert from Speaker Notes
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Targeting Resource Use Effectively (TRUE)
Goal: Optimize hospice use– Increase appropriate referrals to hospice– Increase the length of stay of hospice
patients (days of care)
How: By forming multidisciplinary community based teams to implement strategies to address barriers to optimal hospice use in the XXXXX community
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What is the Reality?
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The Medicare Hospice Benefit is Widely Underutilized• The median (50th percentile) length of stay in
hospice was 18.7 days in 2012• 30% of all Medicare Beneficiaries enrolled in
hospice died within three days or less• 35-40% of patients enrolled in hospice died in
seven days or less– NHPCO 2012 Data
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Triggering Events for a Hospice Referral
Triggering Events for Hospice Referral• Recurrent infections
• Recurrent hospitalizations/clinic visits
• Repeated home care admissions
• Declining health
• Weight loss
• Decrease in independence in ADL’s
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Triggering Events for Hospice Referral cont’d• Increase in pain/interventions
• Unexplained weight loss
• Patient/family request
• Change in goals of care
• Provider referral
• Other
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Opportunities for Conversation• Expressions of spiritual/social distress
affecting daily life• Quality of life/patient stated goals for
care/interventions in conflict• Expressed desire for advance care planning
or revision of current plan• Lack in clarity of goals• Conflict among family members
and/or patient
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Communicating with Physicians & Providers
Suggestions…
• Gather the facts– Assessments
• (Demonstrating comparison and contrasts)
– Observations of client• Recount expressed feelings, behavior, emotions
– Patient complaints• Pain, fatigue, weight loss, depression, etc
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Suggestions… cont’d
– History of ER visits, clinic visits, home care readmissions
– Patient/family stated questions/comments (if any)
– Caregiver observations– Advance Care Directives– Other
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Phrasing….• Frame the conversation:
– I am calling you about ______________.– During the past _________(time) I have
noted the following of our mutual patient.• Share your assessments/observations• Patient/family quotes• Concerns
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Shared Decision-Making
Between Physician and Patient:• Physician’s Responsibility:
– Inform and recommend best treatment option(s)
• Patient’s Responsibility: – To choose or refuse treatment option(s)
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Hospice and the Hospice Medicare Benefit
Hospice
• Definition-philosophy and services
• Benefits
• Eligibility
• Guidelines
• Level of Care/Reimbursement
• Transfers/Revocation/Discharge
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Hospice PhilosophyHospice is based on a Philosophy which embraces six significant concepts:
• Death is a natural part of life. When death is inevitable, hospice will neither seek to hasten or postpone it.
• Hospice care establishes pain and symptom control as an appropriate clinical goal.
• Hospice recognizes death as a spiritual and emotional as well as physical experience.
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Hospice Philosophy• Patients and their families are a unit of care.
• Bereavement care is critical to supporting family members and their friends.
• Hospice care is made available by most hospices regardless of the ability to pay.
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Hospice Today
• Over 5300 hospice programs nationwide
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Holistic Needs-Holistic Care
• Physical
• Spiritual
• Emotional
• Psychological
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Hospice Team Members
• Medical Director/Attending Physician• Nurses (RN on-call 24/7)• Social Worker• Chaplain/Counselor• Volunteers (Active and Bereavement)• Hospice Aide• Therapies (PT/OT/ST)• Registered Dietician• Pharmacist
– Pet Therapy– Massage/Music– Other
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Who Qualifies for Hospice Care?• Terminally ill persons whose life
expectancy is six months or less given the current progression of their disease process (any age-any diagnosis)– Minnesota Medical Assistance ≤ 12 months
• Patient is seeking palliative care rather than curative treatment
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Local Coverage Determination Guidelines for Hospice• CMS Provides guidelines for hospice admission
– Alzheimer's and related dementia– Cardiac disease– Lung disease– Liver disease– Acute and chronic renal disease– Stroke and coma– AIDs– ALS– Cancer– General decline in status
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Primary Hospice Diagnosis 2012
• Cancer 36.9% • Non-Cancer Diagnoses 63.1%
– Debility Unspecified 14.2% – Dementia 12.8% – Heart Disease 11.2% – Lung Disease 8.2% – Other 5.2% – Stroke or Coma 4.3% – Kidney Disease (ESRD) 2.7% – Liver Disease 2.1% – Non-ALS Motor Neuron 1.6%– (ALS) 0.4% – HIV / AIDS 0.2%
NHPCO published 2013
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Levels of Care
• In-home
• Respite
• Continuous Care
• General Inpatient
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Medical Supplies
• Per diem includes all supplies to terminal illness and related conditions
• Wheelchair• Walker• Oxygen• Wound care• Incontinent products• Dressings• Ostomy supplies• Other
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Medications
• Per diem includes all medications related to the “terminal and related conditions
• Hospice may charge $5.00 co-pay for medications
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Palliative Care Treatment Measures
• This may include: Chemotherapy Radiation Blood products Enteral feedings IV fluids Dialysis Surgery Other
“Palliative” care
measures as
approved
by the IDG team
related to the
alleviation of pain
and suffering
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Transportation
• Emergency transportation by ambulance is covered by hospice if approved by Hospice Team and deemed the mode of transportation needed for transfer
• Non-emergency transport not mandatory-individual agency decision
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Who Pays for Hospice Care?
• Medicare• Medical Assistance• Most Insurance
Plans• Private Pay• Long Term Care
Insurance
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Revocation
• Patient and/or family initiated
• Requests revocation of the hospice
• No penalty to patient to re-enroll
• Patient signs statement of revocation on effective date
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Discharge
• Hospice provider may initiate if:– Patient moves out of service area– Patient is no longer deemed terminally ill– Chooses facility in which hospice does not
have a contract– Behavior is disruptive, abusive, or is
uncooperative
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The Reality Again – Expressed by Patient and Family
• “I wish I had enrolled in hospice sooner”
• “I didn’t realize all the support hospice offered”
• “Why didn’t my doctor tell me about hospice?”
• “Why didn’t I know about hospice?”
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Average Length of Stay in Hospice in Days
• 2012 - 35.5% died/discharged in ≤ 7 days
• 2012 - 71.8 average length of stay
• 2012 - 18.7 median length of stay
NHPCO Data 2013
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Questions
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Stratis Health is a nonprofit organization based in Minnesota that leads collaboration and innovation in health care quality and safety, and serves as a
trusted expert in facilitating improvement for people and communities.
This templatewas prepared by Stratis Health, the Quality Improvement Organization for Minnesota, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of
Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-MN-SIP TRUE HOSPICE-14-68 050214