For both initial hospice certification and recertification, the Centers for Medicare and Medicaid Services (CMS) requires an attestation by the hospice medical director that the patient has a medical prognosis of six months or less if the disease follows its normal course. Most of the burden for certification and recertification falls on the hospice medical director. However, the entire interdisciplinary group (IDG) plays an important role in this process. Hospice organizations need to leverage all members of the IDG to support accurate documentation of the patient’s terminal diagnosis at every visit.
Every discipline should understand the difference between subjective and objective data. Subjective data is what the patients say. Objective data is what the provider sees. As an example, the hospice patient tells the social worker that there have been more frequent episodes of shortness of breath since the last visit. The social worker notices that the patient is puffing when talking and is sitting up and leaning forward. The social worker can document what the patient said and what they observed. They should also notify the registered nurse (RN) case manager of the change in condition and document that notification.
Documentation at the point of service improves accuracy and streamlines IDG documentation. Documentation from every discipline needs to provide evidence that supports the patient’s decline and a plan of care that reflects disease progression. A technology partner that enables visit documentation to flow to the IDG summary ensures that all documentation that supports eligibility and decline is added to the IDG discussion.
Hospice eligibility begins at admission with a thorough review of the patient’s medical history and assessment of current conditions. RNs who complete the admission assessment must be trained in the CMS Local Coverage Determination (LCDs) for each diagnosis. It is essential that clinical staff have tools that clearly list the criteria for the general decline and diagnosis-specific indicators that support eligibility. The best tools are handy, portable and easy to use during assessment and documentation. Some technology partners, like Axxess Hospice, enable users to select the information necessary to support hospice eligibility during the admission assessment. Otherwise, clinicians need to document item by item to show why the patient has a prognosis of six months or less if the disease follows its normal course.
When recertifying a patient for the hospice benefit, clinicians must document to the LCDs and describe how the patient has declined since admission or the last recertification. This documentation should include any signs of health decline that will contribute to the terminal prognosis. It is important for hospice organizations to select and partner with technology providers that offer ongoing tracking of vital signs, weights and other scales and measures, as well as the LCD guidance for assessing patients’ continuing hospice eligibility.
Leveraging the IDG to support eligibility is based on documentation at every visit, by every discipline and at every IDG meeting. Whether you are a skilled nurse, social worker, chaplain or hospice aide, you need to know what the patient’s terminal diagnosis is, recognize changes in condition and connect these to the discipline plan of care.
Axxess Hospice supports documentation of eligibility with built-in LCD documentation, quick links to measurements that track the patient’s decline and the ability to move documentation to the IDG summary with simple checkbox functionality.