Transcript Medicare Hospice Benefits and More

Medicare Hospice
Benefits and More
Presented by: XXXXX
Introductions
1
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
3
Local Project Hospice
Lead(s)
• Insert from Speaker Notes
4
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
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•
•
•
•
•
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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Is Your Serious
ents
andthe Elephant
Illness
in Your
Doctor’s
s can
work
Examining Room?
er to
move
Here’s
the situation:
Patients and their families think
that if they
have a serious illness,
ephant”
out
their doctor will start the talk.
Doctors say that they will have
examining
these talks if their patients bring
and make
Doctors and their patients both
think that having these talks are
important.
at everyone
Here’s the problem:
d canDoctors
have
and patients are each
waiting for the other to start the
conversation.
important
Because of this, these talks may
not take place at all. Or, they
ersations
may take place during a health
crisis or emergency, when it’s
now.very stressful for everybody.
This is how to start.
You can ask your doctor:
Do I have a serious or life-limiting
This is how to start.
illness?
You can ask your doctor:
Can my illness be cured?
Do I have a serious or life-limiting
If my illness
can’t
be
cured,
are
illness?
Patients and
Can my illness be cured?
there treatments that can slow
If my illness can’t be cured, are
can work
downdoctors
my illness?
there treatments that can slow
Whattogether
kind of care
is available to
to move
down my illness?
What kind of care is available to
focus
on“elephant”
making me comfortable?
the
out
focus on making me comfortable?
If my illness keeps getting worse,
If my illness keeps getting worse,
examining
when is it a good time to think
whenofisthe
it a good
time to think
about getting supportive and
aboutroom
gettingand
supportive
make and
comfort focused care?
comfort
focused
care?
Will you be the one to tell me when
sure that everyone
to contact hospice?
Will you be the one to tell me when
Will you stay involved with my care
involved
can have
to contact
hospice?
even when I am no longer looking
for treatment for my disease?
Will you
stayimportant
involved with my care
these
even when
I am no longer looking Although your doctor doesn’t know
conversations
exactly how you are going to respond
for treatment for my disease?
to a treatment, it is important to make
now.
Although your doctor doesn’t know
exactly how you are going to respond
to a treatment, it is important to make
sure you have enough information to
make an informed choice about what
you want.
sure you have enough information to
make an informed choice about what
you want.
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
16
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 Philosophy
Hospice 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
Dementia
Heart Disease
Lung Disease
Other
Stroke or Coma
Kidney Disease (ESRD)
Liver Disease
Non-ALS Motor Neuron
(ALS)
HIV / AIDS
14.2%
12.8%
11.2%
8.2%
5.2%
4.3%
2.7%
2.1%
1.6%
0.4%
0.2%
NHPCO published 2013
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Levels of Care
•
•
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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 copay 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
33
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 mandatoryindividual agency decision
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Who Pays for Hospice Care?
• Medicare
• Medical Assistance
• Most Insurance
Plans
• Private Pay
• Long Term Care
Insurance
35
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
36
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
40
Contact Information
XXXXXXX
XXXXXX
www.stratishealth.org
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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