Complete Story
02/19/2010
Hospice E-News Volume 15, Issue 7 February 19, 2010
- JOB OPPORTUNITIES
- NHPCO COMPLIANCE AND REGULATORY UPDATES
- GRIEF AND CULTURE
- RESEARCH & RESOURCE NOTES
- OTHER NOTES
- CMS AND FEDERAL NEWS
- STATE NEWS
- PALMETTO GBA UPDATES AND CHANGES
- WHY ARE FEWER PATIENTS ENROLLING IN HOSPICE?
job opportunities
Click here to view current job opportunities in home, hospice and palliative care!
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NHPCO COMPLIANCE AND REGULATORY UPDATES
CR6440 - SW calls Q&A Update ID#: 9970, Posted February 19, 2010
Question: In CR6440, CMS wrote that: "Report only social worker phone calls related to providing and/or coordinating care to the patient and family, and documented as such in the clinical records." Does this sentence mean that only calls to the patient and family are to be considered for reporting?
CMS Answer: Because of the nature of a social worker's job, social workers perform a portion of their work without face-to face contact with either the patient or their family, which is why CMS allowed social workers to record their phone calls as visits. For instance, off hours counseling of the patient and/or counseling of family members who live out of town, would be considered appropriate and necessary when provided via a phone conversation. However, it would be inappropriate to record every phone call that a social worker makes on behalf of a patient.
As stated in CR#6440, only social worker phone calls that are necessary for the palliation and management of the terminal illness and related conditions as described in the patient's plan of care (such as counseling or speaking with a patient's family or arranging for a placement) should be reported. Given the nature of a social worker's job responsibilities, we would expect that almost all social worker phone calls reported would be between the social worker and either the patient or the patient's family. It is feasible, however, that care coordination phone calls by a social worker to other than family members could be reportable. For example, if a SW facilitates alternate care arrangements for the patient in a scenario where the patient's primary caregiver suddenly becomes unavailable to provide care, those calls should be recorded. Clinical judgment should be applied to determine if a particular social worker phone call is reportable. In essence, report only social worker phone calls related to providing care to and/or coordinating care of the patient for the palliation and management of the terminal illness and related conditions, as well as for the counseling of a patient's family, and document those phone calls as such in the clinical records. (NHPCO, 2/19/10)
Clarification of CR6778 Q5003 Nursing Facility Bed/Continuous Care
NHPCO spoke to CMS about two issues in the recently released CR6778. CMS responded that they will be issuing a clarifying Q&A for these issues some time soon.
- Hospices should use Q5003 for patients who reside in the nursing facility and are not receiving SNF level of care. Typically, it would be unusual for a hospice patient to be receiving SNF level of services at the routine home care level of care, and most often the site of service code would be Q5003. For the Q5003 code, continuous home care CAN be provided. It will be incumbent on the hospice to determine whether the patient is in a NF bed or a SNF bed.
- Providers have asked questions about the definition of "more than half" for nursing services for continuous home care. CMS responded that the language in the COPs is "predominantly" and the interpretation of that language is more than 50%. For example, if the patient has 8 hours of continuous home care provided in a 24 hour period, that would be 32 15-minute increments to be billed. Nursing care must be at least 17 of the 32 increments in that 8 hour period. Correspondingly, if there is more than 8 hours of continuous care provided in a 24 hour period, the same "more than half" applies. (NHPCO, 2/18/10)
GRIEF AND CULTURE
In the February 1 The New Yorker, author Meghan O'Rourke discusses the expression of grief in different cultures, and briefly surveys the cultural history of grief. Click here to read the full article. (The New Yorker, 2/1)
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RESEARCH & RESOURCE NOTES
- "Safety Plan for Opioids Meets Resistance, Opioid Deaths Continue to Soar," in the current JAMA, says that the FDA plans to require that patient safety imformation to be improved and for opioid prescribers to undergo additional training is running into resistance. Healthcare groups are arguing that mandatory training for physicians will reduce patient access to pain medication. Scott M. Fishman, MD, chief of the pain medicine division at the University of California-Davis, says that such training should be initiated in medical school curricula, and that state boards might make such training a requirement for renewing a medical license. Opioid deaths tripled between 1999 and 2006, but a spokesman for the National Center for Health Statistics says that the reasons are not clear, and that the data "do not specify whether the individuals who died obtained the drugs by prescription or illegally." If you're a JAMA Member, use this link to access the article. (JAMA, 2010; ;303(6):495-497)
- "Is It Always Wrong to Perform Futile CPR?," in the current NEJM, explores a rare situation where the family of a severely neurologically damaged patient refused to sign a DNR order, insisting that everything possible be done. Author Robert D. Truog, MD, argues that there are cases where families do not see "a good death" the way most Westerners do, and it is important to them to "believe that they fought until the very end." This may be most important, Truog says, when the family is from a part of the world where ICU care is not available, and where "giving up ... would be deemed wrong and inconceivable." Truog concludes, "Actions surrounding the moment of death are highly symbolic and often of great significance to the surviving family. By sometimes agreeing to provide futile CPR, we send a message to our communities not that clinicians can be bullied into performing procedures that good medical judgment would oppose, but that our hospitals are invested in treating patients and families with respect and concern for their individual needs." (NEJM, 2010;362:477-479)
- A University of Pittsburgh study reports that "patients admitted to hospitals with higher-intensity end-of-life care live longer than those admitted to hospitals with low-intensity approaches." The study, which did not address cost effectiveness or quality of life issues, defined higher-intensity care as the "greater use of life-sustaining measures such as ICU admission, intubation or mechanical ventilation, kidney dialysis and feeding tubes." Thirty days after admission, patients at higher-intensity hospitals had a 7% risk of dying, compared to 9% in lower-intensity hospitals. There was no difference in risk of dying six months after admission. (Medical Care, 2010; 48(2):125-132; EurekAlert!, 2/11)
OTHER NOTES
- Rosemary Salerno, a psychotherapist who has worked in end-of-life care for 18 years, defines "dying well" as a statement given by the daughter of a hospice patient: "You helped my dad end his life with dignity, with freedom from pain, and on his own terms. I was able to witness that and that is what has greatly helped me to cope now." Diana Wilkie, professor at Chicago's College of Nursing of the University of Illinois, says, "It's important for us to recognize that end-of-life care needs to be personalized. ... You only die once." The article explains the work of hospice, and features several hospices in the Chicago area. (Journal of Oak Park and River Forest, 2/9/10)
- "Death Becomes Him," in the March The Atlantic Monthly, provides a profile of Ludwig Minelli, founder of the Swiss organization Dignitas. Dignitas, whose slogan is "To live with dignity, to die with dignity," has helped more than a thousand people commit suicide, and "has cornered the market in what has come to be called ‘suicide tourism.'" Minelli crusades for what he calls "the last human right," and "he believes that helping more and more people to die advances his cause." Click here to read the full article. (The Atlantic Monthly, 3/20/10)
- The US Conference of Catholic Bishops has released guidelines which say that Reiki, an Eastern healing technique in which the practitioners hands are placed on or above a patient's body to "enhance the flow of energy," is superstition. According to the guidelines, "It would be inappropriate for Catholic institutions, such as Catholic health care facilities and retreat centers, or persons representing the Church, such as Catholic chaplains, to promote or to provide support for Reiki therapy." According to the article, the National Institutes of Health has funded a study of the potential health effects of Reiki. Click here to read the full article. (PBS, 2/12/10)
- As part of Black History Month, the Milwaukee Courier has published a list of prominent African Americans who have benefited from hospice care. The list includes Ernest O. Brown, one of the first African Americans to graduate from the Medical School at the University of Maryland; Johnnie Cochran, prominent attorney; George William Crockett, Jr., US Representative from Michigan and vice president of the National Lawyers Guild; Charles Norman Mills, artist; Hale Smith, composer and pianist, and August Wilson, playwright. Click here to read the full article. (Milwaukee Courier, 2/6/10)
- A recent directive from US Catholic bishops has strengthened the Church's position on artificial nutrition and hydration for dying patients. The statement, "which is more definitive than previous church teachings," requires food and water to be given "indefinitely by natural or artificial means" as long as the patient is "otherwise healthy." It "appears to apply broadly to any patient with a chronic illness who has lost the ability to eat or drink, including victims of strokes and people with advanced dementia." According to the article, there are exceptions. If a person is actively dying, no feeding tube is required. Click here to read the full article. (Chicago Tribune, 2/8/10)
- Two physicians in Muskegon, Michigan, have differing views about medical marijuana. Dr. Gerald Harriman, medical director of Harbor Hospice, thinks the state's medical marijuana act was "rushed," that it needed more planning, and that there are too many loopholes. Dr. Virgil F. Vasquez, outpatient psychiatrist at Pine Rest Christian Medical Services, has been practicing in Muskegon since 1970, and has seen very few cases of marijuana addiction. He approves the passage of the law. The Muskegon Medical Society, which has about 200 members, has not yet taken a position on the laws. Click here to read the full article. (Muskegon Chronicle, 2/7/10)
CMS AND FEDERAL NEWS
Express Scripts Becoming NonProfit
Click here to read the full article. (Kaiser Health News, 2/19/10)
Second in Command Picked for CMS
Click here to read the full article from The Hill.
Modern HealthCare reports "Tavenner's hiring comes after the largest payer for healthcare services announced a restructuring, creating a new Center for Medicare and streamlining other departments to create the Center for Medicaid and State Operations, the Center for Program Integrity, the Center for Strategic Planning and the Office of External Affairs & Beneficiary Services" (DoBias, 2/17). (Kaiser Health News, 2/18/10)
Obama To Present Own Bill at Summit this Week
President Obama will offer "comprehensive" health reform legislation in advance of next week's planned summit with Republicans, The New York Times reports. Click here to access the entire article, including all of the News Stories. (Kaiser Health News, 2/19/10)
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STATE NEWS
ODH Released Hospice Stats for End of 2009
As of 12/31/09, there were 111 certified hospices, 123 licensed hospices, 8 agencies have pending applications for certification and 4 applications pending for licensure. There were a total of 10 hospice complaints during the last quarter of 2009, 3 substantiated, 3 unsubstantiated, and the remainder are still under investigation. (ODH, 2/18/10)
OHIP Receives more than $50 M for Statewide HITECH Projects
The Ohio Health Information Partnership (OHIP), the state designated entity for health information exchange development, is pleased to announce more than $50 million in funding to help make electronic health records more widely available in Ohio. OHIP was awarded $43.3 million as part of the HITECH provisions in the American Recovery and Reinvestment Act (ARRA) of 2009. The state's 2010-11 biennial budget also allocates $8 million, in non-GRF funds, to the Ohio Department of Insurance to support efforts in health information technology (HIT). More than one-third of the federal funds, $14.8 million, will go toward development of a statewide health information exchange to allow for the sharing of electronic health records between authorized healthcare facilities and health care providers.
In addition, $28.5 million of these funds are designated to help with the creation of regional extension centers (REC), which will support hospitals and health care providers in their adoption of electronic health records. HealthBridge, a not-for-profit health information organization serving Greater Cincinnati and surrounding areas, has also been awarded a $9.7 million Regional Extension Center grant from the federal government to serve a tri-state region, including portions of southern Ohio, northern Kentucky and southern Indiana. In September 2009, Governor Strickland designated the OHIP as the non-profit entity that will lead the implementation and support of health IT throughout Ohio. OHIP subsequently applied for two HITECH grants - one to create a statewide HIE and the other for regional extension center development. More information is available at http://www.ohiponline.org. (OHIP, 2/12/10)
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PALMETTO GBA UPDATES AND CHANGES
Responding to a Hospice Additional Development Request
This article includes 17 recommendations for what to include when responding to an Additional Development Request (ADR).The article also links you to a hospice checklist tool to use when returning an ADR. (PGBA, 2/19/10)
Revisions to Consultation Services
Palmetto GBA would like to clarify the changes announced by the Centers for Medicare and Medicaid Services (CMS) regarding the use of CPT consultation codes in the inpatient hospital and nursing facility settings. Effective January 1, 2010, consultation codes are no longer recognized for Medicare Part B payment. Providers shall code patient evaluation and management (E/M) visits with E/M codes that represent where the visit occurred and that identify the complexity of the visit performed. In the inpatient hospital setting and the nursing facility setting all physicians (and qualified nonphysicians where permitted) who perform an initial evaluation and management service may submit the initial hospital care CPT codes 99221 - 99223, or nursing facility care CPT codes 99304-99306. A service that does not meet the minimal requirements for an initial hospital visit CPT codes 99221-99223, may be submitted as subsequent hospital visits (CPT codes 99231-99233). A service that does not meet the minimal requirements for an initial nursing facility visit (CPT codes 99304-99306), may be submitted as a subsequent nursing facility visit (CPT codes 99307-99310). Providers must ensure that documentation supports the level of services billed. Additional information is available through the following:
CPT® Professional Edition 2010, Initial Hospital Care, New or Established Patient, Page 14, Internet-Only Manuals
Pub.100-04 Chapter 12; MLN Matters Article, MM6740-Revisions to Consultation Services Payment Policy; Final rule. Select the CMS-1413-FC link, Select CMS-1413-FC (Published November 25, 2009) located at bottom of page under "Related Links Outside CMS" (PGBA, 2/15/10)
Medicare Systems Edit Refinements Related to Hospice Services
This article is based on Change Request (CR) 6778, which: 1) revises existing Medicare standard systems edits to allow Medicare Fee-for-Service (FFS) claims to process for beneficiaries in a Medicare Advantage plan, 2) adds new edits ensuring the appropriate place of service is reported for hospice general inpatient care (GIP), respite, and continuous home care; and 3) provides a technical correction to the Medicare Benefit Policy Manual regarding the requirement for nursing care related to hospice continuous home care. Be certain your billing staffs are aware of these Medicare changes. (PGBA, 2/16/10)
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WHY ARE FEWER PATIENTS ENROLLING IN HOSPICE?
Suddenly, many hospices are admitting fewer patients. Others are increasingly caring for people for just days or hours before they die. The result: cash-strapped hospices are cutting back on nurses and aides, and patients are missing out on critical end-of-life care. To read the full Howard Gleckman article, click here.
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Thanks to Don Pendley for contributions.Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2010. Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division. Ask your insurance agent to visit their website at www.hccis.com. Hospice News Network is published 45-47 times a year by a consortium of state hospice organizations. Copyright, 2010. All rights reserved to HNN subscribers, who may distribute HNN, in whole or part, to provider members of the subscribers' state organizations. If readers need further information, they should consult the original source or call their state association office. HNN exists to provide summaries of local, state and national news coverage of issues that are of interest to hospice leaders. HNN disclaims all liability for validity of the information. The information in HNN is compiled from numerous sources and people who access information from HNN should also research original sources. The information in HNN is not exhaustive and HNN makes no warranty as to the reliability, accuracy, timeliness, usefulness or completeness of the information. HNN does not and cannot research the communications and materials shared and is not responsible for the content. If any reader feels that the original source is not accurate, HNN welcomes letters to the editor that may be shared with HNN readers. The views and opinions expressed by HNN articles and notes are not intended to and do not necessarily reflect views and opinions of HNN, the editor, or contributors. Only subscribing state hospice organizations have rights to distribute HNN and all subscribers understand and agree to the terms stated here. (Volume 14, Number 6, February 16, 2010)
