Introduction, or How to Use This Book

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:

1. General Considerations. This area contains general information about the diagnosis and the patient’s health problem in relation to hospice care. Specific regulatory information about a specific disease may also be listed in this section.

2. Eligibility Considerations. Patient eligibility for hospice is determined by the hospice physician and in consultation with the referring and/or attending physician. Diagnoses information is also listed when there are implications for admission and/or care. For example, when addressing Alzheimer’s disease and other dementias, readers are referred to their MAC or other regulatory bodies for up-to-date and specific guidance. This section provides information to help support medical necessity from quality and payer perspectives.

3. Potential Diagnoses ICD-10-CM Diagnostic Coding. This section refers to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10-CM), which is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as classified by the World Health Organization.

4. Safety Considerations. This section lists standard safety considerations that may be considered for safe, individualized care. Safety consideration should be based on the patient’s unique condition and environment. The information listed in safety considerations is to be used upon assessment and throughout care planning and care planning–related processes.

5. Skills and Services Identified. The section lists the hospice team members and some of their specialized functions and interventions, based on the patients/families, diagnoses or problems, and their unique circumstances. These services include the registered nurse, hospice aide, social worker, volunteer(s), spiritual counselor, and other services. This section assists with the individualization of care, care planning, and documentation. This information is provided as a list to help identify needed hospice care services and assist team members by identifying possible interventions and care based on the team member’s education and professional scope of practice and the hospice patient’s/family’s individualized needs.

6. Patient, Family, and Caregiver Educational Needs. This section identifies care regimens that contribute to safe and effective care at home between the hospice team member’s visits. This is a list of possible caregiver educational needs. This information is not all-inclusive and must be based on the patient’s and family’s unique circumstances and needs.

7. Tips for Supporting Quality, Safety, Eligibility, and Reimbursement. These tips help contribute to clear, specific documentation of care and care planning–related processes. These are often practical tips related to supporting medical necessity and individualizing documentation of the patient’s hospice care.

8. Quality Metrics. The questions listed in this section were created to help clinicians and managers identify possible areas for improvement of care and related processes. Some of the questions help support medical necessity, while others are specific to assessment and other components of care. These questions could be incorporated into educational sessions for opportunities to improve care, operations, and practice. Organizations/providers should refer to the hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) questions and measures for additional quality metrics related to the caregiver experience.