medicare guidelines for hospice discharge

Palliat Med. Epub 2021 Oct 26. The hospice discharge rate in our study population increased from 2.0% (109 of 5528) in 2005 to 4.9% (968 of 19590) in 2014 (P value for trend<.001) (eTable 4 in the Supplement). Most of the 4588 patients discharged to hospice received comfort measures (n=3192 [69.6%]), followed by patients with advanced HF (n=578 [13.3%]) and other patients in the GWTG-HF registry (n=2580 [2.3%]). How many other patients are assigned to each member of the hospice care staff? eCollection 2022. The hospice medical director or your doctor will need to meet with you in person and re-certify that your life . In addition, a beneficiary may transfer hospice agencies only once in each benefit period. The medical community is making strides in increasing access to hospice as nearly 52% of all Medicare decedents received hospice in 2019, up from 48.2% in 2015 (National Hospice and Palliative Care Organization [NHPCO], 2021). New CMS rules put the focus on informed patient choice One metric, short survival in hospice, has been proposed.14 However, a downtrend in survival in hospice has been noted nationally, driven by the increase in patients with noncancer diagnoses enrolling in hospice.15 Further, diseases such as HF are difficult to prognosticate, and therefore, many patients might be receiving hospice referrals very late in the trajectory of disease.16 This might be one important reason why patients with heart disease continue to be grossly underrepresented in the hospice-enrolled population in the United States compared with patients with other diseases, such as cancer.4 Therefore, early recognition of poor prognosis and palliative consultation could facilitate timely hospice referral.17 In our study, 15% of patients survived more than 6 months, similar to rates for other diseases.18,19 However, about 1 in 10 patients in our study discharged to hospice survived for more than 1 year. Factors associated with 1-year all-cause readmissions in heart failure patients readmitted from hospice. 20 - Certification and Election Requirements 20.1 - Timing and Content of Certification 20.2 - Election, Revocation, and Discharge 20.2.1 - Hospice Election This is particularly noteworthy as individuals receiving home hospice care are more than 7 times as likely to be discharged alive than those receiving hospice in other settings such as nursing homes and hospice inpatient facilities (Luth et al., 2020). Focusing on the discharge process is one approach for improvement. However, that analysis did not report patient survival, differentiate hospice site, or provide rates or predictors of readmission. Medicare-participating hospice programs must provide discharge planning, including having a: Discharge planning process that takes into account the prospect that a patient's condition might stabilize or otherwise change such that the patient cannot continue to be certified as terminally ill. Front Cardiovasc Med. Epub 2012 Mar 28. Current practices of live discharge from hospice: Social work perspectives, Live discharge from hospice care: Psychosocial challenges and opportunities, https://creativecommons.org/licenses/by-nc/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, National Hospice and Palliative Care Organization [NHPCO], 2021, Centers for Medicare & Medicaid Services (2018), https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Downloads/Development-of-Draft-HQRP-Transitions-Measure-Specifications.pdf. GIP care can only be provided in one of the following three settings: Does Medicare Cover Hospice? - Healthline.com Patients discharged to hospice had a median survival of 11 days, and 4% of patients discharged to hospice were readmitted to the hospital; nonwhite race and younger age were the strongest predictors of hospital readmission. There are a limited number of reasons under the Medicare Hospice Benefit (MHB) for patient discharge. Hospice social workers report that patients with greater resources and those in urban areas with access to home-based palliative care programs do better following a transition from hospice than others (Wladkowski & Wallace, 2019). J Am Med Dir Assoc. Percent standardized differences (standardized differences100) were calculated. When a hospice claim is received with a discharge status code other than 30 (still a patient), 40, 41 or 42 (patient deceased), or 50 or 51 (hospice transfer), and there is no occurrence code 42 on the claim, a revocation indicator will be posted to the beneficiary's hospice benefit period posted on the Common Working File (CWF). Wang SY, Aldridge MD, Gross CP, Canavan M, Cherlin E, Bradley E. End-of-Life care transition patterns of Medicare beneficiaries. PDF Medicare Home Health Benefit Booklet - HHS.gov Curr Probl Cardiol. PDF Discharge in Hospice Care - NHPCO This site needs JavaScript to work properly. Only 690 patients (15.0%) discharged to hospice lived for 6 months or more. Unable to load your collection due to an error, Unable to load your delegates due to an error. This would eliminate the need for a live discharge as failure to decline in condition while on hospice is often a temporary state. Log-rank test was used to assess the difference in mortality. LeSage K., Borgert A. J., Rhee L. S. (2015). The NOMNC (CMS-10123) is not required. (2018). We excluded 8330 patients with missing discharge disposition, who died in-hospital, who transferred to another short-term hospital, who left against medical advice, and/or with missing socioeconomic information. Dr Hernandez has received personal fees from AstraZeneca, Amgen, Bayer, Boston Scientific, Merck & Co, Novartis, and Pfizer as well as grants from AstraZeneca, GlaxoSmithKline, Merck & Co, Novartis, Luitpold, and Bristol-Myers Squibb. Robust sandwich variance estimators were used in the model to account for correlation among patients from the same hospital. Inpatient respite care is provided to the beneficiary only when necessary to relieve the family members or other caregivers that are caring for the beneficiary at home. This list must include why they made that determination. Study concept and design: Warraich, Xu, DeVore, Yancy, Fonarow, Allen. These findings highlight significant areas for potential improvement in the quality of end-of-life care received by patients with HF. Randomized trials have shown that patients with HF have better quality of life when receiving palliative care.11,12,13 However, there are limited metrics for assessing quality of care at end of life. eTable 11. Patients discharged to hospice who were readmitted (497 of 4588) compared with patients with advanced HF (2948 of 4357) and other patients in the GWTG-HF registry (73804 of 113045) were older (median [IQR] age, 84 [76-89] years vs 78 [71-83.5] years and 81 [74-87] years), were less likely to have a primary cardiovascular diagnosis (216 [43.5%] vs 1693 [57.4%] vs 35702 [48.4%]) or have a cardiovascular procedure performed (67 [13.5%] vs 767 [26.0%] vs 16637 [22.6%]), and were more likely to die during the readmission (59 [12.1%] vs 266 [9.1%] vs 4428 [6.1%]) or discharged back to hospice (131 [26.8%] vs 180 [6.2%] vs 2812 [3.9%]) (eTable 11 in the Supplement). Trends in observed median survival in hospice. J Palliat Med. Secondary outcomes/end points that we analyzed included demographic, biologic, hospital, and sociological factors, and we assessed if they were associated with discharge to hospice. Hospice use has grown to about 4.9% of Medicare HF hospital discharges, with significant hospital-level variation. It would also be useful to develop tools to predict patients who experience such long survival in hospice. What services do hospice volunteers offer? Coverage for respite care does not require a worsening of the beneficiary's condition. Centers for Medicare & Medicaid Services. Currently, there is no consistency across how hospices approach a live discharge (Wladkowski & Wallace, 2019). Teno J. M., Gozalo P., Trivedi A. N., Bunker J., Lima J., Ogarek J., Mor V. (2018). eTable 1. Trend of hospice rate in study population (121 990 patients from 438 sites). Rates of readmission from hospice did not change through the course of the study (eTable 13 in the Supplement). 2 . A Medicare-certified hospital or a skilled nursing facility that also meets the standards specified in 418.110 (b) and (e) regarding 24-hour nursing services and patient areas. Patients discharged to hospice also had greater hazards of the composite outcome of all-cause mortality and all-cause readmission in both adjusted and unadjusted analyses compared with patients with advanced HF and other patients in the GWTG-HF registry (Figure 2C). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. What is the state of hospice care in older patients hospitalized with heart failure? Hospice discharges increased from 2.0% (109 of 5528) in 2005 to 4.9% (968 of 19590) in 2014. Periodic interim payments. Our study confirms the poor overall survival of older adults discharged after an HF hospitalization.1 A 2012 report8 from GWTG-HF reported on hospice discharges between 2005 and 2010. 418.306. Fiscal Year 2024 Hospice Payment Rate Update Final Rule (CMS-1787-F) Before FOIA Overall, there were 6350 patients (5.2%) in our study cohort who received comfort measures only at any point during the hospitalization and survived to discharge, 3192 (50.3%) of whom were discharged to hospice. Chapter 9 - Coverage of Hospice Services Under Hospital Insurance . Linking inpatient clinical registry data to Medicare claims data using indirect identifiers, Utilization of hospice and predicted mortality risk among older patients hospitalized with heart failure: findings from GWTG-HF, Hospice enrollment in patients with advanced heart failure decreases acute medical service utilization. We compared 4588 patients discharged to hospice with 4357 patients with advanced HF (ejection fraction 25% and any of the following: inpatient inotrope use, serum sodium level 130 mEq/L, blood urea nitrogen level 45 mg/dL [to convert to micromoles per liter, multiply by 0.357], systolic blood pressure 90 mm Hg, or comfort measures during hospitalization) not discharged to hospice and with 113045 other patients with HF in the GWTG-HF registry. HHS Vulnerability Disclosure, Help The primary outcomes of interest were all-cause mortality, all-cause readmission, and a composite of mortality/readmission at 30 days, 6 months, and 1 year after index discharge. Hospice | CMS - Centers for Medicare & Medicaid Services The Get With The GuidelinesHeart Failure program is provided by the American Heart Association, is sponsored in part by Amgen, and has been funded through support from Medtronic, GlaxoSmithKline, Ortho-McNeil Pharmaceutical, and the American Heart Association Pharmaceutical Roundtable. We assessed the outcomes of patients admitted to the hospital by final disposition, eg, death, discharge to hospice, or discharge without hospice plan. Quintiles (Cambridge, Massachusetts) served as the registry coordinating center, and the Duke Clinical Research Institute (Durham, North Carolina) was the data analysis center. Accessibility How does the hospice staff respond to after-hour emergencies? Almost a quarter of patients discharged to hospice die within 3 days of discharge, and about 4.1% of patients are readmitted to the hospital within 30 days. FOIA Finally, the U.S. healthcare community needs a consistent framework to talk about live discharges from hospice. You and your family members are the most important part of a team that may also include: A hospice doctor is part of your medical team. They were not involved in the editorial evaluation or decision to accept this article for publication. The median (IQR) survival for patients discharged to hospice was 11 (3-63) days compared with 318 (78-1095) days for patients with advanced HF and 754 (221-1784) days for other patients in the GWTG-HF registry. You may have the right to ask the BFCC-QIO for a fast appeal. They were also more likely to be discharged from an urban hospital (74 [3.8%] vs 110 [5.3%] vs 31 [6.9%]) and transplant-capable hospital (157 [11.1%] vs 140 [9.0%] vs 28 [8.3%]) (eTable 8 in the Supplement). Acknowledging live discharges as a care transition, rather than being forgotten or misdiagnosed, will go a long way in identifying those affected and incorporating proper assessment and intervention to support ongoing continuity in their care. Trends in Hospice Discharge and Relative Outcomes Among Medicare Select the topic below for additional information. A beneficiary or representative may choose to revoke the election of hospice care at any time. Your hospice benefit covers care for your terminal illness and related conditions. Minimally, for patients with chronic illnesses (i.e., ADRD, CHF, COPD, CVA), policy requirements for recertification, and therefore, maintaining eligibility, must be re-evaluated to better reflect their disease process. Inpatient Hospice Guidelines for Our Patients - VITAS Hospice Use and Palliative Care for Patients With Heart Failure: Never Say Never in Medicine, but It Is Never Too Early to Start the Conversation. You can get covered services for any health problems that arent part of your terminal illness and related conditions. Objective: o Death: patient or authorized representative decides to transfer to another hospice. Austin BJ, Fleisher LK Financing end-of-life care: challenges for an aging population. Hospice discharge: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Medicare Approved Types of Live Discharge From Hospice Care - Axxess Cumulative incidence for readmission outcomes accounted for the competing risk of mortality. Stephanie P. Wladkowski, School of Social Work, Eastern Michigan University, 317 Everett L. Marshall Building, Ypsilanti, MI 48197, USA. However, the aim of this study was to better define patterns of hospice use at the end of life for patients with HF. Overall, 1034 patients (22.5%) discharged to hospice died in less than 3 days, while 739 (34.1%) discharged to a hospice facility died in less than 3 days. patient/staff safety) 52Discharge for patient unavailability, inability to receive care, or out of service area 85Delayed recertification of hospice terminal illness (effective for claims received on or after 1/1/2017) A, Hospice discharge rates from sites with 25 or more hospice discharges were included, leaving 350 sites and 120923 patients. Luth E. A., Russell D. J., Brody A. The regulations for discharge are included in the Medicare hospice regulations, 42 CFR 418.26.1 Once a hospice chooses to admit a Medicare beneficiary (patient), it may not automatically or routinely discharge the beneficiary at its discretion, National Library of Medicine At this meeting follow up care will be arranged. Readmission at 30 days was lower in patients discharged to hospice (189 [4.1%]) compared with patients with advanced HF (1185 [27.2%]) and others in the GWTG-HF registry (25022 [22.2%]). Accessibility Russell D., Luth E. A., Ryvicker M., Bowles K. H., Prigerson H. G. (2020). To remain on hospice, an individual must demonstrate ongoing, steady decline at recertification intervals of every 90days for the first 6months, then every 60days thereafter until death or discharge. Variation in Hospice Discharge Rate Among Hospitals, Figure 2.. Time-to-Event Comparisons Between Patients Discharged, Figure 2.. Time-to-Event Comparisons Between Patients Discharged to Hospice, Patients With Advanced Heart Failure, and, Figure 3.. Time-to-Event Comparisons Between Patients Discharged, Figure 3.. Time-to-Event Comparisons Between Patients Discharged to Home Hospice and a Hospice Facility, MeSH Dr Allen has consulted for Novartis, Boston Scientific, Janssen, Cytokinetics/Amgen, ACI Clinical, and Duke Clinical Research Institute and has received research grants from the Patient-Centered Outcomes Research Institute, the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the American Heart Association. PDF Hospice Guidelines for the Expedited Determination (ED) Process Important: If you were in a Medicare Advantage Plan before starting hospice care, and you decide to stay in that plan: If you start hospice care on or after October 1, 2020, you can ask your hospice provider for a list of items, services, and drugs that theyve determined arent related to your terminal illness and related conditions. Persons with more chronic illnesses, such as Alzheimers Disease and Related Dementias (ADRD), stroke (CVA), lung and heart diseases (i.e., COPD, CHF), have a trajectory that is less predictable in decline, unlike cancer. Payment for respite care may be made for a maximum of 5 continuous days at a time including the date of admission but not counting the date of discharge. These patients are often referred to as not dying fast enough, or failure to die on time, as ultimately, they are still dying, and they are still terminally ill, just not within the prescribed 6-month framework. Your hospice provider is also required to give this list to your non-hospice providers or Medicare if requested. Patients discharged to hospice and readmitted from home hospice were younger than patients readmitted from hospice facilities (median [IQR] age, 83 [75-88] years vs 86 [80-91] years), but no significant differences were noted in other characteristics (eTable 12 in the Supplement). This finding warrants further investigation to identify factors driving high and low hospice discharge rates in hospitals. government site. Nonwhite race and younger age were the strongest predictors of readmission from hospice. Once discharged to hospice, few patients are readmitted to the hospital, and most die within 2 weeks of hospice referral. Discharge from Hospital - HSE.ie Hospice General Inpatient Care - Healthcare Provider Solutions Rothenberg LR, Doberman D, Simon LE, Gryczynski J, Cordts G. Patients surviving six months in hospice care: who are they? PDF Hospice Medicare Billing Codes Sheet After your hospice benefit starts, you can still get covered services for conditions not related to your terminal illness. If you need to get inpatient care at a hospital, your hospice provider must make the arrangements. Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness. Only 4.9% of Medicare patients hospitalized with HF were discharged to hospice, and there was significant hospital-level variation in hospice discharge rates. Recognizing changes in condition that requalify patients for hospice can also assist in reestablishing necessary supports before death, which then follow families through bereavement. Author Contributions: Dr Warraich and Ms Xu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The hospice benefit allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. 2000-2010 utilization patterns. Only 4.9% of Medicare patients hospitalized with HF were discharged to hospice, and there was significant hospital-level variation in hospice discharge rates. Hospice use remains infrequent in patients with heart failure, and those patients are referred late.

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