The Hospice e-News

What the Media Said about End-of-Life Care This Week

Week of May 29, 2006

…a service of Florida Hospices and Palliative Care

 

 

HOSPICE CONTINUOUS HOME CARE TO BE SCRUTINIZED

 

Two articles in Medical Newswire provide tips for hospices on how to “weather the coming storm” over continuous home care.  The first article, “Continuous Care Probe Hits Hospices,” suggests that there will be increased scrutiny of continuous home care (CHC) offered by hospices. 

 

Hospice attorney Mary Michal, of Reinhard Boerner Van Dueren, in Madison, Wisconsin, says, that for the first time in recent memory, CHC has been “targeted for a probe edit.”  But this should be no surprise, says Beth Carpenter, of Beth Carpenter and Associates, because CHC is “a fast-growing segment of a fast-growing Medicare benefit.”

 

Sharon Litwin, of 5-Star Consultants in Baldwin, Missouri, says that hospices tend to either overuse or underuse the service.  Those who underuse see it as “too complicated or staff-intensive” to offer and those who overuse CHC “set inappropriate goals for high percentages of CHC.”

 

Michal says there are many legitimate reasons for CHC growth.  Nursing staff shortages and complicated rules for administering and tracking CHC kept many hospices from offering it.  But competition is forcing increased usage and patients generally would rather have home care than be admitted to the hospital.

 

Michal thinks the focus of the current probe is too narrow and says, “Authorities should really look at target hospices’ provision of CHC in conjunction with their utilization of inpatient care.”  The way the current probe is structured, it will be impossible to determine whether “the outlier hospices chosen for the probe edit are simply doing a better job of keeping patients at home and out of the hospital,” Michal says.

 

“Combat Continuous Care Scrutiny With 6 Steps,” the second article, offers suggestions from experts in the field.

 

*  Be sure to bill correctly.  Understand the CHC requirements and bill accurately.  As an example, the article says that billing “even one more hour of aide service than RN or LPN service means that you can’t bill CHC but must use the lower routine home care rate.”  Litwin says, “Setting a goal as a company to reach a certain percentage of continuous care is not appropriate.”  The regulations may be downloaded from www.cms.hhs.gov/transmittals/downloads/A03016.PDF. 

*  Make sure care plans are individualized.  Michal says, “A cookie cutter approach to care planning, where everyone essentially gets the same care, will not fly and may place the hospice at grave risk.”

*  Document and then document some more.  Carpenter says, “Without appropriate, ongoing, complete justification and documentation for continuous care… reimbursement for the continuous care services will be denied.”

*  “Tailor” ADR responses.  The supporting documentation for medical review may be insufficient and Michal suggests including a cover letter that points out the portions of the medical record that are pertinent to CHC eligibility.

*  Be careful about underutilization.  Overutilization may result in denied claims, Litwin says, but underutilization can result in survey deficiencies.  Litwin relates the story of a hospice that got a deficiency from surveyors because it admitted an inpatient without “even thinking about doing continuous care.”  Litwin recommends that the hospice interdisciplinary team and medical director evaluate patients for CHC and reevaluate every shift.

            *  Be sure the staff is educated about CHC.  “If your staff don’t understand the requirements for CHC, chances are you aren’t furnishing it correctly.”

 

            At HNN press time, the articles were online at www.medicalnewswire.com.  Search for CHC in the search box.  (Medical Newswire Website, 5/12)

 

 

BUCHWALD WRITING BOOK ABOUT HIS EXPERIENCES AT EOL

 

Art Buchwald says that even though he’s a hospice patient, he isn’t going to Heaven immediately when he dies – he plans to stop over in Martha’s Vineyard on the way.  Buchwald says that when it became known that he was in hospice, he became a celebrity.  “The more publicity I got,” Buchwald says,” the more attention my kidneys got, and instead of going quietly into the night, I was holding news conferences every day.”  Buchwald is leaving the hospice on July 1 and plans to finish a book about his experiences, “Standby in Heaven:  The Man Who Wouldn't Die.”

 

Doctors say he has lived “an improbably long time without properly functioning kidneys or dialysis,” but that he’s not likely to die immediately.  By all accounts, Buchwald has enjoyed his time in hospice, saying that “I never realized dying was so much fun.” 

 

Friends and family, members of Congress, even the French ambassador came to say goodbye and the National Hospice Foundation honored him.  People came with “flowers, cheesecake and corned beef sandwiches,” says The Washington Post article.  Buchwald says, “I sat in the salon of the hospice and, pretty soon, when people came to see me, it was as if they were visiting Lourdes.  They came to be blessed and cured.  Alas, the people who come to visit me now look at me with great suspicion.  They want to know if the whole thing was a scam. They can't believe, after I said goodbye, I'm going to Martha's Vineyard instead of Paradise.”

 

With his improved status, he says, “Things I didn’t care about because I was going to die, I now had to care about.  This included shaving in the morning, buying a new cell phone that works, rewriting my living will and scrapping all the plans for my funeral.  I also had to start worrying about Bush again.”  (The Washington Post, 5/23; AP, 5/24))

 

 

RESEARCH AND RESOURCE NOTES

 

*  The results of a study commissioned by the California Institute for Nursing and Health Care show that all but two of the state’s 24 regions fall below the national average in the ratio of filled RN positions per 100,000 residents.  Letter grades were assigned to the regions, with a grade of C representing the national average.  Half the regions were graded D or F.  (AHA News Now, 5/23)

 

*  Retired nurse Mary Wohlford, age 80, wants to be sure about what happens to her at the end of life.  She’s told her family members what she wants, her signed living will hangs on her refrigerator and she’s had “DO NOT RESUSCITATE” tattooed on her chest.  Wohlford is healthy and helps care for two other women.  Her decision to get the tattoo was the result of her 30 years as a nurse and the Terri Schiavo controversy.  Medical and legal experts “give her credit for originality,” but doubt that the tattoo would prove legally binding.  (Des Moines Register, 5/16)

 

*  A research study on levels of care in ICUs found that “the factors that determined the establishment of directives for advance life support differed from the factors that informed a decision to limit or withdraw support after admission to an intensive care unit.”  The study also reaffirmed the imprecise nature of physician prognoses, saying that they usually err on the side of underestimating the probability of short-term survival.  “Some degree of discomfort was common in care providers in the intensive care unit, most often because they thought interventions were excessive and not compatible with an acceptable future quality of life.”(American Journal of Critical Care, 2006;15(3):269)

 

*  “Appraising the WHO Analgesic Ladder on its 20th Anniversary:  An interview with Kathleen M. Foley, MD” is online at www.whocancerpain.wisc.edu/eng/19_1/Interview.html.  Foley responds to questions about the usefulness of the ladder, whether it is too simple or outdated, and suggests that it is still a viable tool, particularly in developing countries.  (WHO Cancer Pain Website)

 

 

PUBLIC POLICY NOTES

 

*  Senator Ron Wyden (D-Oregon) testified before the Senate Judiciary Committee’s Subcommittee on the Constitution, Civil Rights and Property Rights.  Wyden, who spoke in  potential abuses.”  Wyden, who is opposed to assisted suicide and twice voted against the DWD Act, said, “While I do not know how I would vote if the issue were to appear on the Oregon ballot once more, I believe it is time for me to acknowledge that my fears concerning the poor elderly were, thankfully, never realized.  The law has not been abused.”  He called on Congress “not to impose one set of values, religious beliefs or wishes on the most personal and private of decisions.”  Senator Sam Brownback, a Kansas Republican who opposes assisted suicide, called for the hearing.  (KTVZ Website, 5/25; AP, 5/26)

 

*  A provision in the US Senate immigration bill “would throw open the gate to nurses, and, some fear, drain them from the world’s developing countries.”  Senator Sam Brownback (R-Kansas) sponsor of the bill, said it could have an impact on India and the Philippines, already the source of thousands of foreign nurses who come to the US each year.  According to the article, “Many African countries have begun to demand compensation for the training and loss of nurses and doctors who move away.”  (The New York Times, 5/24)

 

*  Both houses of the New Hampshire legislature passed a bill that revises the state’s living wills laws.  If the governor signs it, and his spokeswoman said he “is favorable” toward it, it will define “when hospitals, doctors or families can decide when an individual is permanently unconscious and hydration and nutrition can be removed.”  It also specifies rules on DNR orders.  (The Union Leader, 5/25)

 

 

OTHER NOTES

 

*  First quarter results for VITAS Healthcare Corporation showed a 10% increase in average daily census, a 7.3% increase in admissions, and an increase of 15% in quarterly net patient revenue.  (Obesity, Fitness & Wellness Week, 5/23)

 

*  The cable network A&E is developing two reality shows about death.  “Last Requests” will help dying persons “find closure before they go.”  The producers are the same ones who are responsible for “The Eyes of Tammy Faye” and “Monica in Black and White.”  The other show, “Six Months” asks, “What would you do if you only had six months to live?” and tries to grant those wishes.  (New York Daily News, 5/15)

 

*  An article in the Newark Star-Ledger urges greater use of hospice, saying that too many New Jersey residents die “high-tech deaths.”  Patricia Murphy, an ethics and bereavement expert, hopes that the recently released Dartmouth Atlas study (see HNN, 5/23) is a “wake-up call.  The motivation to prolong life is fine, but it may not be possible.  And, in the end, aggressive care may mean death in an ICU unit with all the equipment and distraught families instead of a peaceful death at home.”  (Newark Star-Ledger, 5/26)

 

*  The Orange County Register recently printed a feature article about Eileen Hadley Mouzoon, a dot-com executive who became a hospice volunteer after she was laid off from her high-tech job.  Mouzoon volunteers with the hospice service of Saddleback Memorial Medical Center in Laguna Hills and finds her work “invigorating.”  “This has turned out to be much more positive than I thought it would be,” she said.  (Orange County Register, 5/12)

 

Thanks to Don Pendley for contributions.

 

Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2006.  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.