by editor | Dec 8, 2024 | Blog, Keys to Compassionate Care
Reopening of prior year CAP calculations is always difficult to manage and is one of the dreaded letters that you may receive any year. It’s difficult enough to manage CAP during a given CAP year, but you also need to efficiently estimate CAP for patients who move between hospice providers so that you can estimate your risk of CAP overage and associated estimated overpayments.
The OIG released an audit of CGS’ cap calculation process for the 805 hospices that operated in CGS’s jurisdiction. Of these, 61 had net cap overpayments totaling $9.1 million for cap year 2020.
As part of the audit, the OIG reviewed the templates used to calculate aggregate cap amounts and selected 45 hospices to determine whether CGS followed its processes and whether the calculations in the templates were accurate.
The audit identified that CGS accurately calculated the initial 2020 cap amounts for all 805 hospices and collected or attempted to collect the $9.1 million in cap overpayments in accordance with CMS requirements.
For the the 45 selected hospices, the audit revealed that CGS did not reopen and recalculate most hospice caps for prior cap years (i.e., 2017, 2018, and 2019) resulting in lost collections of overpayment for these prior years. (CAP calculations may be reopened for up to three years.)
As a result, the OIG recommended actions that would increase CGS’ compliance with the policy of reopening prior year CAP calculations.
Hospice agencies operating in the CGS jurisdiction should take note of the results of this audit as it will likely result in increased identification of CAP overpayment demands in upcoming years.
For Additional Information
Link to full OIG report: https://tinyurl.com/ym3vu3ez
Video: Hospice CAP and key indicators for hospice CAP risk
by editor | Dec 8, 2024 | Hospice Research Articles
Abstract
The Medicare hospice program is intended to provide palliative care to terminal patients, but
patients with long stays in hospice are highly profitable, motivating concerns about overuse
among the Alzheimer’s and Dementia (ADRD) population in the rapidly growing for-profit
sector. We provide the first causal estimates of the effect of for-profit hospice on patient spending
using the entry of for-profit hospices over twenty years. We find hospice has saved money for
Medicare by offsetting other expensive care among ADRD patients. As a result, policies limiting
hospice use including revenue caps and anti-fraud lawsuits are distortionary and deter cost-saving
admissions.
Read the Full Article
Link to full Article: https://tinyurl.com/43ffsufm
by editor | Dec 8, 2024 | Hospice Research Articles
Abstract
The US hospice industry has shifted from not-for-profit to for-profit ownership models,1,2 producing concerns about care quality. For-profit hospices may have higher rates of live discharges3 and hospitalizations4 and worse caregiver-reported experiences.1 Recently, hospices have been acquired by private equity firms (PEFs) and publicly traded companies (PTCs).5 Although all for-profit ownership models are oriented toward profit maximization, PEF and PTC ownership structures are distinct in being incentivized to generate short-term and above-market returns for investors,5 raising questions about the potential influence of financial objectives on quality. We compared differences in caregiver-reported hospice quality across categories of ownership.
Link to Full Article
Link to article: https://tinyurl.com/bdda96ej
by editor | Dec 8, 2024 | Hospice Research Articles
Abstract
Objective: The project aimed to standardize advanced care planning (ACP) at an internal medicine clinic by initiating physician-patient communication regarding the patient’s knowledge, understanding, and openness to pursuing advanced medical directives.
Methods: Data collection was conducted from February 1 to April 1, 2024, with the study concluding on April 24, 2024. ACP was facilitated through an initial standardized six-question pre-intervention survey in both English and Spanish. This pre-survey included questions on prior survey exposure within the past three months, current age, existing or previous medical conditions, possession of an advance directive (e.g., living will or durable power of attorney for healthcare), and interest in learning more about advanced medical directives. For patients interested in learning more, standardized educational materials from the National Institute on Aging were provided, along with a Texas out-of-hospital do-not-resuscitate (OOH-DNR) order, a Medical Power of Attorney form, and instructions in both English and Spanish. Post-education, patients completed a post-intervention survey asking if they had previously discussed advanced medical directives with a physician. The survey also included Likert scale questions about the discussion’s usefulness, comfort with end-of-life discussions, perceived importance of advanced directives, and likelihood of completing an advance directive.
Results: During the three months, 52 patients completed the pre-intervention survey, with an average age of 59 years. Hypertension, dyslipidemia, and diabetes were the most common conditions among participants. Statistical tests indicated no significant difference between patients’ age or number of comorbidities and possession of an advance directive (p > 0.05), nor was there a significant association between these variables and interest in learning more about advanced directives (p > 0.05). However, post-intervention survey results showed a significant correlation between age and prior discussions about advanced directives (p = 0.013) and between the number of comorbidities and having had past discussions (p = 0.025). Only 1.2% of patients reported having advanced directives before this study, highlighting a substantial gap in documentation.
Conclusion: This project revealed a notable gap in ACP documentation among patients at the internal medicine clinic, with very few patients having advanced directives prior to the intervention. While age and comorbidity count were not significantly associated with interest in advanced directives, older patients and those with more comorbidities were more likely to have had previous discussions. This underscores the need for targeted efforts to encourage ACP, particularly among younger patients and those with fewer medical conditions. Standardized educational resources effectively facilitated discussions, raising awareness and promoting engagement in ACP.
Link to Read Article
Link to article: https://tinyurl.com/2zwkc894
by editor | Dec 7, 2024 | Hospice 101 - Aides, Hospice 101 - Chaplain, Hospice 101 - Nurses, Hospice 101 - Social Workers
The world of hospice care is deeply personal and profoundly compassionate. As a hospice clinician, your primary focus is providing compassionate care to your patients and their families during their most vulnerable moments. But the intimate nature of home-based care can sometimes expose you to unexpected risks of workplace violence.
The Growing Concern of Workplace Violence
In recent years, workplace violence has emerged as a critical issue in healthcare, particularly for homecare professionals. A survey conducted by Transcend Strategy Group (https://transcend-strategy.com/insights-workforce-safety/) revealed that over 50% of healthcare workers have witnessed or experienced a violent event.
Workplace violence extends far beyond physical assault. It encompasses a broad spectrum of threatening behaviors including verbal abuse, psychological harassment, and intimidation. These experiences can have devastating consequences — not just physically — but emotionally and professionally.
There are some steps that you can take to help reduce your risk of experiencing workplace violence including pre-visit preparation, situational awareness, and setting boundaries. Let’s explore these further.
Pre-Visit Preparation is Key
Effective safety starts with thorough preparation. Before entering a home, confirm who will be present during your visit. Don’t hesitate to ask about potential safety concerns, ask to have pets restrained, and ensure no weapons are visible. Clear communication with patients and their families can prevent many potential incidents.
Proactive Safety Strategies: Situational Awareness
On visiting a patient’s home, situational awareness is a key preventative action. Situational awareness begins before you even step into a patient’s home. As you approach, take a moment to observe your surroundings. Notice changes in the in the environment – are things different from the previous times you visited the patient’s home? Are there more or fewer cars? Did something change in appearance? This isn’t about paranoia – it’s about being prepared and alert.
When you enter the patient’s home and say hello to the patient and family members, ask the patient or caregiver to introduce you to anyone else in the room if there are new people there. As you look around the room, note potential exit routes in case you need to quickly exit.
Setting Boundaries and Maintaining Professionalism
Your personal safety is paramount. While providing compassionate care is your mission, it should never come at the expense of your well-being. If a situation feels uncomfortable or threatening, you have the absolute right to remove yourself. Engage with management immediately if you feel that your safety is compromised.
Reporting and Documentation: A Critical Process
If you experience workplace violence, it is important that you report the event and that the event is documented. Unfortunately, clinicians are often hesitant to report the experience, citing reasons such as:
- Workplace violence is “part of the job” (acceptance)
- It wasn’t really a big deal… (acceptance)
- Nothing can be done about it anyway (acceptance)
- What will management think if I say something (fear of job loss)
- I want to avoid conflict with the patient/patient’s family (fear of job loss)
- I don’t want to be labeled as incompetent (fear of job loss)
- I was in the wrong place at the wrong time” (blame)
Although you may hesitate to report an incident, it is important that every incident of workplace violence is documented.
Documenting incidents is not just a procedural requirement – it’s a crucial step in preventing future occurrences and in protecting fellow clinical staff. Detailed, confidential reports help agencies identify patterns, implement preventive measures, and create safer working environments. It is important that fellow staff members are aware of potentially problematic situations that may arise when they visit the patient.
Contact Information / Buddy System
Make sure that you have provided your management with emergency contact information for so that someone can be contacted in the case of an emergency. Avoid after dark visits. If after dark visits cannot be avoided, use the “buddy system.” Make sure that someone knows where you are going and is anticipating your return or is anticipating contact from you and will either go out to look for you or call 911 if they do not hear from you.
Wrapping it Up
In summary, workplace violence is a real concern for home healthcare workers but here are steps that you can take to protect yourself:
- Conduct a home assessment to identify potential risks in the home. Be sure to act on those potential risks.
- Establish boundaries: Set your personal safety boundaries. Your personal safety is most important.
- Emergency contact: Ensure your management knows whom you would like to have contacted in case of emergency
- Avoid after dark visits: Try not to visit patient homes after dark.
- Buddy system: Make sure someone knows where you are going, knows when to expect to hear from you, and will go look for you or will call 911 if they do not hear from you by the predesignated time.
- Early termination of visit: If you feel that a situation has escalated or that you are feeling threatened, terminate the visit and engage with management to notify them of the situation.
Want to Learn More?
