The hospice interdisciplinary group (IDG) creates a patient’s plan of care and provides holistic care to the patient, caregiver, and family. Hospice Conditions of Participation require the IDG to “review, revise, and document the individualized plan as frequent as the patient’s condition requires, but no less frequently than every 15 calendar days.”
As such, the IDG meet at a minimum every 15 days. In many hospice organizations, the interdisciplinary group meets weekly to review patient status and to determine if changes are required to a patient’s plan of care. It is important that during the IDG meeting patients’ care plans are reviewed and updated based upon patients’ assessments. Timely and accurate documentation is critical; this documentation may be reviewed by surveyors and by CMS to ensure compliance with regulations.
Who is required to attend an IDG Meeting
Required members of the IDG meeting include:
A doctor who is an employee or under contract with the hospice agency
Registered nurse
Social worker
Pastoral or other counselor
These four individuals are minimum participants in the IDG meeting. If one of these members i missing from the IDG meeting, the meeting does not meet Medicare regulations and it is considered as if the meeting did not take place. . Care must be taken to ensure that the minimum requirement – IDG meeting with the participation of at least these four individuals at a minimum of once every 15 days – is met.
Additionally, a staff member is typically identified to serve as the scribe for the IDG meeting. The scribe captures any changes to a patient’s plan of care that are agreed upon during the meeting.
What activities occur during the IDG meeting?
When the meeting begins, all participants sign the meeting sign-in sheet. These sheets serve as documented proof that the hospice has met the Medicare Conditions of Participation – that the required members of IDG participated in the meeting. Sign in sheets are stored in a place that is accessible for review upon the request of auditors or surveyors.
Prior to the IDG meeting, a list is drawn up of the patients who will be reviewed during the meeting. For each of these patient’s members of the care team provide an update on the patient’s current condition, highlighting any concerns. The team then discusses the plan for the upcoming two weeks.
Patients may be ordered for discussion as follows:
Deaths
Admissions
Recertifications
Evaluation
Let’s review each of these in detail.
Deaths
Each death since the prior IDG meeting is reviewed. The team discusses whether bereavement has been requested or declined. In the case where bereavement has been requested, the individuals who will be receiving bereavement services are identified. Any further details or concerns on the services that will be provided are discussed.
Admissions
The RN Case manager discusses any new admissions since the prior IDG meeting, including patient diagnosis and hospice eligibility criteria. Visit frequency is discussed, hospice aide services, and patient psychosocial needs. Typically, all team members partake in this discussion including a discussion about patient medications and prognostic indicators.
Recertifications
At this stage in the IDG the team discusses all patients who are the end of their benefit period and need to be recertified. Any face-to-face visits that were conducted will be discussed and any that are still pending will need to be scheduled. For patients who were evaluated and are found not to meet criteria, the team discusses how to notify the family and details on how to transition the patient off of hospice care.
Evaluations
All remaining patients on the list are reviewed by the members of the IDG. The team discusses whether any changes to the plan of care are needed, whether any medications need to be changed or if any additional support is required (e.g., chaplain, volunteer). The plan of care may be updated if the team agrees that a change in visit frequency is required.
Updating patients’ plan of care
While each patient is discussed, any changes to the patient’s plan of care are entered into the patient’s chart, which is signed by the medical director.
Hospice care is patient- and family-centered, where the patient’s and family’s preferences and needs drive the care plan.
The hospice interdisciplinary group (also referred to as Hospice IDG or IDG), also referred to as the interdisciplinary team (IDT) is a team of healthcare professionals who work together to create a plan tailored to the needs of hospice patients. The IDG is crucial because it reflects the fundamental principle of hospice care: a multidisciplinary and holistic approach to treating a patient. Hospice care is not just about managing medical symptoms; it involves addressing the physical, emotional, social, and spiritual needs of the patient and their family. This comprehensive care model requires combined expertise of different healthcare professionals working together as a cohesive team.
Multidisciplinary and 360-degree approach
The idea of a multidisciplinary approach is central to hospice care because a single healthcare professional cannot fully address the complex needs of a patient at the end of life. Hospice patients often experience pain, emotional distress, social isolation, and spiritual concerns, all of which need to be treated so that the patient has a peaceful and dignified end of life experience. Each of the members of the IDG can address different aspects of hospice patient needs.
Physical needs: Managed by the physician and nurse. The physician provides medical direction and oversees patient care while the nurse manages the patient’s medical needs such as pain control and symptom management.
Emotional and social needs: The social worker provides emotional and social support, caring for emotional health, caregiver stress, and family dynamics. Consideration is also given to connecting the family with community resources
Spiritual needs: These are managed by the chaplain, who offers spiritual care and counseling, based on the patient’s and family’s beliefs. The chaplain helps patients and families explore spiritual concerns, questions of meaning, or religious beliefs in the context of their journey.
Daily living needs: Hospice aides assist with personal care like bathing, dressing, and grooming. They ensure dignity and comfort in activities of daily living like bathing, dressing, and grooming.
Companionship and support: The hospice volunteer offers companionship and practical help, like errands or respite for family caregivers.
By involving individuals from different disciplines, hospice care can take a 360-degress approach to a patient’s needs. It means that every aspect of care – physical, emotional, social, and spiritual – is addressed by someone with the expertise to manage that particular dimension. This all encompassing approach is what makes hospice care unique and effective.
Are all member of the IDG required per CMS regulations?
Per CMS regulations, only core members must always be part of the IDG to ensure that hospice care addresses every critical aspect of the patient’s experience. Four disciplines are considered core required members of the team. These include:
Physician
Registered nurse
Social worker
Chaplain
Some professional members may be included in the IDG as needed, depending upon patient’s individual circumstances. These include:
Hospice Aide
Volunteer
Therapists
Bereavement Counselor
How is the IDG aligned with regulatory standards?
CMS requires that hospice care involve an interdisciplinary approach because it reflects the need to treat the “whole” patient, not just their medical condition. The IDG ensures that the care plan is tailored to the patient’s evolving needs and that it incorporates feedback from multiple disciplines to achieve the best outcomes. The interdisciplinary model is also a regulatory requirement under the hospice Conditions of Participation (CoPs). As such, surveyors will review the functioning of the IDG during inspections to ensure compliance. A well coordinated interdisciplinary team ensures regulatory compliance and quality patient care.
Why is the interdisciplinary hospice team essential?
Hospice care is patient and family centered, meaning that the patient’s and family’s preferences and needs drive the care plan. The IDG works collaboratively to ensure that the care plan remains flexible and responsive to changes in the patient’s condition. As hospice patients often experience rapid changes in health, having professionals from different disciplines ensures that all aspects of care can be addressed promptly and effectively.
In summary, the IDG reflects hospice’s holistic, multidisciplinary approach to care by ensuring that all dimensions of the patient’s well-being are addressed. Required team members focus on medical, emotional, and spiritual care, while optional members can be added to meet unique or additional needs. This alignment ensures that hospice remains flexible and patient-centered.
As a manager in hospice care, your role goes beyond overseeing patient care and managing staff. It includes ensuring that your team feels valued and fairly compensated. Pay transparency is becoming a hot topic, and understanding its implications can help you effectively navigate this evolving landscape.
What Is Pay Transparency?
Pay transparency refers to the practice of openly sharing information about compensation within an organization. This can include posting salary ranges in job listings, discussing pay openly among employees, or providing detailed breakdowns of how pay is determined. The goal is to ensure that employees understand how their pay is calculated and that there are no disparities based on gender, race, or other factors.
What is the status of pay transparency regulations in the U.S.?
The U.S. is starting to experience a trend in adoption of pay transparency regulations. Several states have introduced laws that require employers to provide salary ranges in job postings or upon request. For example:
Colorado: The state’s Equal Pay for Equal Work Act requires employers to include salary ranges in job postings and provide pay information to employees upon request.
New York City: The city requires employers with four or more employees to include salary ranges in job advertisements.
California: As of January 2023, California employers with 15 or more employees must include pay scales in job postings.
It is likely that more states will follow and that the laws with transparency requirements will continue to be more comprehensive.
Why Is Pay Transparency Important?
Fosters Trust and Engagement: When employees understand how their pay is determined and believe it is fair, they are more likely to feel valued and engaged in their work. In a field as emotionally demanding as hospice care, high employee engagement is crucial for maintaining a positive work environment and delivering high-quality care.
Reduces Pay Disparities: Pay transparency helps to identify and address pay disparities that may exist within your organization. In healthcare, where women and minorities are often overrepresented in lower-paying roles, transparency can be a tool for promoting equity and ensuring that all employees are paid fairly for their work.
Compliance with Regulations: Some states in the U.S. are implementing laws that require employers to provide pay ranges in job postings or share salary information upon request. Staying ahead of these regulations by adopting pay transparency practices can help your hospice avoid legal challenges and demonstrate a commitment to fairness.
How to Implement Pay Transparency
Review Current Pay Practices: Start by conducting a thorough review of your current pay practices. Ensure that salaries are consistent with market rates and that there are no unexplained disparities among employees with similar roles and experience levels.
Communicate Clearly: If you decide to move towards more transparency, communicate clearly with your team about what information will be shared and why. For example, explain how pay ranges are determined and what factors influence individual salaries.
Train Managers: Provide training for all managers to ensure they understand the principles of pay transparency and are equipped to have open and honest conversations about pay with their team members.
Update Job Postings: If your state requires it or if you choose to do so, include salary ranges in job postings. This not only meets regulatory requirements but also attracts candidates who appreciate transparency and fairness.
Regularly Review and Adjust: Pay transparency is not a one-time effort. Regularly review your compensation practices and make adjustments as needed to ensure ongoing fairness and compliance with any new laws or guidelines.
Challenges of Pay Transparency
Managing Expectations: One of the challenges of pay transparency is managing employee expectations. If employees see that their pay is lower than a colleague’s, they may feel undervalued, even if there are legitimate reasons for the difference. It’s important to be prepared to explain these differences clearly and fairly.
Confidentiality Concerns: In some cases, employees may prefer to keep their salaries private. It’s important to balance transparency with respect for individual preferences and privacy.
Complexity in Pay Structures: Healthcare organizations often have complex pay structures with various factors influencing salaries, such as certifications, years of experience, and additional responsibilities. Transparency requires clear communication about these complexities, which can be challenging.
The Future of Pay Transparency in the U.S.
It is likely that the U.S. will continue to see increased pressure for transparency in the coming years. The healthcare industry, including hospice care, may need to adapt to more stringent regulations and expectations around pay disclosure.
As a manager, staying informed about these trends and proactively implementing transparent pay practices can position your hospice to lead in this area. Not only will this help in complying with potential future regulations, but it will also foster a more equitable and supportive work environment for your team.
Conclusion
Pay transparency is an important and evolving issue. Adopting transparent pay practices now can help foster trust, promote fairness, and ensure compliance with current and future regulations. By being proactive in this area, you can create a more equitable and positive work environment for your team, ultimately leading to better care for your patients.
Where Can You Find Out More
Gallagher: How managers can respond to pay transparency
SHRM: How Companies can Respond to New Pay Transparency Laws
Creating and using benchmarks to compare your company’s hiring demographics against those used by government agencies like the EEOC (Equal Employment Opportunity Commission) is crucial. Benchmarking helps ensure that your company’s hiring practices are fair and compliant with federal regulations. Here’s are some considerations to keep in mind when you consider the right benchmarks
Why Benchmarking Matters
Government agencies monitor and require companies to report on the demographic composition of their workforce, especially larger companies. For instance, the EEOC uses benchmarks to compare a company’s demographics against broader population data from sources like the U.S. Census and the American Community Survey. Knowing how your company’s demographics stack up against these benchmarks is essential for several reasons:
Diversity Goals: Meeting your company’s diversity and inclusion goals.
Fair Hiring Practices: Ensuring fair and unbiased hiring practices.
Best Practices for Benchmarking
Collect Internal Data: Gather detailed demographic data of your current workforce and applicants.
Ensure you track data on race, gender, age, and other relevant demographics.
Choose the Right External Data: Depending on your hiring scope, use national, regional, or local data. For example, if you recruit nationwide, use national benchmarks. For local hires, consider regional data.
Occupation and Industry-Specific Data: Align your benchmarks with the specific occupations and industries relevant to your company. Different industries and roles may have distinct demographic compositions.
Adjust for Educational Requirements: Consider the educational requirements for the roles you are hiring. This will help you compare your applicant pool against the qualified population.
Use Census Data: The U.S. Census Bureau provides comprehensive data that can be segmented by occupation, geography, and other factors. This data is a good starting point for creating your benchmarks.
Ensuring Fair Selection
To avoid over- or under-selecting any protected group, follow these steps:
Regularly Update Benchmarks: Demographic data changes over time. Ensure your benchmarks are based on the most recent data.
Monitor Hiring Practices: Continuously monitor your hiring practices and outcomes against your benchmarks.
Training and Awareness: Educate hiring managers on the importance of diversity and compliance with hiring practices.
External Data Sources
Looking at external data sources is important because it provides a broader context for your internal data. It helps you understand the labor market and demographic trends in your industry and location. External benchmarks serve as a snapshot of the current workforce composition, which can change over time.
Creating effective benchmarks involves a blend of using accurate external data and understanding your company’s unique needs. By comparing your company’s demographics against reliable benchmarks, you can ensure fair and compliant hiring practices. Regularly updating these benchmarks and educating your hiring team on best practices will help maintain a diverse and inclusive workforce.
Where Can You Find Additional Information?
Of Significance: Don’t Miss the Mark! Podcast on what to keep in mind when creating benchmarks
Harvard Business Review: Smart benchmarking starts with knowing whom to compare yourself to
The podcasts cover a wide range of interesting and timely topics such as leadership, workplace violence, revenue capture, AI, use of technology, and how to best work with healthcare consultants.
Plan to listen while you are driving to patient visits!
Check back often to see what new podcasts have been released.
Root Cause Analysis (RCA) is a systematic and structured process used to identify the root causes that results in an undesirable outcome or adverse event and to develop corrective actions. The goal of RCA is not just to treat the symptoms of a problem but to delve into the underlying causes of the failure. By understanding these causes, a hospice agency can develop strategies to mitigate risks and implement corrective actions to prevent future occurrences. This approach to addressing adverse events will lead to improved patient safety and enhanced quality of care. Further, by promoting a culture of safety, RCA fosters a culture of transparency, accountability, and continuous improvement in the hospice agency.
When is root cause analysis used
A hospice agency can use root cause analysis to investigate any unexpected occurrences such as hospice acquired pressure ulcers, medication errors, or process variations where recurrence could result in serious adverse outcomes. Candidates for RCA may be identified via patient satisfaction surveys, incident reports, surveys, or other reports and audit activities. A root cause analysis focuses on systems and processes, rather than individuals in the agency. The objective of the RCA is to reduce the risk of recurrence by identifying opportunities to improve or redesign systems or processes. By implementing system changes, this will lead to sustained system improvement.
Elements of root cause analysis
A comprehensive root cause analysis includes the following elements:
Problem identification: Identify the adverse event to be investigated and gather preliminary information. Events and issues can come from many sources such as patients and their families, staff, or regulatory bodies. The agency should have a process for deciding what events are selected for RCA.
Define the event: Clearly describe the adverse event, error, or near miss. Include specifics such as what happened, where, when, and who was involved.
Gather initial data: Collect all relevant information about the event including incident reports, patient records, and witness statements.
Assemble RCA team: Select the members of the RCA team and the team facilitator. Team members should be knowledgeable about the processes and systems that they will be investigating.
Multidisciplinary team: Form a team that includes individuals with diverse expertise and perspectives. This may include clinicians, administrators, and support staff.
Assign roles and responsibilities: Clearly define the roles and responsibilities of each team member to ensure an organized and effective RCA process.
Data collection and investigation: Collect and organize the facts about the adverse event that will be investigated.
Detailed event timeline: Create a detailed timeline of events leading up to, during, and after the incident. This helps in understanding the sequence of events.
Conduct interviews: Interview staff involved in the event to gain insights into what happened and why. Ensure a non-punitive approach to encourage open and honest communication. Review documentation: Examine all relevant documentation including patient records, policy and procedure manuals, and any relevant logs.
Identify contributing factors and root causes: Identify the situation, circumstances, or conditions that increased the likelihood of the adverse event. Conduct a thorough analysis of contributing factors that lead to identification of underlying process and system issues.
Cause and effect analysis: Use tools such as fishbone diagrams (Ishikawa) or flow charts to map out the possible causes and identify the root causes. Five whys technique: Ask “why” repeatedly (usually five times) to drill down to the underlying root cause(s) of the problem.
Develop action plan: Develop plan for best changing the processes and systems to reduce the likelihood of another similar event. Design and implement changes to eliminate the root causes. This may involve creating new processes.
Corrective actions: Develop specific, measurable, achievable, relevant, and timebound (SMART) corrective actions to address the root causes.
Assign responsibility: Assign responsibility for implementing each corrective action to specific individuals or teams. Timeline: Establish a timeline for the implementation of each corrective action
Implementation and Monitoring: Implement the plan and evaluate its performance. Create mechanisms to gather data that can be used to measure the success of changes that were introduced.
Implement changes: Put the corrective actions into practice. Ensure that staff are trained and aware of changes to procedures or policies. Monitor effectiveness: Continuously monitor the effectiveness of the corrective actions. This may involve regular audits, follow up assessments, and a feedback mechanism.
Documentation and Reporting: Create documentation of the RCA process including all findings, root causes, and corrective actions taken. Share findings with stakeholders, promoting a culture of transparency.
Detailed Reports: Document the entire RCA process, including findings, root causes, corrective actions, and implementation outcomes.
Communicate findings: Share the RCA findings and action plans with all stakeholders including staff, patients, and regulatory bodies.
Continuous improvement: Review the RCA process on a periodic basis to identify any necessary modifications or areas that could benefit from improvement. Continuous improvement ensures that the agency promotes a culture of growth and continuous learning.
Review and revise: periodically review the RCA process and outcomes to ensure sustained improvements. Revise strategies as necessary based on new data and feedback.
Promote a learning culture: Foster an environment where continuous learning and improvement are encouraged and staff feel empowered to report issues and participate in problem solving.
Root cause analysis is a vital tool in hospice care for understanding and addressing the underlying causes of adverse events and errors. By systematically identifying and correcting these root causes, hospice agencies can significantly enhance patient safety, improve quality of care, and promote a culture of continuous improvement. A well-executed RCA resolves the immediate issue and provides valuable insights to prevent future occurrences, thereby ensuring better outcomes for patients and their families.
