Documenting patients' rapid decline
"Rapid decline" may become the next buzzwords for hospice managers. As hospice physician Brad Stuart, MD, points out in this month's cover story, patients who fail to meet the clinical criteria in hospice local medical review policies (LMRPs) for non-cancer admissions can still qualify for hospice coverage, if the hospice clearly documents evidence of rapid decline.
Parameters for documenting such decline are being developed by the National Hospice Association in Arlington, VA, working with fiscal intermediary medical directors, Stuart says. At press time, plans were under way for telephone audio conferences in each fiscal intermediary's region, to provide information for providers on the new criteria and other documentation issues. The first conference will be Sept. 25, for the region covered by Palmetto Government Benefits Associates in Columbia, SC.
"Evidence of rapid decline has to do with elements of palliative care, such as functional status, activities of daily living, weight, and nutritional status," Stuart reports. "It's even possible to do anthropometric measurements of triceps skinfold thickness, to document decline in weight for bedbound patients who can't be weighed." Such parameters are also a good way to justify recertifying patients for the second or subsequent benefit period, as well as documenting the need for hospice care for patients who appear to be terminal but remain on the benefit longer than six months, he notes.
Criteria for evidence of rapid decline are found on an LMRP Compliance Worksheet developed by Stuart's agency, VNA and Home Hospice of Northern California in Emeryville. Elements on this checklist include medical history, examination data, Karnovsky functional status rating, level of physical activity, and mental status. Activities of daily living include ambulation, bathing, dressing, toileting, and urinary and fecal continence.
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