In an effort to keep you on the edge of your seat, I am finally posting my last summary of Board Review Course – day three! Of course the delay has nothing to do with the craziness of my life and the concept we refer to as life-work tight rope walking. Balance is a bit out of the equation right now.
That aside, here are some highlights from the last day…
Hospice Medicare Benefit (Bruce Chamberlain)
- Understand the benefit periods and timing of when IDG must review each patient
- Understand the difference between revocation, transfer and discharge
- MD must be actively engaged in the Quality Assurance Performance Improvement (QAPI) program- where the hospice actively measures, analyzes and tracks quality indicators
- What are the different levels of hospice care?
- What are the medication review requirements under the new COPs?
- How many medical directors can a hospice have?
Hospice Eligibility (John Manfredonia)
- At initial certification the attending physician and the hospice medical director must certify the patient’s prognosis is likely less than 6 mo
- At recertification only the hospice medical director needs to make this statement
- After January 1,2011- hospice MD or NP must have a face-to-face encounter with each hospice patient within 15 days of recertification prior to the 180th-day certification and each certification thereafter (may be too new to be on this exam- but who knows??)
- Physician narrative for certification is mandatory
Prognosis (Joseph Shega)
- MDs overestimate prognosis in general
- Cancer: if pt spends 50% of time in bed, px about 3 months
- COPD- BODE index can be helpful when evaluating severity of disease and justifying keeping a patient on hospice
- Hepatorenal syndrome supports <6mo px in ESLD
Billing (Bruce Chamberlain)
- GV modifier used by the attending of record- who is NOT the hospice medical director when billing for any care
- GW modifier used by physician for billing unrelated to hospice diagnosis
- Hospice medical director never uses GV modifier, even if he/she is the attending of record
- Hospice medical director cannot bill for plan of care oversight
- Any physician other than attending of record, seeing the patient for issues related to the patient’s terminal diagnosis must have a contract with the hospice- and bills the hospice directly
Discontinuation of Technological Support (Joseph Shega)
lots of links to Fast Facts and Concepts
- Withdrawal of the Ventilator
- Symptoms with Ventilator withdrawal
- Key points of Artificial Nutrition and Hydration
- Dialysis Withdrawal
- Symptoms with Dialysis Withdrawal
Goal Oriented Decision Making (Sean Morrison)
- 8-Step Protocol for Negotiating Goals of Care
- What is the differential diagnosis of conflict
Other fascinating discussion in this lecture was unrelated to the boards- but still worth your time: NPR interview with NYU historian Tony Judt
And that’s the summary… Keep the engines running… November 16th, is just around the corner!!
Tanya Stewart MD FAAHPM