When the Patient is Clearly Terminal, but the Diagnosis Isn't
Are you flummoxed when trying to admit a patient who appears terminal, but doesn’t have an end-stage diagnosis? Are you using the disease-specific guidelines correctly as you assess and document eligibility? What do information do you gather to support certification of a patient with an uncommon diagnosis or one who is medically complex without a clear terminal diagnosis? How do you determine which diagnoses are designated “related” for reporting and coverage purposes?
What about your interdisciplinary team processes for these types of patients? The importance of the initial and comprehensive assessments and the process of re-assessment is becoming more important every day and, particularly in these challenging situations, is a vital component of ensuring that care is coordinated, integrated and everyone is “on the same page.”
Perhaps most importantly, what organizational and team processes do you have in place for determining consistent and medically rational answers to any of these questions when the answers are not obvious? Do you and other interdisciplinary team members (particularly medical directors and physicians) understand your changing role with respect to these issues? What about the challenges they pose to the function and practice of the interdisciplinary team?
Drawing on her experiences as a hospice medical director, medical reviewer, and member of the MAC/NHPCO Collaborative Workgroup, Dr. Harrold will address these and similar questions that often create dilemmas where clinical mission and regulatory compliance intersect.
CE/CME Credit Available: Nurse, Physician, and Non-Physician Healthcare Professional CE credit