Bereavement Services As indicated previously, both hospice and palliative care programs offer support to bereaved family members as they anticipate the patient’s death. However, hospice programs that are Medicare certified are required to also offer bereavement care to the family for 13 months after the death. These Hospice Medicare Benefit Sources of payment for hospice care include private health insurance, veteran’s benefits, the patient’s own income or family support, charitable donations, Medicaid, or Medicare (American Hospice Foundation, n.d.-b). Medicare patients have a specific Hospice Medicare Benefit (HMB) that reimburses the hospice on a per diem basis. The hospice provides clinical support from the IDT, as well as durable medical equipment and coverage of medications associated with terminal illness. Approximately 85% of hospice reimbursement/payment comes from the HMB (CMS, 2021a). The HMB does not cover curative treatments or medications, care from specialists not approved by the hospice provider, or room and board for hospice care provided in a patient’s home or another facility such as a nursing home (CMS, 2021a). In addition, hospice items and services under the HMB require that items and services be provided by Medicare-approved hospice programs that include physician and nursing services, physical and occupational therapy, speech-language pathology, medical social services, home health aides, counseling (including dietary counseling), medical supplies and medical appliances, and short- term inpatient care (including both respite care and procedures necessary for symptom management; CMS, 2021a). The HMB consists of two 90-day benefit periods and unlimited 60-day benefit periods (American Academy of Professional Coders [AAPC], 2018). At the end of each benefit period, the provider must document changes in the patient’s status and eligibility to stay in hospice care. According to CMS (2021), hospice care is continuous from one benefit period (90–90–60) to another unless the patient revokes the hospice benefit or the physician discharges or does not recertify the patient. If this occurs, the remaining days in the benefit period cannot be used (CMS, 2021a). The patient can be readmitted to hospice if they elect coverage again and if they meet the hospice coverage requirements (AAPC, 2018). The HMB also stipulates that the Initiation of Hospice Care Anyone can inquire about hospice services for a patient; however, initiation of hospice care requires a physician’s referral and certification (NHPCO, 2021). Once this occurs, a nurse will conduct an initial assessment within 24 hours, beginning with the presenting problem and moving through the individual’s history to ensure the patient meets hospice requirements. The comprehensive assessment, which is different than the initial assessment, must be completed within five days of the election of hospice care. This assessment is required to be submitted to CMS as part of an assessment of quality measures. If hospices do not provide this information in a timely manner, CMS penalizes hospices by withholding reimbursement payment. The nurse then provides information about hospice philosophy, along with identifying specific patient needs. The most prevalent issues facing the patient and family members are identified, which directs the development of an initial individualized written plan of care (POC; NHPCO, 2021). Oftentimes, other members of Hospice Performance Measures Under the Tax Equity and Fiscal Responsibility Act of 1982, CMS established the Conditions of Participation (CoPs), requiring hospices to comply with specific components of patient care and processes (MedPAC, 2020). Hospices must undergo an initial certification and subsequent audits to ensure regulatory requirements are met. In 2010, as part of the Patient Protection and Affordable Care Act (ACA), CMS established a quality reporting program for hospices, requiring all Medicare-certified hospices to report quality measures (CMS, 2021b).
bereavement services may include monthly phone calls to the family members, acknowledgements of anniversaries, receptions honoring those on hospice services, and resources for support groups (CMS, 2021).
IDT includes members of specific disciplines. These disciplines are (CMS, 2021a): ● The medical director, who oversees all patients’ medical care and assists the team in creating patients’ plan of care. The medical directors can but are not required to be the attending physicians for hospice patients. They work with the IDT to provide suggestions and collaborate with the patient, family, attending physician, and hospice team. ● Nurses, who coordinate patients’ care and assess and manage symptoms. They provide patient and family education, collaborate with the physician and other team members, initiate and administer treatments, provide physical care, and offer emotional support. ● Home health aides, who are certified Nurses Assistants who provide personal care, support, and light housekeeping for the patient and family. ● Social workers, who evaluate and support caregiving resources, seek out community resources, assist patients and families with any legal or insurance concerns, and offer supportive counseling. ● Chaplains or pastoral counselors, who offer spiritual support to patients and family members directed by the patient and family members’ needs, values, and beliefs. ● Bereavement counselors, who facilitate support groups, train bereavement volunteers, and design and distribute bereavement material to families. Following the patient’s death, bereavement support is made available to caregivers, families, and friends for 13 months. ● Volunteer coordinators, who administer and develop the volunteer programs for each hospice. The coordinators recruit, train, and assign volunteers to hospice patients. ● Other members of the hospice team can include counselors, physical and occupational therapists, speech-language pathologists and volunteers. the IDT, such as a social worker or chaplain, will be involved with the initial assessment and add to the POC. If the patient is alert and oriented, they make the decision to receive hospice care and determine the family members’ level of involvement. If the patient does not have decision-making capacity, the designated, documented power of attorney (POA) makes the decision for the patient. A comprehensive assessment needs to be completed within five calendar days after the election of hospice (NHPCO, 2021). After the comprehensive assessment is completed, the hospice team creates an interdisciplinary plan of care. The plan of care identifies the patient- and family-specific needs and related goals. This initial plan of care is developed to guide the care provided during the first days of hospice care. This plan can be updated as frequently as required by patient needs, but regulations require that the plan be updated every 15 days based on the ongoing assessments of the full IDT (CMS, 2021a). The performance of these seven measures, called the Hospice Item Set (HIS), is then evaluated and benchmarked against other hospice programs and determines financial impact (payment) to the hospice (CMS, 2021b). Finally, in 2015, CMS implemented the Consumer Assessment of Healthcare Providers and Systems (CAHPS), which was developed by the Agency for Healthcare Research and Quality (Agency for Healthcare Research and Quality [AHRQ], 2019).
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