Home Health & Hospice Week

Host of changes will require hospices to make significant operational shifts.

The long-awaited hospice COPs are finally out, and they will require some big - and costly - adjustments in the future.

The Centers for Medicare & Medicaid Services proposed the COP revisions in the May 27 Federal Register. Because so much time had elapsed since CMS proposed its last COPs in 1997, the agency had to re-propose the regulation rather than finalize it. "We have been waiting for these new COPs for years," notes consultant Heather Wilson of Weatherbee Resources Inc. in Centerville, MA.

And the re-proposal contains a lot of new material, experts note. One of the biggest changes is new requirements for comprehensive assessments, notes attorney Mary Michal with Reinhart Boerner Van Deuren in Madison, WI.

CMS is setting out a comprehensive assessment requirement as its own new COP to emphasize its importance, the agency says in the proposed rule. Nationwide survey trends "indicate that the current assessment requirements are not sufficient," CMS explains.

"The fourth most frequently cited deficiency is that the plan of care did not include an assessment of the patient's needs."

Under the new assessment COP, hospices will have to conduct a comprehensive assessment (including a drug review) within 24 hours of a physician's order for hospice care, complete the assessment within four days of hospice election, update the assessment at least every 14 days and update it at recertification.

Additionally, hospices will have to review and update the plan of care at least every 14 days.

Requiring the continuous assessments and POC revamping is a good idea, because dying patients often have rapidly changing conditions and needs, says attorney Connie Raffa with Arent Fox in New York City. But the requirements are going to mean a whole lot more staffing and resources, Raffa contends.

No early assessments: Hospices that are used to conducting assessments before they receive an official physician's order for hospice will have to rearrange their scheduling, points out attorney Deborah Randall with Arent Fox's Washington, DC office. The new COP would prohibit hospices from using an assessment conducted before the order, Randall says.

And hospices whose current assessment procedures require updates of only certain parts of the care plan will have to switch to full-blown assessments at least every two weeks, Randall adds. Likewise, interdisciplinary communication on updates will have to move to more than "touching base" under the new guidelines, she points out.

Hospices won't have too much trouble hitting the new deadlines, Wilson predicts. But they may wrestle more with keeping information between the updated assessments and care plans consistent, she worries. That could easily become a survey problem.

And under the new COPs, surveyors will be paying a lot of attention to the assessment and care plan areas [...]