Home Health & Hospice Week

Sidestep this new admission landmine.

You could find yourself in hot water with surveyors if they take a hard line with new hospice admission requirements.

Beefed-up admission rules are part of the Centers for Medicare & Medicaid Services' final rule on hospice amendments that took effect Jan. 23 (see Eli's HCW, Vol. XIV, No. 44). The final rule, published in the Nov. 22, 2005 Federal Register, requires a hospice to admit a patient on the recommendation of the medical director, after the director has consulted with the patient's attending physician.

A win: Hospices were relieved to see CMS clarify that the hospice medical director and attending physician didn't have to actually talk to each other before admission. "It is not our intent to require a face-to-face or any type of direct consultation between the director and the attending physician," CMS said in the final rule.

CMS revised the language to indicate that patient information can be obtained from the attending physician through direct consultation or indirectly by a hospice nurse, etc.

Watch out: But another new requirement might put hospices in the survey hot seat. When deciding on terminal illness certification, the medical director must consider the patient's terminal illness diagnosis, other health conditions and "current clinically relevant information supporting all diagnoses," the reg says.

This requirement "may sound somewhat onerous," the National Hospice and Palliative Care Organization admits in a summary of the final rule. But the final rule notes "the medical documentation does not necessarily need to be physically in the hands of the medical director, but that the information presented is considered in the decision. The medical reports may arrive later for retention in the patient's medical record."

Red flag: How surveyors interpret this requirement may be another story, warns attorney Deborah Randall with Arent Fox in Washington, DC.

Hospices should "be mindful of the emphasis that is being placed on ... the 'information in hand prior to certification' responsibility on the hospice medical director," Randall stresses. "This provision may delay hospice admissions if surveyors say the medical director must see written documentation first."