Non Acute Unit 5

What types of care is given to end-stage renal disease (ESRD) patients?

- Hemodialysis (HD) - Continuous ambulatory peritoneal dialysis (CAPD) - Continuous cycling peritoneal dialysis (CCPD)

Identify the members of the interdisciplinary team for hospice care

1. A doctor of medicine or osteopathy 2. A registered nurse 3. A social worker 4. A pastoral or other counselor

Short term facilities include:

1. Detention centers which hold juveniles awaiting jurisdictional or dispositional hearings. 2. Shelters are used for dependent and neglected juveniles and are usually not secure buildings. 3. Reception and diagnostic centers are basically way stations for juveniles moving from short to long term facilities.

What are the major objectives of a correctional facility's grievance process?

1. Improve institutional management and problem identification 2. Reduce inmate frustration and the potential for violence 3. Increase prospects for inmate rehabilitation 4. Hold down the volume of litigation 5. Promote justice in institutional procedures

List the 6 required elements of a plan of care for a hospice patient

1. Interventions to manage pain and symptoms 2. The scope and frequency of services required to meet the needs of the patient and caregivers. 3. Measurable outcomes anticipated from implementing the plan of care. 4. Drugs and treatments necessary to meet the patient's needs. 5. Medical supplies and equipment necessary to meet the patient's needs. 6. Documentation of the patient's involvement, understanding, and agreement with the plan.

Describe the four levels of hospice care described in the Medicare Conditions of Participation.

1. Routine Home Care- a patient is at "home" and is not receiving continuous care 2. General Inpatient Care- a patient is in an inpatient facility for pain control or acute or chronic symptom management that cannot be managed in other settings. 3. Continuous Care- a patient receives hospice care consisting predominantly of nursing care on a continuous basis at "home". It must be at least eight hours to be reimbursed at the continuous care rate. 4. Inpatient Respite- a patient receives care in an approved facility on a short-term basis.

Identify three organizations that offer voluntary accreditation and also have deemed status for compliance with CMS's Conditions of Participation for hospice programs? DON"T STUDY!!!!

1. The Joint Commission (TJC) 2. The Community Health Accreditation Program (CHAP) 3. The Accreditation Commission for Health Care, Inc. (ACHC) offer voluntary accreditation and also have a deemed status for compliance with CMS's COP for hospice program. DONT STUDY!

Three primary purposes of jails include:

1. To detain those awaiting trial after arrest 2. To hold those being transferred to a state or federal prison or mental facility 3. To incarcerate those serving a sentence of less than a year for a minor crime (misdemeanor).

Long term facilities include:

1. Training schools primary purpose is the reeducation and development of juvenile offenders. 2. Ranches, camps, and farms are in rural settings and tend to offer fewer academic and vocational programs. 3. Group homes are found in urban environments and residents usually attend school or have jobs. 4. Halfway homes are generally used for first time offenders, those almost ready to release and sometimes for juveniles with no other available living arrangement.

Who develops the patient assessment for a dialysis patient?

A registered nurse or licensed nurse practitioner

Do all branches of the armed forces operate correctional facilities? Where?

All branches of the U.S. military operate their own correctional facilities in the United States and overseas.

What are bereavement services?

Bereavement refers to the time period immediately following the death of the patient. In hospice, clinical staff help family and significant others through this period

What type of individuals is detained in ICE correctional facilities?

Bureau of Immigration and Customs Enforcement (ICE) are "used to hold individuals placed into administrative detention during periods of investigation into their legal status or resolution of removal order.

Describe some of the reasons given for charging inmates for care provided

Charging fees or copayments based on the facility's economy is thought to control abuse of health services. Inmates who spend money to Buy cigarettes rather than save it in case they become ill will continue making the same irrational choices once they are released.

Describe the HIPAA exception to the individual right to access PHI that is provided to correctional facilities that are considered a covered entity.

Correctional institutions are granted an exception to the access rule when such access would "jeopardize the health, safety, security, custody, or rehabilitation of the individual or of other inmates, or the safety of any officer, employee, or other person at the correctional institution or responsible for transporting of the inmate"

Describe the documentation that occurs when a hospice patient dies in his/her home?

Depending on the state, and individual cities and counties, a home death may require opening a medical examiner's case file. document all steps clearly in the clinical record, including the notification of the medical examiner, notification of police, the time of the patient was pronounce dead, and contact with a funeral home to pick up the patient's body, as well as the condition of the family and significant others present

What levels of government in the U.S. operate correctional facilities?

Each level of government, federal, state, county, and city is responsible for the operation of some type of correctional facility.

Who usually obtains the written certification?

HIM department

What type of care is typically NOT provided?

Hospices do not routinely use X-rays, transfusions, chemotherapy, radiation therapy, intubations, cardiopulmonary resuscitation or any other therapy that would be considered curative

What types of patients receive hospice care?

Hospices provide palliative care or symptom management rather than curative therapy to patients considered terminally ill, with a life expectancy of less than six months based on the physician's clinical judgment regarding the normal course of the individuals illness.

Which coding and classification systems are used in hospices?

ICD-9-CM is used for diagnoses, although the specificity of codes isn't necessary because they do not determine reimbursement. Depending on the location of the patient, either in home or in an inpatient facility, the current procedure terminology (CPT) evaluation and management codes can be used to bill for hospice physician services

What happens if a patient revokes the hospice coverage?

If patient revokes the hospice coverage, they need to signed a revocation form and filed by hospice, stating that patient will lose the remaining days in the current benefit period and the effective date of the revocation. Standard Medicare coverage resumes. If the patient chooses to be readmitted to hospice, he or she will be admitted in the next consecutive benefit period.

What significance does Estelle v. Gamble have for incarcerate individuals?

It supplants the idea that all prisoners all human beings and must receive the same amount of health care and respect as any other individuals. The failure to provide the appropriate medical care would still be considered malpractice within the prisons of the incarcerated individuals. Thus, documentation must be concise so a scenario where the inmate Gamble does not occur where an inmate did not receive the right treatment for his medical conditions.

When will Medicare's prospective payment system for ESRD be fully implemented?

January 1, 2014

What level of government is most likely to operate a jail?

Local governments

With what regulations must a hospice comply to receive Medicare reimbursement?

Medicare COP Hospice regs

What is the source of payment for most patients who have been on dialysis for over 30 months?

Medicare part a

Identify three organizations that offer voluntary accreditation to correctional facilities for the administration of health care services that meet their standards.

National Commission on Correctional Health Care (NCCHC) American Correctional Association (ACA) Joint Commission

Describe three settings for hospice care. Which is the most common?

Patient's Residence is the most common of hospice programs. They provide patient care in the patient's place of residence, which may include the patient's home, a relative's or a friend's home, a nursing home, or a senior citizen complex. In a nursing home or hospital, hospices contract with major hospital complexes and/or nursing homes to establish hospice units or wings. The hospice wing then becomes the patient's place of residence. In stand-alone hospice, some hospice programs build their own facilities. These facilities are not associated with an existing hospital or nursing home.

Which is the most common source for operational funding of health care services provided to inmates?

Potential sources include additional tax revenue available from the federal or state governments, payments from inmates, and private sources including grants, federal and state legislature

shelters

Shelters are used for dependent and neglected juveniles and are usually not secure buildings.

FBP

The Federal Bureau of Prisons operates under the direction of the U.S. Department of Justice

Does the hospice per diem include reimbursement for physician visits?

The Medicare hospice per diem does not include payment for physician visits. The physician can billed separately from the hospice per diem payments.

What is the typical reimbursement methodology for hospices?

The amount of reimbursement is based on the four levels of hospice care: routine home care, general inpatient care, continuous care, or inpatient respite. The level of care is directed by the interdisciplinary team and the medical record must document the need for care. Medicare, Medicaid, and most insurance companies reimburse hospice care on a per diem basis for each day the patient is hospice program.

What is the election statement?

The election statement must include the requirements described in the Medicare COP, it must identify the hospice, and it must contain a statement that the patient is aware of the palliative nature of hospice care.

What services are included in the Medicare per diem rate for hospice care?

The hospice per diem include not only visits by hospice clinical staffs e.g., nurses, social workers ,hospice aids and chaplains, but also medications relating to hospice diagnosis, durable medical equipment, laboratory work, oxygen, supplies, and bereavement services, when the patient expires

What is meant by 'certification' for hospice patients?

The meaning 'certification' for hospice patients is to be eligible to elect hospice coverage under Medicare, the patients must be entitled to Medicare Part A and be certified as terminally ill by the attending physician and the hospice medical director.

Who is responsible for this documentation?

The nurse

Describe the role of the nurse on the interdisciplinary team.

The nurse acts as the case manager and coordinates changes to the care plan with other members of the team

Upon release from custody, what happens to the privacy rights of inmates?

The privacy rights of inmates is returned to a normal citizen upon release from custody and all their private medical information is covered under HIPAA

What is the purpose of U.S. correctional facilities?

The purpose of the U.S. correctional facilities is to enhance public safety by keeping separate those persons deemed a threat to other individual or their property

What entity licenses hospice programs?

The state

What is the unit of care in hospice?

The unit of care in hospice is the patient/family

how many facilities it operates and what type of individuals are housed there.

There are more than 100 federal facilities operated by the FBP Federal prisons house individuals charged and convicted of crimes against the United States, such as kidnapping.

What services ARE NOT covered by Medicare for patients who have elected the hospice benefit?

Upon election of the Hospice Medicare Benefit, Medicare will pay for no other Part A services and treatments that are related to the patient's diagnosis

Does the per diem payment continue for provision of bereavement services after the patient's death?

When the patient expires, reimbursement stops, even though the family and friends may be receiving bereavement services for up to one year

Inmate

a person confined to a correctional institution such as prison

Detainee

a person held in custody awaiting trial or disposition

According to federal regulations, what is required in terms of a plan of care for a dialysis patient?

a written, individualized comprehensive plan of care that specifies the services necessary to address the patient's needs, as identified by the comprehensive assessment and changes in the patient's condition

Who performs regular surveys of dialysis facilities?

by each state's own surveying agency.

What services ARE covered by Medicare for patients who have elected the hospice benefit?

clinical staff, medications, durable medical equipment, oxygen, supplies, laboratory work, therapy, and bereavement support.

Identify three synonyms for jails.

detention centers, county prisons, or workhouses

List the key elements must be included in the plan of care

dose of dialysis, nutritional status, mineral metabolism, anemia, vascular access, psychosocial status, modality, rehabilitation status.

Identify two areas of focus for quality assessment/performance improvement efforts of the health information management department in a hospice.

ensure compliance with federal, state, and local accrediting agencies the second is ensuring the integrity of all data abstracted and captured on the computer.

Identify the type of information that is included in a correctional facility health profile.

expected inmate volume, health needs of the population, resources of the correctional system, resources available from other public agencies, staffing needs, and costs of transportation services

Juvenile detention facility

facilities operated by a unit of government for the confinement of individuals under the age of 18

Who performs validation surveys of dialysis facilities?

federal surveyors from the CMS regional offices.

Describe the health information management role that would be performed by an HIM consultant in a dialysis center.

give advice on the development of the systems to provide timely, appropriately accessible patient information to caregivers and administrators.

traditional organizational model

health professionals must report directly to the warden, which does not promote consistency in the policies and procedures used to operate a health care delivery system. It can also be a source of conflict and ethical concern for health care professionals if the warden is not sympathetic to the health care needs of inmates

Why is it NOT just the patient?

hospice recognized that the dying process is difficult for both the patient and the patient's family and significant others. It also focuses on the patient's needs, physical, emotional, and mental states of those around the patient

Briefly describe Medicare requirements for use of volunteers in hospice care.

hospices must document volunteer hours in both administrative and patient care activities in an amount that equals 5 percent of the total care hours of all paid employees and contract staff. HIM department should participate in volunteer orientation programs to provide basic documentation guidelines. Basic education on the do's and don'ts of documentation"

Describe how incarceration may affect an individual's civil rights

limited rights to speech and religion, due process in the right to administrative appeals and right of access to the parole process, right to vote

Who usually obtains the oral certification?

obtained from a clinical staff member (usually the nurse)

What is meant by "electing hospice benefit"?

obtaining hospice coverage through Medicare Part A, and if hospice is chosen Medicare will not pay for any other services covered under Medicare Part A related to hospice because the benefit of choosing this option is that all services will already be covered.

In what type of activities do volunteers participate?

offering companionship & comfort, transportation, light housekeeping and direct patient care - depending upon their professional qualifications

Who is considered the primary care giver for a hospice patient living in his/her home?

patient's immediate family and/or his friends

What type of documentation could be used to demonstrate that the patient's attending physician, if not a hospice employee, participated in the development and maintenance of the plan of care?

physician orders, clinical staff conferences with the patient's attending physician, communication with the attending physician regarding the patient's status, and the updates made to the plan of care. "It is also important that the plan specify the interval until next review".

What role do the ESRD networks play in the collection and aggregation of data on dialysis patients?

process and analyze data provided by the ESRD facilities and provide other types of services, such as patient education

health services director (HSD)

responsible for overseeing the health care delivery system, developing statewide policies and procedures, and approving the health services budget." In an ideal system, the HSD is the leader in a separate division, with the direct access to the head of the department of corrections (DOC). A HSD must have had clinical and administrative experience to be hired.

Who must sign the written certification statement?

signed by both the certifying physician and the hospice medical director before submission to Medicare

By whom and when must the election statement be signed?

signed by the patient or legal representative at time of admission to hospice care.

What must the prognosis be for life expectancy in order to receive hospice care?

six months or less based on physician's clinical judgment.

At a minimum, what type of documentation (forms) are included in a hospice record?

the initial and subsequent assessments, plan of care including interdisciplinary team updates, identification data, consents, authorizations, election forms, pertinent medial history, and complete documentation of all services.

Continuous ambulatory peritoneal dialysis (CAPD)

the patient is able to perform his or her own dialysis almost anywhere, because very little special equipment is needed

Hemodialysis (HD)

the patient's blood circulate outside the body through an artificial kidney that removes metabolic wastes and helps maintain homeostasis. To keep the body free of excessive waste products, the patient generally dialyzes 3 times per week for 3-5 hours per session.

List four items (more than four are required) that are required to be included in the patient assessment.

the patient's blood pressure, weight, medications, and results of monthly lab tests.

Why are these regulations considered the main set of standards that hospices follow?

they are also commonly used by state regulators to assess hospice programs for licensure purposes

true or false: Laboratory and radiology services may or may not be performed on site.

true

Continuous cycling peritoneal dialysis (CCPD)

untilizes a machine to perform peritoneal dialysis once each day while the patient sleeps rather then 3- 4 time throughout the day.

How long are they available to family and friends following the patient's death?

up to one year and longer if requested by the patient's family and friends

Halfway homes

used for first time offenders, those almost ready for release, and sometimes for juveniles with no other available living arrangements