Understanding the Hospice Discharge Process

Introduction

As hospice care focuses on providing quality end-of-life support, understanding the hospice discharge process becomes essential for patients and their families. This process includes both logistical and emotional aspects, ensuring patients transition smoothly into their post-hospice life while maintaining dignity and care continuity. There are several important facets to this process, from the circumstances that lead to discharge, to documenting such transitions properly. This article will explore these aspects in detail.

Understanding Medicare Guidelines for Hospice Discharge

What are the Medicare guidelines for hospice discharge?

Medicare guidelines for hospice discharge specify the conditions under which a patient may exit hospice care. These include:

• Revocation of hospice benefits by the patient.
• Transfer to another hospice provider.
• Patient death, which is the most common reason for discharge.
• Moving out of the hospice's service area.
• Improvement in the patient’s medical condition, leading to them no longer being classified as terminally ill.

Before discharging a patient due to anything other than revocation or transfer, hospices must obtain a written order from the hospice medical director. This ensures that discharges are accountable and documented accurately.

Circumstances for discharge

Hospice discharges can occur under several circumstances:

1. Patient driven: Patients may choose to terminate their hospice care voluntarily.
2. Agency driven: If a hospice determines that a patient is no longer terminally ill, this may necessitate discharge.
3. Behavioral issues: Discharges can occur due to disruptive behavior that impacts the care environment, but only after documented attempts to resolve the situation.

Documentation requirements

Documentation is crucial in the hospice discharge process. Patients requesting to revoke their hospice election must submit a signed written statement; verbal notifications are insufficient. Additionally, hospices are responsible for notifying Medicare contractors about patient discharges, ensuring compliance with regulations. When discharging a patient, hospices must also provide a complete discharge summary that outlines the care provided, recommendations for ongoing care, and ensures continuity in care regardless of the discharge reason.

Signs Indicating the End of Life in Hospice Patients

What are the types of live discharges in hospice care?

There are various types of live discharges in hospice care, classified mainly as patient-initiated or hospice-initiated discharges. Patient-driven reasons include voluntary revocation of the hospice benefit, relocating out of the hospice service area, or transferring to another hospice. On the other hand, agency-driven discharges occur when the hospice determines a patient is no longer terminally ill or if disruptive behavior is affecting care delivery.

What are the regulatory requirements around patient discharge?

Patient discharges are governed by the Medicare Hospice Benefit and Conditions of Participation, which ensure patient rights and care continuity. A written physician's discharge order is mandatory, along with a comprehensive discharge summary that outlines the patient’s stay and future care recommendations. Hospices are required to provide at least a two-day notice when anticipating a discharge due to the patient no longer being terminally ill.

How are hospice discharges documented and processed financially?

Documentation is crucial in the discharge process, especially in cases where the patient’s behavior necessitates discharge. Specific coding is used for claims related to discharges for reasons such as revocation or a transfer, ensuring proper billing practices. The hospice must also submit a Notice of Termination/Revocation (NOTR) within five days of discharge to the Medicare Administrative Contractor. This structured process ensures that all parties remain informed and compliant with regulations.

Why might a patient be discharged from hospice care?

Patients may be discharged for various reasons:

• Improvement in Health: If a patient is determined to no longer be terminally ill, they may be discharged.
• Relocation: Moving out of the hospice service area requires appropriate procedures to be followed, including documentation.
• Behavioral Concerns: If patient or caregiver behaviors disrupt the care, the hospice will document efforts made to resolve these issues before discharging.

What options do patients have upon discharge?

Upon discharge, patients no longer receive hospice coverage and can return to prior Medicare coverage. Importantly, patients maintain the right to appeal discharge decisions if they believe their services are ending prematurely. If circumstances change, patients may re-elect hospice benefits if they become eligible again, keeping the focus on continuity of care and support.

Post-Discharge Considerations and Coverage

What happens when you are discharged from hospice?

Upon discharge from hospice, a patient's coverage under Medicare for hospice care ends, meaning they lose any remaining days in that election period. Discharges can occur through patient-initiated means, like revocation, or hospice-initiated, such as when the patient is no longer terminally ill. Each type of discharge has specific documentation processes that must be followed, ensuring compliance with regulations established by CMS.

Patient coverage after hospice

When discharged, patients automatically return to their previous Medicare coverage, which had been waived during hospice care. It's crucial that patients are informed of these changes, so they know how to navigate their ongoing care options after discharge. They can re-elect hospice benefits later if their health status changes and they meet eligibility requirements.

Impact of discharge on family

Discharge from hospice has implications not just for patients but also for their families. This transition can come with emotional challenges, as families adjust to changes in care dynamics. Hospice organizations typically provide resources and support to help families cope during this period, ensuring they receive timely counseling and necessary follow-up care options.

Effective Communication with Hospice Staff

Importance of Communication

Effective communication with hospice staff is vital for ensuring personalized and compassionate care. Patients must feel empowered to express their wishes and preferences regarding their hospice experience. This includes discussing the level of care, such as whether they prefer at-home services or assistance in skilled nursing facilities.

Patient Rights and Preferences

Patients have the right to dictate their care decisions, which can include the refusal of certain treatments or medications. Open dialogue with hospice staff not only helps in meeting patients’ needs but also promotes a collaborative environment where their goals are respected. Furthermore, care teams are dedicated to addressing physical, emotional, and spiritual concerns, making it essential for patients to communicate their values and wishes clearly to achieve a supportive end-of-life experience.

The Path of Live Discharge from Hospice

What is a live discharge from hospice?

A live discharge from hospice occurs when a patient leaves hospice care while still alive. This can be initiated by either the patient or the hospice provider. Discharge reasons may vary, including the patient revoking their hospice care, transferring to another hospice, or being deemed no longer terminally ill.

Regulatory requirements play a crucial role in this process to ensure compliance and maintain patient rights. This includes thorough documentation and discharge planning.

After a live discharge, Medicare coverage for hospice services is terminated, and any remaining days in the hospice benefit period are forfeited. However, general Medicare benefits are reinstated, allowing the patient access to other necessary medical services.

Factors influencing live discharges can include unplanned hospitalizations or changes in the patient’s health condition. It’s important to note that some individuals may face challenging transitions post-discharge, which could lead to readmission to the hospital shortly after leaving hospice.

Conclusion

Understanding the hospice discharge process is critical for patients and their families, ensuring that each transition is handled with care and precision. By familiarizing themselves with the regulatory guidelines, discharge types, and communication strategies, patients can better navigate this complex journey, preserving both dignity and quality of life. Whether discharge is due to improved health, personal choice, or regulatory reasons, knowing the steps involved can provide much-needed clarity in what might otherwise be an overwhelming time.

References

• [PDF] Understanding and Managing Live Patient Discharge in Hospice Care
• Live Discharge from Hospice Services - Palmetto GBA
• [PDF] A Hospice Provider's Guide to Live Discharges A patient may be ...
• Hospice Discharge, Revocation and Transfers - CGS Medicare
• 42 CFR § 418.26 - Discharge from hospice care.
• When The Hospital Recommends Discharge To Hospice
• Approved Types of Live Discharge From Hospice Care - Axxess
• CAHPS Education: Hospice Discharge & Revocation