Hospice Risk Management

Over the past few years, the hospice industry has seen many regulatory changes that have put providers in the spotlight and subject to more scrutiny. Hospice risk management is critical as their programs are now surveyed at least once every three years. Now, the consumer can search for and compare hospice providers based on quality data and other families’ experiences.

These changes provide an outline for measuring care across the hospice industry and are designed to put patients’ needs first. However, in today’s hospice and patient care environments filled with understaffed services and an ongoing shortage of nurses, it can be hard to provide the detailed and comparative documentation that regulators require. So, how can hospices meet these demands? One way is through a positive survey that highlights a well-functioning hospice provider.

Here are tips that hospice providers can use for a successful survey.

Tips for Survey Success

Taking steps to ensure a plan of care is meeting regulatory requirements will not only prepare a hospice provider for a survey, but it will significantly improve the level of care each patient receives. Here are some best practices that can put a hospice provider on the path to a successful survey:

  • Have a Unique Plan: All hospice care and services to patients and their families must follow an individualized written plan of care established by the hospice group in collaboration with the attending physician and the primary caregiver. To meet the demands of the patient, hospice providers should refrain from creating generic care plans. While the primary goal should be the same for all patients (i.e. relieving suffering and provide comfort), hospice care organizations need to provide a unique plan for how they’ll achieve this for each person, keeping in mind their cultural, religious, and personal requirements.
  • Have Defensible Documentation: If a claim period or length of stay were to be audited by an agency, there must be evidence of disease progression, palliative care intervention, and medical necessity.

    The group documentation in the clinical record is the best defense to reduce the risk of scrutiny and customer complaints. This highlights the need for a more comprehensive approach to hospice risk management and education around documentation.

    Providers should ensure that all group members, including various staff, understand their responsibility for documenting patient eligibility during every visit. The clinical record must speak for itself by detailing the patient’s disease trajectory and care plan.

  • Have Disciplined Narratives: When documenting care, hospice provider clients need to compose a disciplined narrative and refrain from using check boxes. The issue here is that they don’t tell the entire story of a patient’s clinical status and make it hard to track disease progression. Each visit needs to incorporate a documented narrative that details evidence of disease progression.

About Highland Risk

At Highland Risk, we use our expertise and experience to provide insurance information and programs to those who serve long-term care and senior living facilities. Since 2007, we’ve been offering insurance and risk management plans designed to help our agents give their clients the ability to achieve continued growth while simultaneously protecting against loss, containing costs and increasing profitability. With three offices to serve you in Chicago, Illinois; Phoenix, Arizona; and Burlington, Connecticut, we do everything we can to make your experience with us as professional and transparent as possible. To learn more, contact us at (877) 890-9301.