In an effort to keep you on the edge of your seat, I am finally posting my last summary of Board Review Course – day three! Of course the delay has nothing to do with the craziness of my life and the concept we refer to as life-work tight rope walking. Balance is a bit out of the equation right now.

That aside, here are some highlights from the last day…

Hospice Medicare Benefit (Bruce Chamberlain)

  • Understand the benefit periods and timing of when IDG must review each patient
  • Understand the difference between revocation, transfer and discharge
  • MD must be actively engaged in the Quality Assurance Performance Improvement (QAPI) program- where the hospice actively measures, analyzes and tracks quality indicators
  • What are the different levels of hospice care?
  • What are the medication review requirements under the new COPs?
  • How many medical directors can a hospice have?

Hospice Eligibility (John Manfredonia)

  • At initial certification the attending physician and the hospice medical director must certify the patient’s prognosis is likely less than 6 mo
  • At recertification only the hospice medical director needs to make this statement
  • After January 1,2011- hospice MD or NP must have a face-to-face encounter with each hospice patient within 15 days of recertification prior to the 180th-day certification and each certification thereafter (may be too new to be on this exam- but who knows??)
  • Physician narrative for certification is mandatory

Prognosis (Joseph Shega)

  • MDs overestimate prognosis in general
  • Cancer: if pt spends 50% of time in bed, px about 3 months
  • COPD- BODE index can be helpful when evaluating severity of disease and justifying keeping a patient on hospice
  • Hepatorenal syndrome supports <6mo px in ESLD

Billing (Bruce Chamberlain)

  • GV modifier used by the attending of record- who is NOT the hospice medical director when billing for any care
  • GW modifier used by physician for billing unrelated to hospice diagnosis
  • Hospice medical director never uses GV modifier, even if he/she is the attending of record
  • Hospice medical director cannot bill for plan of care oversight
  • Any physician other than attending of record, seeing the patient for issues related to the patient’s terminal diagnosis must have a contract with the hospice- and bills the hospice directly

Discontinuation of Technological Support (Joseph Shega)

lots of links to Fast Facts and Concepts

Goal Oriented Decision Making (Sean Morrison)

  • 8-Step Protocol for Negotiating Goals of Care
  • What is the differential diagnosis of conflict

Other fascinating discussion in this lecture was unrelated to the boards- but still worth your time: NPR interview with NYU historian Tony Judt

And that’s the summary… Keep the engines running… November 16th, is just around the corner!!

Tanya Stewart MD FAAHPM