Hospice Resources for Medical Directors
Care Delivery: The Compassus Way​
Care Delivery the Compassus Way is based on the foundational understanding that all patients with serious illnesses and at the end of life have universal needs. These needs are comfort, safety and autonomy, and quality of life. Â
- Establish goals of care to determine Patient/Family Greatest Concern
- Develop a team-based plan of care SBAR Model & Symptom Management
- Medication reconciliation Guide to Medications
- Monitor disease progression and address pain control Total Pain Management
- Reassess goals of care at each IDT focused on Quality of Life
Workplace Essentials & Tools
Hospice Admission & Certification Pearls
- Hospice eligibility
- Certification of Terminal Illness
- Prognostication and scoring tools
- PointCare: Physician’s or NP’s Guide to Face-to-Face Encounters
- DrFirst Login Details & User Manual
- American Academy of Hospice and Palliative Medicine
- National Hospice & Palliative Care Organization
- Face-to-Face Recertification Encounter Timesheet
- MD Time Sheets
- Bring your own device – request form
- Know your hospice team
- Microsoft Teams
Homecare Homebase (HCHB)
Medical Director Responsibilities
- Timely documentation (IDT notes, F2F, CTI, order signatures & timesheets)
- F2F Point Care Training Video
- Face-to-Face Recertification Encounter Timesheet
- MD Timesheet
- IDT Time Template
- Elements (Discussion 5-6 min. for new admit, 2-3 min for recerts and recurring)
- Determining Medication Necessity
- All medications are reviewed at admission by the admitting RN with the hospice physician
- Determination is based on the physician
- Medications are considered regarding relatedness and covered and in each case are based on the unique circumstances of the patient.
- Entresto: related but not covered -have a therapeutic interchange
- Cardiac meds in cancer – depends on whether the cardiac condition is impacting prognosis. If stable cardiac wise unrelated; if symptomatic, oxygen dependent, etc. -related.
- There are four classes of medications that are always provided:
- Analgesics
- Anxiolytics
- Antiemetics
- Laxatives/stool softeners
- Activate & utilize Compassus email/Microsoft Teams
- Promptly respond to messages and calls (urgent requests within the hour)
- Timely face-to-face completion
- Participate in quarterly medical director meeting
- Notify DCS when taking time off and coordinate coverage
- Death certificate completion
- Establish and maintain accreditation Hospice Medical Director Certification
- Medical Directors Roles and Responsibilities
- Participate in QAPI (Quality assessment Performance Improvement) Â Â
- Lead Interdisciplinary team (IDT) (Bimonthly meeting to develop a patient and family-centered plan of care)
- Document clinical disease progression to initiate, maintain, or recommend discontinuing hospice servicesÂ
General Inpatient Care (GIP)
- Short-term hospice care for symptom control not achieved in an outpatient setting (intractable pain, terminal agitation, IV drip)
- Daily documentation supporting the need for inpatient care
- Develop a disposition plan in advance of symptom control
- GIP is not a substitute or bridge to nursing home placement
- GIP Toolkit(PDF, 4.1 MB)
- GIP Care for the Hospice Patient
Interdisciplinary Team Meeting (IDT)
- Review patient clinicals prior to IDT to discuss patient care plan and complete CTIs
- IDT Agenda and Sign-in
- CTI Physician Tip Sheet
- CTI Examples(PDF, 65 KB)
- De-prescribing Recommendations
- Optum formulary
- Enclara formulary
- Document subjective & objective data to demonstrate the progression of illness
- Recommend discontinuation of hospice services if ineligible with the transition to palliative care
- Cloning notes is strictly prohibited
- Avoid the use of signs or symptoms as a hospice diagnosis (FTT or debility)
Pain Assessment & Opioid Stewardship
- Pain is complex and multifactorial
- Identify pain threshold and goals
- Utilize PQRSTE (Palliating/provoking factors, Quality, Radiation, Severity, Time, Effect)
- Utilize the PAINAD scale(PDF, 60 KB) for patients unable to self-report
- Therapy should focus on medication and non-drug treatment
- Total Pain Management Tool
- Guide to Opioid Stewardship
- Opioid Conversion Calculator
- Opioid Stewardship:Â Self-guided clinical compliance video training
- Download the Guide to Opioid Stewardship
Onboarding
- Infection Control / BBP / Exposure Control/ TB
- Professional Boundaries
- MD Timesheet
- PointCare user set up
- Bring your own device – request form
- Emergency Operations Plan at local level
- Hospice-specific benefit training
- Attestation of CTI Course Completion
- CTI Physician Tip Sheet
- CTI Examples(PDF, 65 KB)
- HCHB training (F2F visits and Physician hospice visits)
- nVoq (Note Assist)
