Circulatory and heart diseases are common diagnoses in hospice care, second to cancer. However, because their symptom management and disease management are often very similar, determining an accurate prognosis can be challenging. Are these chronic symptoms or is this a terminal disease?
Adding to the chronic or terminal confusion, studies have shown that hospice care extends the life of cardiac patients. Hospice professionals need to use recommended tools to accurately document cardiac patients and pass regulatory scrutiny.
Determining Hospice Eligibility for Cardiac Disease
Use of provided Local Coverage Determinations (LCDs) is the key to determining hospice eligibility for any patient.
The LCDs are made up of three parts. A patient is determined to have a life expectancy of six months or less if there is a decline in the clinical status guidelines in part one. Any other non-disease and disease-specific guidelines from parts two and three will establish that expectancy.
There are three disease-specific factors for heart disease eligibility; the first two must be present and the third acts as supporting documentation:
- At hospice certification, the patient must have presence of heart disease.
- The patient should meet criteria for New York Heart Association Class IV.
- Documentation of these factors will support hospice eligibility:
- Treatment-resistant symptomatic supraventricular or ventricular arrhythmias
- History of cardiac arrest or resuscitation
- History of unexplained syncope
- Brain embolism of cardiac origin
- Concomitant HIV disease
Documenting Hospice Eligibility for Cardiac Disease
End-stage cardiac disease can look different based on which diseases are present and the clinical history of the patient. It is important to identify what type of heart disease the patient has:
- Cardiovascular disease
- Congestive heart failure
- Heart failure with preserved ejection fraction (right-side heart failure)
- Heart failure with reduced ejection fraction (left-side heart failure)
- Aortic stenosis
- Pulmonary hypertension
Because patients with lower social determinants of health (SDOH) have increased mortality and morbidity and a shorter prognosis than patients with higher SDOH, include these SDOH in eligibility documentation.
Remember, each note should show that the patient is hospice eligible, not just the Certification of Terminal Illness (CTI), the admission assessment or a recertification.
To remain compliant, clinicians should use these quality assurance audit questions on each note:
- If you do not have the diagnosis in front of you, can you tell what it is when reading the note?
- Can you tell if the patient is hospice eligible from reading the note?
- Does the interdisciplinary group (IDG) summaries show progress toward goals on the plan of care and continued eligibility for hospice?
In this blog series, we explain how to use LCD tools to determine hospice eligibility, as well as signs to look for to measure eligibility for neurological and respiratory disease patients.
For an in-depth examination of chronic versus terminal illnesses, including case scenarios to practice skills, watch these webinars with California Hospice and Palliative Care Association (CHAPCA) and Axxess.
Axxess Hospice, a cloud-based hospice software, includes built-in documentation capabilities for clinical evaluation/LCD visits to help with detailed reporting histories for each patient.
