Discharge planning documentation for hospice can be lacking; in most cases hospice discharges occur at death and are not planned. However, surveying organizations always ask for discharged patient records to review during the survey process to ensure the hospice met all the patient’s regulatory care coordination and planning needs. Medicare details the expectations for live discharges in the State Operations Manual Chapter 2 – The Certification Process and the Medicare Benefit Policy Manual Chapter 9 – Coverage of Hospice Services Under Hospital Insurance.
Discharge Planning Requirements
As reviewed previously, the reasons for live discharge include:
- Discharge for Extended Prognosis
- Discharge for Leaving the Service Area
- Revocation of Hospice
- Discharge for Cause
Before discharging a patient for any of the above reasons (except revocation), the hospice interdisciplinary group must obtain a written physician’s discharge order from the hospice medical director. If a patient has an attending physician involved in their care, this physician should be consulted before discharge, with their review and decision included in the discharge note.
In some cases, the hospice must provide an Advance Beneficiary Notification (ABN) or a Notice of Medicare Non-Coverage (NOMNC) to patients who are being discharged, which includes notification that they have the right to appeal the discharge to the Quality Improvement Organization (QIO) for review.
Documentation of Discharge for Extended Prognosis
Discharging a patient due to extended prognosis cannot be a one-day occurrence and must include any education and counseling, as well as any additional services the patient needs. This includes patient education or other services before the patient is discharged because they are no longer terminally ill.
Documentation of Discharge for Leaving the Service Area
Referrals to other necessary community organizations (i.e., Adult Protective Services) or healthcare providers must also be considered before discharge. The discharge summary must be provided to the receiving care providers and include the summary of the patient’s stay on hospice, all current orders and plans of care, and any other clinical documentation to provide a coordinated discharge plan if requested by the receiving organization.
Documentation of Revocation
Documentation of revocation must indicate that the revocation is a voluntary action taken by the patient or representative. The election of the hospice benefit is the patient’s choice rather than the hospice’s choice, and the hospice cannot revoke the patient’s election.
Documentation of Discharge for Cause
Discharge for cause documentation must thoroughly detail all steps the hospice took to resolve the situation causing the unsafe, abusive, disruptive or uncooperative behaviors leading to the decision to discharge for cause. It is also important to document these issues when the patient is someone with a high utilization of hospice services so that the discharge for cause reason is clear to auditors.
A Hospice Software with Built-In Discharge Documentation
Axxess Hospice provides a Live Discharge Plan of Care to clearly document the reason for discharge, the education given to the patient and caregivers for care management, the arrangement of receiving care providers and durable medical equipment (DME), medications, delivery of the ABN or NOMC, and provision of the discharge summary to the receiving providers.
Additionally, the Discharge Visit and Unattended Discharge Note in Axxess Hospice include reminders to assist hospices with ensuring all aspects of discharge planning are clearly documented. Aspects of discharge planning include a discussion with the physicians, patient and legal representative about the planned discharge, discharge instructions and discharge readiness. This includes safety with care administration, receipt of the discharge order, documented agreement of the receiving provider to assume care of the patient and receipt of the ABN or NOMC. Discharge documentation and the Comprehensive Plan of Care in Axxess Hospice comprise all required aspects of the discharge summary to help your organization succeed during surveys and perform discharge operations seamlessly.
