With claims-based audits increasing, hospices must enforce a tighter review process for hospice eligibility with a clear documentation of tools used.
There are four tools that help determine whether a patient has a chronic illness or a terminal illness for hospice eligibility. An introduction of the tools and an explanation of the Palliative Performance Scale (PPS) can be found in a previous blog.
How to Use the Karnofsky Performance Scale (KPS)
Hospice organizations can choose whether their clinicians should use KPS or PPS, but to meet compliance, the same tool must be used consistently to show a decline.
Because the KPS was originally developed to predict a patient’s survivability to chemotherapy, it is not as specific as PPS with overall hospice and palliative appropriate considerations. Patients with neurological issues or dementia may need to be scored using another tool.
KPS states the patient’s decline should be related to the disease process and not other factors.
In scoring KPS, patients are asked to perform activities of daily living (ADLs) and their abilities will put them into one of three groups. From there, the clinician will review specific ADL levels in their group that best relates to the patient and assign them a score.
Functional Assessment Staging Tool (FAST)
The FAST scale is best used to show a decline in Alzheimer’s Disease (AD). While FAST has not had the same validation for other types of dementia, it can still be used on those patients to show eligibility.
There are seven levels in the FAST scale, with seven being the end stages of the disease. Many times, clinicians will want to include comorbidities while scoring. However, the score must be based on the patient’s highest consecutive level of disability.
Nonconsecutive deficits, like comorbidities, are of clear clinical relevance and should be noted, but should not be scored if they are unrelated to the disease progression. Most hospice patients are scored at six with clear documentation.
The most common mistake clinicians use with the FAST scale is skipping levels; the scoring must be consecutive.
New York Heart Association (NYHA) Classification
NYHA is used to gauge functional symptoms of heart disease by grouping patients into four class levels.
The LCDs look for a Class IV of heart disease for hospice eligibility, as well as other classifications that consider structural cardiac damage.
Clinicians should observe the patient’s breathing, limitations and any physical interactions within their environment. It is also important to interview the patient or their family about their symptoms, functionality and comfort level, as well as document the patient’s history to show a decline.
These functional assessments show the impact of disease on the patient’s status but are still only part of the picture. These scores should be combined with any other medical test results and consistent documentation to be eligible for hospice.
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 a streamlined interdisciplinary group (IDG) workflow for accurate documentation and real-time patient updates.
