hospice diagnosis help

[karbyr]

hi, I am a home healthcare nurse whose agency is 'creeping' into hospice. there are no hospice services in my area.........kinda rural and such.............anyways, I approached the hospice director where I work and asked about two patients on my caseload who I feel would be better served under hospice...............both are in their nineties, frail and kind of 'failure to thrive'.............recurrent pneumonias, poor p.o. intake, little mobility, etc..........I was told that if the Doctors could give a 'terminal diagnosis' they would qualify..................however is hard to be specific..........both are kind of terminally elderly, versus any other diagnosed problem............(have a lot of 90 + y/o's on my caseload, most aren't so frail)..........any ideas or help would be appreciated...........thanks!

[mchospicern]

Depending on the fiscal intermediary who pays your hospice on behlaf of medicare, "Decline in Health Status" may be the preferred dx, rather than "adult failure to thrive." Last time I checked, CAHABA liked AFTT, and Palmetto likes Decline in Health. Whenever possible, however, it is preferable to have a disease specific diagosis. Even if the patient doesn't meet all the criterea on the LMRP, you, the medical director, or the MD can justify in the are provided for supporting doccumentation, why the patient has a limited life expectancy.

[NRSKarenRN, BSN, RN]

Don't know how i missed this thread till today!!

Bookmarked sites. GREAT info!

[Hellllllo Nurse, BSN, RN]

When I worked in hospice, Medicare refused to reimburse for all of our pts who were diagnosed with "Failure to Thrive" or "Multi-system Failure". Medicare said these dx were not approved terminal dx, and our company lost a lot of money. Medicare does reimburse for dx of "Debility- unspecified".

This dx is often used in leau of TMBD (too many birthdays). lol.

[fetchitgold]

Nice to have those links! Thanks. We often use FTT in our program... once you get used to the guidelines, it makes eligibility pretty clear cut. We've never had Medicare refuse payment on these patients.

[fab4fan]

We use FTT and just work off the guidelines in the workbook NHO has for non-malignancy dx.

[NursePaula]

We also use debility unspecified, but use it carefully because then Hospice has to pay for ALL of the drugs they take. This can be very costly. Just a thought.

[Hellllllo Nurse, BSN, RN]

I left hospice nursing in '97. My company was denied payment for pts w/ FTT and multi-system failure as their terminal dx for pts treated in the mid-1990s. Things may have changed since then.

[amshockley]

A physician order of course is necessary.

Here are a few bits of Hospice Criteria for Failure to Thrive.

*BMI

*Declining enteral/paraenteral nutritional support or notn responding to such support.

*Karnofsky score of 12 or less.

*ADL score of 12 or less.

*Descriptive score of 19 or less.

*At time of recert. recumbent measurements (anthropometry) mid-arm circumference in/cm may be substituted for BMI with documentation as to why BMI could not be measured.

*Other co-morbid conditions:

Aspiration Pneumonia

Frequent UTI's

Septicemia

Decubitus Ulcers

Frequent URI's

Frequent opportunistic infections

Weight loss of>10% over preceding months

I hope this helps. I have been a hospice nurse for almost 10 years. Its very difficult to keep up with everyone and all of the criteria as things change in the patients condition.

Good luck and God Bless~ Amshockley

[AtlantaRN, RN]

Debility is a bugger of a diagnosis----I believe AFTT is also a diagnosis where company also has to cover all of the medications, and with the very elderly folks, they are on a billion medications (or so it seems when you look at the cost).

We work hard within the first cert period to find something more concrete-CHF, etc to aleviate the high cost of medications.

linda