Wednesday, August 29, 2012

One from the Heart Awards Breakfast #OFTH

If you only attend one event this fall,
it should definitely be One from the Heart!

Be a part of Pathways’ compassionate and caring mission. This inspirational breakfast has become a “must attend” for nearly 650 friends and supporters of Pathways, corporate and community leaders, and medical professionals. One from the Heart annually honors individuals and organizations that have made an enduring contribution to Pathways and end-of-life care.

Over the past twenty-one years, the One from the Heart Awards Breakfasts have raised over $4 million for Pathways to ensure extraordinary hospice and home health care for the Bay Area.

One from the Heart Awards Breakfast
Friday, October 5, 2012, 7:30 to 9:30 am
Crowne Plaza Cabana Hotel, Palo Alto

Tables and individual seats available.

For more information about the One from the Heart Awards Breakfast or other events, contact Holly Smith, Event & Sponsorship Manager, 408.730.1200 or or visit

Join the conversation:
on Twitter using #OFTH
on our Facebook event page
on our Linked event page

Learn more about our featured speaker, Jon Katz:

Monday, August 27, 2012

Documenting and Billing for Care Plan Oversight

Home Health & Hospice

There is one service that is not face-to-face that physicians can be reimbursed for by Medicare—care plan oversight (CPO) of patients receiving home health or hospice.  Because the rules are complicated, many physicians simply don’t bill for this service.  Here we’ll try to break it down.  
To bill, CPO services must take at least 30 minutes in a calendar month. The services do not need to be provided on the same day, but the total services over the course of a month must add up to at least half an hour.  Medicare uses two HCPCS codes to pay for CPO:  G0181 is for home health, and G0182 is for hospice. 

  • Reviewing charts, reports and treatment plans
  • Reviewing diagnostic studies that weren’t associated with a face-to-face encounter
  • Phone calls with other health care professionals involved in the patient’s care who are not employees of the practice
  • Conducting team conferences
  • Discussing drug treatment and interactions (not routine prescription renewals) with a pharmacist
  • Coordinating care if physician or non-physician practitioner time is required
  • Making and implementing changes to the treatment plan
  • Renewing prescriptions
  • Talking with fellow employees at the practice
  • Travel time
  • Preparing or submitting claims
  • Talking to the patient’s family, even if discussing treatment plan changes
  • Holding informal consults with physicians who are not treating the patient
  • Working on discharge services
  • Interpreting test results at an E/M visit
  • Keep a log of the patients you provide CPO to; use this as a reminder to pull those charts at the end of the month. 
  • Keep a simple CPO log in each of these charts and document the date, total time and a brief description of the services as you provide.  Sign this documentation.
  • At month end gather the logs, total the time and bill for those for whom you provided at least 30 minutes of CPO.  Put the beginning and end dates of the month as the dates of service and be sure to put the provider number of the home health agency or hospice on the claim form.
For more information or questions, or to receive written materials about billing for care plan oversight, call Kaye Holbrook at 408.773.4359 or email your request to

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, August 20, 2012

Communicating with Residents

Be Heard Better

They are just little things, but they make a difference in reducing frustration for you and your residents.  We’re talking about techniques you can use every day to make communication smoother and more satisfying.

First let’s look at body position.  Standing over a resident who is sitting or in bed may feel threatening, especially if you are very close.  Research has shown that patients thought that their doctors stayed longer at the bedside than they actually did when the doctor sat down.  So try sitting down to appear less hurried. 

When people have hearing problems, as many older adults do, it is important to face the person directly and have your face at their eye level.  The shapes our lips make when speaking and expressions give residents a lot of clues to what we are saying.  It should go without saying that we should make sure hearing aides are in place, are turned on, and have fresh batteries.

Next we should speak slowly and clearly, enunciating our words precisely—slow down.  Older ears need more time to decipher what you are saying.  If you also have an accent, slowing down your speech will help older, hard-of-hearing adults understand you better.  It also helps to use gestures to supplement what you are saying.  For example, if you want the resident to sit in a chair, pat the chair or sit down to demonstrate what you would like.

By paying attention to the little details in our communications with the elderly, we can make the interchange more satisfactory for them and us!

This article was originally published in Pathways & Partners Newsletter - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, August 13, 2012

Heart Failure & Hospice

Patients with congestive heart failure who elect hospice live longer than those who don’t.  These were the findings of a defining 2007 study published in the Journal of Pain and Symptom Management.  Other diagnoses also experience longer prognosis with hospice, but none longer than the 81 day extension of life in heart failure.

Many factors probably contribute to the increased longevity.  Hospice care increases monitoring in the home and gives psychological, emotional and spiritual support from friendly visitors.  This holistic attention may increase the desire to live and reduce the sense of being a burden to one’s family.

Skipping the ER

Heart failure is the diagnosis most commonly associated with hospitalization.  By some estimates, patients with heart failure are readmitted at a rate of nearly 50% within six months.  For some patients, knowing that they have 24-hour access to nursing advice and visits for management of symptoms gives them a welcome alternative to the emergency room. 

Who is Appropriate?

Medicare guidelines include:
  • Patient is optimally treated with vasodilators or unable to tolerate them.
  • Patients with conditions usually treated with surgery are either ineligible or decline it.
  • Patient is Class IV on the New York Heart Association scale: unable to do any physical activity without discomfort and symptoms may be present at rest.
  • If ejection fraction is available, 20% or less is appropriate for hospice.
  • Co-morbidities play a large role in estimating prognosis.  The following co-morbidities support a prognosis of 6 months or less in conjunction with the conditions listed above:
  • Symptomatic arrhythmias resistant to treatment
  • History of cardiac arrest, resuscitation or unexplained syncope
  • Brain embolism of cardiac origin
  • Concomitant HIV disease
The extra time that hospice can give patients may be especially important to patients and families trying to find resolution and peace at the end of life.  

Questions to Ask Patients
  • Do you have discomfort when physically active? or Does physical activity give you more discomfort?
  • Do you get short of breath when you are lying down?
  • Do you ever wake up at night feeling short of breath?
  • When you are resting in a chair do you ever feel short of breath, perspire or have chest pain?
  • Do you have any swelling?
  • Do you need help with activities like dressing, bathing, walking or eating?
Supporting Documentation
  • Cyanosis
  • Rales
  • Dusky nail beds
  • Tachycardia or bradycardia
  • Hyper- or hypotension
  • Jugular venous distension
  • Liver enlargement
  • Cachexia
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Decreased ejection fraction
  • Weight gain due to fluid retention

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, August 6, 2012

Power of Music

Music is a powerful force that can stimulate strong emotions within us.  Harnessing that power can benefit the seriously ill by improving their quality of life.  In a 3-year study Sandi Curtis, a music therapy professor at Concordia University in Montreal, Canada, divided university music therapy students and musicians in to pairs working with 371 participating terminally ill patients from 18 to 101 years old.  Participants were seen for a single music therapy sessions from 15 to 60 minutes long with the goal of enhancing pain relief, relaxation, mood and quality of life.

“Our study showed how music therapy was effective in enhancing pain relief, comfort, relaxation, mood, confidence, resilience, life quality and well-being in patients,” said Curtis.  The study was published in the journal Music and Medicine.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at