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 events@pathwayshealth.org or visit www.pathwayshealth.org.

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:
http://www.bedlamfarm.com/
http://hospice.bedlamfarm.com/

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. 

YOU CAN BILL FOR TIME SPENT:

• 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

YOU MAY NOT BILL FOR THE TIME YOU SPEND:

• 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

GOOD HABITS

• 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 kholbrook@pathwayshealth.org.

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 www.pathwayshealth.org/publications.

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 www.pathwayshealth.org/publications.

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 www.pathwayshealth.org/publications.

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 www.pathwayshealth.org/publications.

Walker Safety

Walkers are valuable tools that promote mobility.  They can help when a resident has poor balance (like after some strokes) or is weak.  But incorrect use can have disastrous results.  Here are some simple guidelines for helping residents use their walkers safely.

Right Walker

First, make sure the resident has the right walker.  There should be rubber hand grips and non-skid rubber tips or wheels on the legs.  A lightweight walker allows the resident to easily lift it over bumps or stairs.  Some have wheels on the front legs if the resident has trouble lifting the walker while walking.  Sturdy wheels are a must.  Other options are hand brakes, baskets for carrying and legs that are adjustable to varying heights. If the resident has a tendency to tip backwards, the height of the walker can be adjusted down slightly to redistribute his weight.

Starting Out

When getting up from a chair, put the walker directly in front of the chair.  Then have the resident slide forward in the chair, keeping the feet directly under him.  Then have the resident use the arms of the chair to slowly stand.  The resident should grasp the walker handles firmly and move forward into the center of the walker.  When walking, watch the resident to be sure he does not put the walker too far ahead of this body.

Sitting

When the resident is ready to sit down, have him back up to the chair such that he can feel the chair on the back of his legs.  If one leg is weaker than the other, have the resident put his weight on the stronger leg.  The resident should keep one hand on the walker while the other reaches for the arm of the chair.  When he has a firm grasp, he should move the other arm to the chair, then lower himself down.

Remember, to be safe using a walker:

• the resident must take small steps
• he should never tilt or pull on the walker when getting up from a sitting position
• chairs should have armrests
• walkers should be examined routinely to be sure wheels and tips are secure and not worn down. 

This article was originally published in Pathways Residential Care Journal - Issue 3.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Advance Health Care Directives

A Gift to Families

An advance health care directive tells your family and doctor what you want done if you can’t make decisions for yourself.  Your family and doctor don’t have to guess what you would have wanted.  What would be the highest priority?  It might be to be pain free, or to not be on a ventilator, or to have everything done to keep you alive as long as possible.  This isn’t just for older people, all adults should make one.  After all, young people can be injured in accidents that leave them unable to speak.

Three Parts

An advance health care directive has three parts.  In the first part you name a person to be your agent (and alternates in case the agent is not available).  The agent can legally make health care decisions for you and is called a Durable Power of Attorney for Health Care.  In the second part, you state in detail the treatments you would want, or would not want, and under what circumstances—things like feeding tubes, ventilators and what to do if your heart and breathing stop.  In the third part you can say if you want to be an organ or tissue donor.

Choosing an Agent

The person you choose as an agent must be 18 years old, and someone who knows you well and who will honor your wishes, even if they are different from yours.  A husband or wife is not automatically recognized as a patient’s spokesperson in California.  The agent may be a family member, a friend, or even an attorney, but caregivers in a facility cannot be agents for residents.  Agents may choose a doctor, hospital, skilled facility or hospice for you.  The agent may also accept or refuse treatments on your behalf, and consent to organ donation.

Making it Legal

An advance health care directive does not need to be prepared by an attorney, but it must be signed and dated in front of two witnesses (who are not the agent or alternate) or it can be notarized.   There is no official, standard form.  One web site where you can get advance directives in several languages is www.codaalliance.org.

When complete, you should make sure your doctor, loved ones and agent all have copies.  The original should be kept in a safe place and a copy should go with you to the hospital.  Experts recommend that an advance directive be updated at least every 10 years, in the event of a divorce, or if the agent is unable to act.  The directive is valid forever unless you revoke it or state in the directive the date on which you want it to expire.

This article was originally published in Pathways Residential Care Journal - Issue 3.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.