As of January 1 2011 Medicare has mandated that all Medicare patients receiving hospice care in the home be seen by a doctor or Nurse Practitioner at each recertification period prior to being recertified.
As a case manager for a non profit company providing hospice care in the home my first thought… what an extra burden on the company already stretched financially. Then my thought was, why doesn’t Medicare trust the nurses…. We KNOW if the patient meets criteria or not. So I ignored the idea and waited to see what might happen.
Yesterday just before leaving the house I received a call from a woman who said ”Hi I’m so-and-so I am about to go to your patient’s house for a “face-to-face”. At first I had no idea who she was nor what she was talking about, that expression had not yet become part of my new knowledge. After some back and forth I finally got the picture. This was a Nurse Practitioner about to make a visit for my company in order to keep up with the new mandate.
We met at Mr. P’s house, entered with the lockbox and announced our arrival. Mr P is very shy, very private and not open to new faces but the NP was very personable right from the start, she was warm and compassionate, took her time and did not rush anything.
The visit lasted an hour and I had questions that she had answers to and the patient had questions that she also answered. It was wonderful having a little support to complement and enhance the work being done. It may sound like I am unsure of myself in my professional practice, I am not, but support and running ideas around help justify the practice being given.
I love this woman! It was the best visit and I now think this is a great idea! I’m not sure every 3 months is necessary, maybe every other certification period (ever 6 months) as there are a lot of people to see, but hey, let’s put these wonderful practitioners to work in the field for support sharing their medical knowledge and let the medical director oversee the multitude of patients under his/her care.
This is a good idea!
by: Gigi Trabant RN CHPM
Home hospice case manager
Comments
The visit is intended to be administrative, not medical, so it's not really a good use of an NP or a physician. (kind of like working for an insurance compamy, reviewing charts. That's not why most NP's or physicians went to school.)
Of course, Medicare says we can bill for a portion of the visit, if it includes medical management, but we've been warned that we'll face extra scrutiny if we start billing for these visits, so we get the message not to bill.
I think it will have an overall negative impact on hospices, and I wonder if data will support its continuation.
I will support any venture that will bring advanced practice NPs to the bedside of the dying, I just wish that is was in a position that would enable us to use our clinical skills to the fullest potential. Maybe in a land, far away, there is a hospice patient that gets to have a full complement of team members that includes advanced practice nurses, all working together, to manage the emotional, spiritual, psychosocial, and medical aspects of dying. I just hope it is an idea that catches on and spreads to my hometown!
As an NP that mostly does hospital consults, I relish getting to do FTF home visits and the opportunity to have more contact with our hospice patients.
It's taking some organizational learning, but we seem to be on it. Very do-able.