Many patients within our nursing homes require end-of-life services to help manage the end stages of their disease process. Many nursing homes seek various hospice agencies to provide this service. Hospice falls into the Medicare Part A regulations, and, therefore, is paid a bundled rate for most of the services they provide.
When a patient is referred to therapy, and they are receiving hospice care, then therapy needs to seek permission from the hospice company to provide any treatment. Hospice is required to reimburse the facility for the therapy services since the treatment also is included in the bundled payment rate from Medicare Part A. And, therein lies the rub.
As healthcare providers, we are required to provide all treatment medically necessary for every patient. Many hospice providers are more than willing to work with us to delay the evaluation of hospice if a patient is currently receiving Medicare Part A nursing and/or therapy services.
Other providers, however, create many barriers to granting approval and risk delay of care. This is not a new issue. But it seems to have sparked a new trend: hospice companies providing training to skilled nursing facilities to improve palliative care services.
If a patient is receiving palliative care services, there should be no issues with accessing the Medicare Part A or Part B benefits. Also, per the recent lawsuit from Jimmo v. Sebelius, these patients with chronic, not-improving, long-term diseases are our neediest residents and often require the highest care needs.
Fortunately, the Jimmo lawsuit has re-opened our scope of services to include prevention, wellness, and quality of life. Per Jimmo, “to prevent or slow further decline” is one of the primary principles behind the lawsuit. Those patients with pain issues, splinting/contracture needs, seating and positioning, and so on, are the most likely patients to benefit from therapy interventions and palliative care services.
Although we think about our services as interventions, I think we should also consider how we fit into this palliative care model to further enhance our industry’s care standards.
Shelly Mesure (“measure”), MS, OTR/L, is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a veteran speaker and writer on therapy and reimbursement issues.