BOSTON — Clearer communication between primary care clinicians and hospice providers may decrease the number of denied Medicare approvals for end-of-life treatment, according to a small study presented on April 18 at the American College of Physicians Internal Medicine Meeting 2024.
Tyler Haussler, MD, acting medical director at Brookestone Home Health & Hospice in Carney, Nebraska, said he conducted the study to find out how many denials of coverage by the Centers for Medicare & Medicaid Services (CMS) were attributable to poor documentation by physicians.
“As a medical director, I wanted to make sure I was capturing every aspect of this person’s terminal illness to make sure the documentation didn’t create any red flags for Medicare,” Haussler said.
CMS requires a “face-to-face encounter” between a physician and hospice caregiver to communicate clinical findings and determine the patient’s terminal status. Missing or incomplete documentation of a patient’s medical condition remains one of the main reasons the agency denies hospice coverage.
“A lot of physicians just do a records review to do a hospice referral, and we might get something from their oncologist, but we never have a conversation as a medical director with the primary care physician,” Haussler said.
Haussler presented his work as part of the ACP Early Career Physician presentations. His study received a Certificate in Physician Leadership at the annual meeting.
For the study, administrators at Brookestone Health reviewed the hospice certification documentation for 10 patients who were randomly assigned to one of two group: Five patients received a “handoff conversation” between the referring physician and the hospice medical director, and the other five did not. The administrators assessed the quality of the communication between physicians and the medical director using a 5-point Likert scale that Haussler developed. The scale rated the medical director’s understanding of the patient’s history, the progression of their disease, why hospice would be appropriate, and the chances that Medicare would approve coverage of hospice care in the case.
Hospice administrators found that a handoff discussion between the referring physician and the medical director improved the quality of documentation of the patient’s disease progression. A handoff discussion also offered a clearer understanding of why hospice is appropriate for the patient, Haussler told attendees.
“There’s two questions when somebody comes into hospice: why hospice, and why now,” Haussler said.
Unlike a record review, “the handoff from the primary care physician gives us more context and nuance in the situation,” Haussler said.
During the 2023 study period, Brookstone Health had no Medicare denials, Haussler told attendees.
The findings may also help patient’s loved ones also get a clearer understanding of disease progression, quality and quantity of life, according to Ankita Sagar, MD,associate clinical professor of medicine at Creighton University in Omaha, Nebraska.
“Smoother [physician] handoff may also offer some relief for caregivers as their loved one reaches end-of-life care,” Sagar, who was not involved with the study, said.
Haussler agreed, telling attendees that future studies should examine whether physician to medical director handoffs improve patient care while on hospice.
Haussler and Sagar reported no relevant financial conflicts of interest.
Lara Salahi is a health journalist based in Boston.
Source : Medscape