Quality improvement is not a department or a single entity, but an ongoing conglomeration of approaches for improving cost reduction, efficiency, satisfaction scores, and overall outcomes. Research-based outcomes are now the standard for implementing changes within an organization. Bechmarking against successful organizations is another tool used in quality improvement, as well as surveys, root cause analysis, and a continual re-evaluation process.
Medicare is very particular as to what is covered under hospice care. The patient’s prognosis must be 6 months or less to live. Focus is not on heroic intervention or expensive testing for simple symptom management. Also, keep the goals of care in mind when considering orders, and continue to discuss the patient’s case at interdisciplinary meetings.
General Inpatient Care (GIP) is provided for acute symptom management that can not be adequately controlled in the home or other environments. Approved GIP settings include Medicare certified hospitals, and hospice inpatient facilities that afford 24-hour RN direct patient care services.
The Medicare Hospice Benefit is composed two 90-days periods, and then an unlimitted of subsequent 60- day periods. A certification for terminal illness must be obtained during the first 90-day period. Face-to-face visits must be made with the patient by a nurse practitioner or physician prior to recertification for each benefit period.
Medicare Part A covers hospitalizations, hospice care, home health services, nursing home care, and skilled nursing facility care (SNF). Medicare will pay for up to 100 days for skilled nursing care provided in a SNF post-hospitalization.
Medicare Part B covers two types of services: medically necessary services and preventive services. This includes supplies, healthcare to prevent illness, clinical research, ambulance services, DME, mental health care, receiving a second opinion before surgery, and limited outpatient drug coverage.