Final Flashcards
Palliative Care Definition
care meant to improve QOL who have a serious or life-threatening disease
approach to care that addresses the person as a whole, not just their disease
goal is to prevent, treat the s/s and side effects of disease and its treatment in addition to any psychosocial problems
anyone can receive regardless of age or stage
Three roles of palliative care team
- identify the individuals goals of care
- Symptom management (Total Pain model of care)
- Advanced Care planning (AD, POLST)
How many people prefer to die at home?
70%
How many people die at an hospital?
76%
they receive more aggressive, invasive, poorer quality care than they would ad home
Hospice Care
- type of palliative care
- goal is to improve quality of life through multidisciplinary care through s/s management, spiritual care, psychosocial care
- can receive medical treatment for s/s mgmt, not curative
- offered at the end of disease process
- must have terminal prognosis with 6 mo or less of life left
- payment is through specialized benefit
Palliative Care overview
- goal is to improve WOL in combination with primary medical tx for disease
- goal is to improve QOL through multidisciplinary care including s/s mgmt, spiritual care, psychosocial care
- can still receive curative tx
- can be offered at disease diganosis
- not time limited
- also called supportive care or symptom management
- payment through traditional methods
Durable power of attorney for health care
lets the pt name one of more people to serve as health care agent or proxy, giving them power to make medical decisions on behalf of pt
Living Will
lets pt specify what type of care or treatments they wish to receive and list the circumstances in which they’d like them to be used
If you do not have an AD
- state laws dictate who can make the decisions for you
- in Oregon, it goes down the line as follows: spouse, adult children, your parents, siblings.
- in OR, unmarried partner cannot make decisions unless named as proxy
Situations in which an AD would not be followed
- complex medical situation where it is unclear what you would want
- goes against health care providers conscience
- against health care institution policy
- does not meat accepted health care standards
POLST/MOLST
- forms that provide guidance about your medical care that health care professionals can act on immediately in an emergency
- typically created for persons with a serious progressive illness
- OR founded the program
- pink form
AD overview
- for those 18+
- legal document that you, HCP, witnesses sign
- do not need a lawyer
- pt keeps the form and gives copy to HCP
- it can be changed
- HCP will make sure AD is followed
POLST Overview
- for those with serious illness or are old/frail
- medical order
- doctor fills it out with pt input
- do not need a lawyer
- HCP and electronic POLST system keeps a copy, as well as pt
- can be changed with doctor approval
- doctors, medical staff will make sure it is followed
Medicare part A
- covers hospital, IRF, skilled nursing, home health, hospital
- catastoprhic insurance
- very specific criteria for coverage
- short-term treatment
- no premiums, but includes dedctibles, co-pays
- does not fover custodial care
Medicare Part B
- optional insurance for > 65 or distabled can purchase
- premiums = $175
- deductible = $240 per year
- covers outpatient services, medically necessary, preventative services
Medicare Part C
- medicare advantage plans
- private insurance that provides medicare benefits
- can offer additional coverage including part D, dental, vision
- premiums vary greatly, can be more expensive or economical vs medicare
Shared Risk Model
part of medicare part c
plan manages a group of lives and are paid per life managed
What % of Medicare Advantage have United Healthcare or Humana
47
Medicare Part D
- drug or prescription coverage
- you have to sign up for Part A/B before enrolling Part D
- drugs are divided into tiers, more expensive being in higher tiers
- certain “formularies” are covered by certain plans
CPT vs ICD-10 Codes
CPT: identify services rendered
ICD: represents pt diagnosis
Resident Assessment Instrument (RAI)
determines quality of life for patients in nursing homes or facilities
OASIS Manual
patient-specific, standardized assessment used in Medicare home health care to plan care, determine reimbursement, and measure quality
Three Guiding Principles for Documentation
Medical Necessity
Skilled Service
Reasonable and Necessary
Medical Necessity
- New onset
- Change from previous level of function
- significant risks/deficits/impairments would be there without care
The prognosis and diagnosis cannot be
the sole factor in deciding that a service is or is not skilled or necessary
Skilled Services
- knowledge
- skills
- judgement
services provided must be of a level of complexity and sophistication, or conditions must require the following skills of a PT
Reasonable and Necessary
- Time
- Goals
- generally predictable
The POC at minimum needs to include
- diagnoses
- long term goals
- treatment approaches
- duration
- frequency
A therapy’s POC is
a PT’s prescription
in POC, you should do the following when writing it
- be specific, reasonable, appropriate to each pt
- represent the major impairments and deficits identified
- match approaches, frequency, and duration to the needs
Common mistakes in POC
- not matching the frequency and duration to the assessment and goals
- using a treatment code (CPT) without providing supportive information
- lack of specificity
- make long term goals the same but slightly harder versions of short term goals
- repeating things you have already stated in clinical impressions
When selecting treatment diagnosis codes
- be specific, including body part and type specific
- avoid general codes
- avoid medical diagnoses
- must be compliant with medicare coverage documents
Long Term Goals should
- not mirror STGs
- be comprehensive or global
- answer “what do we want the pt to do by the end of therapy services or the episode of care?”
Use of Clinical Impressions Box
- helps auditor understand clinical reasoning or justify PT services
- not to repeat information
- needs to be patient specific
- can answer what would happen without skilled OT services and detailed plan provided by PT
General Supervision
- supervisor is available for direction by telephone or other form of telecommunication
- not required to be on site
Direct supervision
- supervisor present on site
- immediately available for in person direction
Personal Supervision
- supervisor is physically present
- within direct line of site
Institutional
long term care
hospital OP
rehab
(everything besides private practice)
Professional
private practice settings
Medicar advantage follows
medicare regulations, as an assumption
Medicare Part A Supervision, PTA
- General supervision
- PTA may write progress notes and discharge summaries with co-signature
- decision to d/c and update LTC/POC is by PT only
Medicare Part B Supervision, PTA
Institutional = general
Professional = direct
current waiver allows direct via telehealth through 2024
Progress Notes in Part B
completed by PT
Always follow the most
conservative supervision rules
Part A inpatient SNF (aides)
- may not provide skilled services
- set up time preceding therapy by an aide may be coded by PT/PTA
- direct supervision is required
Part B outpatient (aide)
- cannot provide skilled services
- unskilled services are not reimbursable even when provided via direct supervision of PT/PTA
Part A Inpatient/SNF (students)
- on site supervision, line of site is not neccessary
- can report time on MDS
- state decides about documenting, co-signing, billing with a student
Part B Outpatient (student)
- personal supervision in room and directing service
- supervisor not engaged in other tasks or treatments
- supervisor bills, signs all documentation
Individual Mode
student and supervisor are only providing service to one patient at a time
Concurrent Mode
if student is treating one patient and supervisor is treating another at same time
Group Mode
2-6 pts performing same activities. student and supervisor may only be providing services to the patients in the group
A PT is a person who is
- licensed as a PT by the state in which they are practicing unless licensure does not apply
- has graduated from an accredited PT program
- passed national exam approved by state in which PT services are provided
New Grad PTs and Medicare
new grads that haven’t passed their exam cannot provide services to medicare/medicare advantage pts even if they have a temporary license
Abuse of Elderly Includes
- physical harm or injury
- failure to provide basic care
- financial exploitation
- verbal or emotional abuse
- involuntary seclusion
- wrongful restraint
- unwanted sexual contact
- abandonment by caregiver
- self-neglect due to lack of supervision
What is “adult abuse”?
age 65 +
age 18+ who have disabilities
What happens after report of abuse?
- law protects mandatory reporters, if reporting in “good faith”
- state law protects confidentiality, and will only be given in certain legal situations
- local AAA offices will determine if abuse or neglect has occurred and contact authorities if there has been a crime
Timeframes for reporting
- 24hrs if abuse or crime
- 2 hours if serious bodily injury occurs
Elder Justice Act
- established timeframes for reporting
- financial penalties for not reporting or retaliation for reporting
- expanded mandatory reporter list in long term care facilities
- created elder justice council
At Risk Driver Programs
- PT are required to report to DMV a person whose cognitive or functional impairment affects ability to safely operate a car
- impairment has to be severe and uncontrollable, impacts ability to perform ADLS and is permanent
- requirement of PT only if driver has been seen clinically and if PT has witnessed the impairment
- reporting is not a HIPAA violation
