How can we provide Continuous Care services without going broke?
Continuous care (CC) has gained significant popularity in recent years. Many savvy competitors have aggressively marketed their continuous care services as a means of enticing referral sources. Why is this level of care so popular? The most important reason is that so many of our hospice caregivers need help when symptoms escalate. Another reason that this level of care appeals to hospices and referral sources is that CC results in better patient outcomes. According to Wang, et. al. (2017), patients who receive continuous care have a statistically significant reduction in rehospitalization and revocation.
When Should We Provide Continuous Care?
Continuous Care is the level of care that should be provided to patients who live in private homes with a caregiver when their symptoms become too difficult for an unskilled person to manage. CC is often used for uncontrolled pain, respiratory distress, terminal agitation that requires frequent medication changes, but can be used in other scenarios. Continuous Care is NOT appropriate for symptoms that are typically seen at the end of life – low grade fever, the need for traditional comfort medications, tachypnea, tachycardia. Remember, dying is not an uncontrolled symptom. CC should also not be used to address caregiver breakdown.
Is There a Downside to CC?
Yes, there is absolutely a downside. The ongoing scrutiny of hospices has extended to higher levels of care, most recently SMRC audits on CC cases. Improper use of CC can lead to claim denials. Poor documentation, failing to understand the requirements for billing and lack of oversight can also lead to claim denials.
If you are offering this level of care to facilities (or worse yet, you are required by the facility to offer it and you acquiesce) and the patient is not eligible, you could easily be required to pay back the reimbursement. Additionally, this could be misconstrued as incentivizing for referrals. Unfortunately, this has become far too common in some markets and hospices are facing intense pressure from referral sources to provide continuous care (often called “crisis care” in the final days of life.
How Can We Effectively And Compliantly Provide CC?
One of the biggest barriers for most hospices is how to implement a good compliant continuous care program without breaking the budget. The hospice Registered Nurse should be assessing the patient to ensure that they qualify for this higher level of care, but that doesn’t mean that they must sit at the bedside. There are multiple solutions to this dilemma. One example is to hire and train prn staff. Hiring one or two prn LPN/LVNs and a prn hospice aide (experienced in end-of-life care) can help reduce cost and burden.
Many smaller programs move patient visit schedules, offer bonus pay or flexible hours to ensure that their staff are willing to provide direct CC hours. If you are in a location that has been granted a nursing waiver, agency nurses can supplement the care that your team provides.
Before you execute a program, it is critical that you train your front-line care team and your managers on how to deliver continuous care compliantly. Training should include medical indications to initiate CC, what documentation is required and how to successfully discontinue. We also suggest that you train your liaison team on how to properly message CC – including how to explain why CC cannot be offered for every patient who is actively dying.
Meeting the CC needs of your patients and families will reduce the likelihood of revocation, improve quality of care, meet the expectations of your referral sources and will pay off in more referrals, higher CAHPS scores and reduced after-hours calls and service failures.
The Hospice Support Specialists team offers the training and support that you need to implement a successful Continuous Care program that will enhance patient satisfaction and meet regulatory requirements. For help setting up your continuous care program, program tools or more information please schedule a 1:1 discovery call with one of our hospice, palliative and home health leaders by clicking here.
