End of Life Care

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Did you know? Inpatient mortalities are tracked and publicly reported by CMS.

Patients enrolled in a Medicare hospice program prior to admission or within the first day of admission are exempt.

  • Terms such as comfort care, DNR/DNI and poor prognosis DO NOT qualify for this exemption (but may risk adjust).
  • Statements and/or orders, such as will consult palliative care or will consult hospice, DO NOT qualify for this exemption.

Medicare’s mortality metrics are risk adjusted based on the patient’s comorbidities (coded diagnoses).

  • Therefore, it is critical to ensure patients who are not going to survive a given hospitalization have all disease processes appropriately described.
  • DO NOT decrease the amount of documentation because the patient is on or will be transitioned to comfort care.
  • DO propagate all diagnoses from the time of admission through the entire record to the D/C summary regardless of when the patient was transitioned to comfort care.
    ▪ Ex: ICU transfers after aggressive interventions have been withdrawn.
  • DO NOT forget to capture diagnoses as new conditions develop while a patient is on comfort care.
    ▪ Ex: Comfort care patient becomes tachypneic with labored respirations and low oxygen saturations two days before they pass. Assuming you treat this situation (i.e. increase the
    morphine), this patient is accurately diagnosed as having acute respiratory failure.

Download the complete tip, End of Life Care.