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The Joint Commission
Community Based Palliative Care: A Unique Certification for Home Health and Hospice
Providers
Margherita C. Labson MSHSA, CPHQ, CCM
Executive Director
Nov 16, 2016
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Continuing Education Nurses: This session has been approved for 1.0 contact hours. Hospice & Palliative Care Network of Maryland is an approved provider of continuing nursing education by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Social Workers: The Maryland Board of Social Work Examiners certifies that this program meets the criteria for 1.0 credit hours of Category I continuing education for social workers in Maryland.
Conflict of interest
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To the best of my knowledge and belief, I disclose that I have no conflicts of
interest in the presentation of this program. Margherita C. Labson
Objectives
• Define Community Based Palliative Care Services
• Describe various models used by Home Care organizations to provide community-based palliative care services.
• Explore important lessons learned during the development and launch of the Community Based Palliative Care Certification
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Source: http://www.nationalconsensusproject.org/Guideline.pdf
Palliative Care’s Place in the Care Continuum
Background
• Growth of Palliative Care Services
• TJC Advanced Palliative Care Certification Program
• Inception of Community Based Palliative Care Certification Program
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From definition to design
Call to action
Work with experts
Standards development & approval
Learning visits and piloting processes
Refinement and launch
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8 DOMAINS FORMALIZING THE CONCEPT OF PALLIATIVE CARE
1. Structure and processes of care
2. Physical aspects of care
3. Psychosocial and psychiatric aspects of care
4. Social aspects of care
5. Spiritual, religious, and existential aspects of care
6. Cultural aspects of care
7. Care of the imminently dying patient
8. Ethical and legal aspects of care
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*Synergistically advanced by NCP and NQF.
Ref: NCP Clinical Practice Guidelines for Quality
Individuals appropriate for palliative care include those born and/or living with:
chronic and/or life limiting injuries.
chronic diseases that result in significant functional impairment
congenital injuries or conditions leading to dependence on life-sustaining treatment and/or life-time support by others with ADLs
acute, serious, and life-threatening illnesses
conditions where cure or reversibility is possible, but the conditions themselves pose significant burdens and result in poor quality of life.
progressive chronic conditions
terminally ill patients
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Uncovering deterrents to palliative care
Cultural considerations
Religious objections
Reimbursement issues
Operational constraints
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Program Design Options
Community-based Palliative Care
Separate service line of
HH or Hospice
Affiliated with a hospital or
health system
Independent organization
Affiliated with
physician/ practice
Provided along with HH
care
Payer sources
Fee for service (FFS)
ACOs
Bundled payments
or case rates
FFS for performance
with pay
Capitation or
integrated delivery system
Types and range of payment models
Payment
per service
Global or fixed
payment
Grant funded
programs
Medicare Advantage; Medicaid managed care; Insurance companies
CAPC Payer/Provider Toolkit:
https://www.capc.org/payers/palliative-care-payer-provider-toolkit/
National Consensus Project definition of Palliative Care
“The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care is both a philosophy of care and an organized, highly structured system for delivering care. Palliative care expands traditional disease-model medical treatments to include the goals of enhancing quality of life for patient and family, optimizing function, helping with decision making, and providing opportunities for personal growth. As such, it can be delivered concurrently with life-prolonging care or as the main focus of care.
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Defining eligibility:
TJC accredited Home health and/or hospice provider
Capable of providing palliative care services 24/7
Had 5 patients/last 12 months; 3 active on survey
CBPC services provided in patient's residence
Organization uses clinical practice guidelines to provide CBPC services
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Addressing the 8 domains:
Chapters in the Home Care manual with CBPC Certification standards:
Accreditation Participation Requirements (APR)
Human Resources (HR)
Information Management (IM)
Leadership (LD)
Provision of Care (PC)
Performance Improvement (PI)
Record of Care (RC)
Rights and Responsibilities (RI)
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Example: Human Resources - IDT
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HR.01.02.07, EP10 For organizations that elect The Joint Commission Community-Based Palliative Care Certification option: The program’s core interdisciplinary team is comprised of the following: - Physician(s) (doctor of medicine or osteopathy) who has specialized training in palliative care and/or hospice care; clinical experience in palliative medicine and/or hospice care; or is board-certified or board-eligible for certification in Hospice and Palliative Medicine - Registered nurse(s) or advanced practice nurse(s) who has training in palliative care and/or hospice care; clinical experience in hospice or palliative care; or one who has, or is eligible for, palliative care certification - Chaplain(s) who has training in palliative care and/or hospice care; experience in hospice or palliative care; or one who has or is eligible for board certification; or, a spiritual care professional(s)* who has training in palliative care and/or hospice care or experience in hospice or palliative care Note: The program may choose to have a full- or part-time chaplain or spiritual care provider on staff; they may utilize a chaplain from another program within the organization, such as the hospital or hospice; or, they may utilize chaplains and/or spiritual care providers from other organizations in the local community, including parish nurses. The patient also has the right to involve his or her personal spiritual
care provider (such as a pastor, priest, rabbi, or religious leader) rather than the program's chaplain.
Human Resources - IDT (cont'd)
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HR.01.02.07, EP10 (cont'd) - Social worker(s) who has training in palliative care and/or hospice care; experience in hospice or palliative care; or one who has, or is eligible for, palliative care certification Note: The program may choose to have a full- or part-time social worker on staff; they may utilize a social worker from another program within the organization, such as the hospital or hospice; or, they may utilize social workers from other organizations in the community if they are available. Footnote *: Spiritual care professionals are recognized as specialists who provide spiritual counseling. Source: Dahlin, C., editor, The National Consensus Project for Quality Palliative Care Clinical Practice Guidelines for Quality Palliative Care, 3rd edition, 2013, p. 26.
Recognition: certain requirements are critical to guide organizations and help them formalize their program
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HR.01.02.01, EP27-29 Staff with PC education/experience HR.01.02.07, EP12 IDT responsibilities in writing HR.01.02.07, EP24 Staff orientation - content for PC HR.01.06.01, EP27 Competency in providing PC LD.04.03.03, EP34 Process to refer patients to hospice LD.04.04.01, EP27 Written PI plan LD.04.04.09, EP7 Use of CPGs PC.01.01.01, EP49 Process to identify CBPC patients PC.01.02.01, EPs46-52 Initial assessments by IDT members RI.01.05.01, EP23 Advance care planning discussions
Lessons learned during learning Visits and Pilot Surveys:
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Organizations with formal program that have been operational for >6 months are more successful
Review eligibility closely
Comparing your palliative care policies against standards helps verify compliance.
Comparing your policies against practice helps verify operational compliance
Programs are unique and that is expected!
How compliance is determined during the on-site evaluation process:
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Follows a planned agenda
Can be integrated into other evaluative activities, i.e. accreditation
Surveyor(s) evaluate the services provided within the scope of the formalized program
Orientation to the organization includes time to have the agency describe their CBPC program/services
Session re: Credentialing of LIPs is included in the Competency session
Time will be allotted to meet with the IDT members
Time will be allotted for CBPC patient tracers
Key characteristics of successful programs
Leadership and staff able to clearly define, describe the palliative care patient Program should be fully operational for at least 6
months to one year prior to survey Palliative Care Clinical Practice Guidelines (CPG)
identified, embedded and & consistently used Identified staff who demonstrate actively
participate and provide palliative care services IDT established and core members are actively
involved with care of designated CBPC patients 24/7 on call support available and functioning
CBPC Data requirements
• Data Elements identified • Four measures required Two clinical measures
Two non clinical measures
• Four months of data history required (on initial CBPC survey)
• Data collection
• Data analysis
• Improvements initiated
• Data available at time of onsite survey
Relevant data to consider:
• Examples of non-clinical data to collect and monitor (use what you already collect!)
• Referrals and admissions
• Types and totals of visits
• Diagnoses
• Readmission rate
• Number of ED visits, reason for visits
• Patient/caregiver satisfaction
• Number of patients transitioned to hospice
• Discharge/transfer disposition
CBPC clinical quality measures
• Examples of quality measures for CBPC: • Pain screening and assessment
• Pain improvement
• Dyspnea screening
• Dyspnea improvement
• Discussion of advance care planning (treatment preferences)
• Patient and family satisfaction with care
Patient Care Requirements
• Plan of Care • Evidences ongoing patient and staff engagement
• Customized, relevant and appropriate
• Follow up is timely and evaluation against goals evident
• Palliative care needs are specific as are measurable goals
• CPGs are clearly identifiable and used
• Appropriate patient education materials are used
Some leading practices to consider:
Tie the CBPC to the organization’s strategic plan
Get an officer champion
Develop monitoring tools specific to CBPC that focuses on: Pain and symptom management Readmits and emergent care visits Advance Care planning process and DOCUMENTATION Adherence to IDT plan Timely referral to hospice
Involve community resources: Parish nurse programs Volunteer chaplain and spiritual counselors Mental health counselors, groups Financial assistance resources Area Agency on Aging services
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Resources Clinical Practice Guidelines:
Dahlin, C., editor, The National Consensus Project for Quality Palliative Care Clinical Prctice Guidelines for Quality Palliative Care, 3rd edition, 2013
National Hospice and Palliative Care Organization (NHPCO), Standards of Practice for Pediatric Palliative Care and Hospice, 2010
Article:
Leff, B., Carlson, C., Saliba, D., Ritchie, C. The invisible homebound: Setting quality of care standards for home-based primary and palliative care. Health Affairs 2015, 34 (1), p. 21-29.
Professional Organizations:
American Academy of Hospice and Palliative Medicine (AAHPM) www.aahpm.org
Center to Advance Palliative Care (CAPC) www.capc.org
Cal-State University Palliative Care Institute https://csupalliativecare.org/
Hospice and Palliative Nurses Association (HPNA) www.hpna.org
National Hospice and Palliative Care Organization (NHPCO) www.nhpco.org
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Resources for CBPC quality measures
Websites: http://aahpm.org/quality/measuring-what-matters
http://www.qualityforum.org/News_And_Resources/Press_Releases/2012/NQF_Endorses_Palliative_and_End-of-Life_Care_Measures.aspx
http://www.nhpco.org/performancemeasures
https://www.jointcommission.org/new_perf_measures_adv_certification_palliative_care/
Home Care Team Contacts
Account Executive: 630-792-3007
Standards Interpretation Group: 630-792-5900
Brenda Lamberti, BS
Senior Business Development
Specialist
630-792-5252 or
Joint Commission Home Care Program
Help Desk: 630-792-5070 or [email protected]
www.jointcommission.org/accreditation/home_care.aspx
Margherita Labson
BSN, MSHSA, CPHQ, CCM, CGB
Executive Director
630-792-5284 or
Julia Finken
BSN, MBA, CPHQ, CSSBB
Associate Director
630-792-5283 or
Cynthia Cook
BSN, RN
Associate Director
630-792-5121 or
Time for Your Questions!
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