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 1
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. 2
Conflict of interest 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 3
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 4
Palliative Care s Place in the Care Continuum Source: http://www.nationalconsensusproject.org/guideline.pdf 5
Background Growth of Palliative Care Services TJC Advanced Palliative Care Certification Program Inception of Community Based Palliative Care Certification Program 6
From definition to design Call to action Work with experts Standards development & approval Learning visits and piloting processes Refinement and launch 7
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 *Synergistically advanced by NCP and NQF. Ref: NCP Clinical Practice Guidelines for Quality 8
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 9
Uncovering deterrents to palliative care Cultural considerations Religious objections Reimbursement issues Operational constraints 10
Program Design Options Community-based Palliative Care Independent organization Provided along with HH care Separate service line of HH or Hospice Affiliated with a hospital or health system Affiliated with physician/ practice
Payer sources Payment per service Global or fixed payment Types and range of payment models Fee for service (FFS) FFS for performance with pay Bundled payments or case rates ACOs Capitation or integrated delivery system 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 lifeprolonging care or as the main focus of care. 13
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 14
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) 15
Example: Human Resources - IDT 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 boardeligible 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. 16
Human Resources - IDT (cont'd) 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. 17
Recognition: certain requirements are critical to guide organizations and help them formalize their program 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 18
Lessons learned during learning Visits and Pilot Surveys: 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! 19
How compliance is determined during the on-site evaluation process: 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 20
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 26
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 27
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 Joint Commission Home Care Program Help Desk: 630-792-5070 or homecare@jointcommission.org www.jointcommission.org/accreditation/home_care.aspx Margherita Labson BSN, MSHSA, CPHQ, CCM, CGB Executive Director 630-792-5284 or mlabson@jointcommission.org Brenda Lamberti, BS Senior Business Development Specialist 630-792-5252 or blamberti@jointcommission.org Julia Finken BSN, MBA, CPHQ, CSSBB Associate Director 630-792-5283 or jfinken@jointcommission.org Cynthia Cook BSN, RN Associate Director 630-792-5121 or. ccook@jointcommission.org Account Executive: 630-792-3007 Standards Interpretation Group: 630-792-5900
Time for Your Questions! 30
Follow us and join us @TJCHomeCare The Joint Commission s Home Care Program https://www.linkedin.com/company/home-care-accreditation---the-joint-commission Check our website to register for our free upcoming webinars and our library of webinars on demand at: https://www.jointcommission.org/accreditation/home_care_ac creditation.aspx 31