Comparative charting for patients’ activities of daily living (ADLs), showing their functional decline, is a necessary skill to support determinations of hospice eligibility. In addition, discussions about functional changes should occur often among interdisciplinary group (IDG) members for the purposes of updating the plan of care. Medicare guidelines for hospice eligibility include parameters for various functional assessment tools for patients with a prognosis of 6 months or less. These tools are also valuable to further the work of the IDG to document, develop, and support hospice care. This course describes documentation for ADLs in a comparative manner. Also presented are how to use common assessment tools to evaluate and document hospice eligibility at admission and throughout the course of care. The tools covered in this course include the FAST, PPS, KPS, and NYHA classification.
Section 1: Introduction
About This Course
Section 2: Why Function Matters
Hospice Eligibility and the Plan of Care
Activities of Daily Living
Meet Mr. Douglas
Section 3: Karnofsky Performance Scale (KPS)
What is the KPS and How to Use It?
A Caution about Duplicity
Section 4: Palliative Performance Scale, Version 2 (PPSv2)
Structure of the PPSv2 Tool
Descriptions of Function within the PPSv2
Section 5: Functional Assessment Staging (FAST)
Retrogenesis and Alzheimer’s disease
FAST Scale Components
Using the FAST
Clarifying Points: Using the FAST
Section 6: New York Heart Association (NYHA) Classification
The Significance of the NYHA Classification
Meet Mrs. James
What Went Wrong?
Section 7: Conclusion
Expert Reviewer: Lynn Stange, RN, BSN, MA, CHC
Carrie Cooley is the Principal / Chief Executive Officer (CEO) of Weatherbee Resources. Carrie joined Weatherbee in 2009 as an Associate Consultant and was hired as the Consulting Coordinator in 2012. In 2014, Carrie was promoted to Director of the Consulting Division and in July 2015, she assumed the Chief Operating Officer position. Carrie was promoted to CEO in February 2018.
On July 1, 2018, Carrie and her business partner, Lynn Stange, purchased Weatherbee Resources from the company's founders, Heather Wilson, and Joy Barry. Together, Lynn and Carrie plan to continue the long-standing history of Weatherbee Resources' service to the hospice industry.
In her role as Principal / CEO, Carrie ensures Weatherbee's consulting services, products, and education are provided in a professional and cost-effective manner and are specifically tailored to meet each client's individual needs. As one of Weatherbee's owners, Carrie is responsible for ensuring Weatherbee is positioned to assist hospices with the ever-changing regulatory hospice environment. Carrie's excellent rapport with executives and staff alike ‐ coupled with her regulatory and clinical acumen, and knowledge of best practices ‐ assures excellent consulting outcomes.
Carrie's regulatory expertise and extensive consulting experience includes forensic clinical record auditing, baseline compliance audits/mock surveys, customized client education, interim management, clinical due diligence, and executive coaching. Carrie and her team frequently work directly with clients' legal counsel to address a wide range of hospice matters including the defense of clients under payment-related scrutiny by various entities; Carrie frequently serves as an expert witness. Weatherbee also works extensively with clients who are under a Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG); Carrie and her team execute the Independent Review Organization (IRO) audit activities required by the OIG.
Under Carrie's leadership, Weatherbee has assisted hundreds of clients under investigation by various Medicare contractors including: Targeted Probe and Educate (TPE), Zone Program Integrity Contractors (ZPIC), Unified Program Integrity Contractors (UPIC), Benefit Integrity Support Centers (BISC), Recovery Auditors (RA), the Department of Justice (DOJ), Assistant United States Attorneys (AUSA), and the OIG.
As a member of Weatherbee's Speaker's Bureau, Carrie teaches a broad range of hospice, regulatory, and leadership-related topics nationally and is a member of the faculty for Weatherbee's renowned Hospice Regulatory Boot Camps. Carrie also frequently speaks at state and national hospice conferences on compliance-related topics.
Carrie is a registered nurse and holds a master's degree from Samford University with a specialty in nursing leadership and healthcare finance.Disclosure: Carrie Cooley, RN, MSN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Instructor: Colleen O'Keefe, RN, CHPN
Lynn Stange first joined the Weatherbee team as an Associate Consultant in 2006, and was promoted to Director of Consulting in 2007. Lynn re-joined Weatherbee in 2017 as the Chief Compliance & Consulting Integrity Officer and in February 2018, Lynn was promoted to President. In July 2018 Lynn, along with Carrie Cooley, Principal/CEO, purchased Weatherbee Resources, Inc. and Lynn assumed the title of Principal/President of Weatherbee Resources.
In her new role, Lynn is responsible for strategic growth initiatives in the areas of compliance, quality, and education. Lynn works with consulting clients in the areas of Quality Assurance Performance Improvement (QAPI), mock surveys and compliance audits, Joint Commission accreditation, State Licensure preparation, plans of correction, pursuit of the Malcolm Baldrige National Quality Award, hospice acquisitions/sales, and program development. Lynn will also oversee all aspects of Weatherbee's Hospice Compliance Network (HCN) and Weatherbee's product line. Lynn's breadth of experience with a variety of regulations and standards allows her to connect with clients quickly to aid them in identifying their most critical needs thereby assuring excellent outcomes.
Lynn is a nationally recognized speaker in both the hospice and compliance arenas, having spoken at both the National Hospice and Palliative Care Organization (NHPCO) annual Management and Leadership Conference and at the annual Health Care Compliance Association (HCCA) national conference. Lynn is a member of the NHPCO Regulatory Committee since 2014. As a member of Weatherbee's Speaker's Bureau, Lynn teaches on a variety of regulatory, compliance, and leadership-related topics and is a permanent faculty member of Weatherbee's renowned Hospice Regulatory Boot Camp.
Lynn has been a registered nurse for 30 years with a Bachelor's degree in nursing from Carroll College in Helena, Montana and a Master's degree in Organizational Management from the University of Phoenix, Las Vegas. Lynn has been a State surveyor in both Montana and Nevada, and earned her Certification in Healthcare Compliance (CHC) in 2014.Disclosure: Lynn Stange, RN, BSN, MA, CHC has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Colleen O'Keefe RN, CHPN, is the Senior Project Specialist for Weatherbee Resources. She is certified in Hospice and Palliative Care and is also a Hospice and Palliative Nurses Association (HPNA) Approved Educator. Colleen has served as an RN Case Manager, Supervisor for a Continuous Home Care team, Clinical Educator, and Compliance Officer. Her clinical, regulatory, and leadership expertise allows her to deliver uncompromising consulting services.
As a Senior Consultant & Project Specialist with Weatherbee Resources, Colleen conducts clinical record audits for hospice organizations facing Additional Development Requests, writes independent expert cover letters to support technical and clinical eligibility for hospice care, and provides assistance and guidance throughout the appeals process. Colleen conducts comprehensive baseline assessment audits and mock surveys to assess regulatory compliance and identify potential risk exposures, and devises action plans to address problem areas. She also conducts education for hospice organizations across the country. Colleen also has experience and expertise in conducting investigations for hospices facing payment-related scrutiny by governmental agencies.
Colleen is a registered nurse and holds a bachelor's degree from Northwestern University.Disclosure: Colleen O'Keefe, RN, CHPN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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