Additional Development Request (“ADRs”) and Hospice Care – Three Ways to Improve Documentation

Second, avoid generic documentation by closely assessing the patient according to their specific hospice diagnosis. For example, with patients who have end stage heart disease, rather than asking generically about pain, focus your questions on the symptoms you would expect them to have. Ask the following questions: how many pillows do they sleep on at night? Do they wake up at night due to shortness of breath? Do they have a sensation of pressure in their chest and what activities bring on this sensation?

Third, document measurable data hospice care provider instead of observational data. Rather than stating that your patients with chronic obstructive pulmonary disease had difficulty breathing, document measured changes in their respiratory rate (breaths per minute). What was their respiratory rate after walking 20 steps and how many minutes did they require to return to baseline after they rested.

Too many patients are not offered hospice care at the end of life. The end result of this increased Medicare scrutiny of hospices could result in still fewer patients receiving hospice care. Hospices may decide to limit their admissions to those patients that will not cause them either ADRs or audits. Clinical Staff play a key role in preventing this. Simple changes in clinical documentation can demonstrate that hospice patients are in fact declining and therefore eligible and appropriate for hospice care.