The Part A Medical Affairs Department revised this article to include the following changes:
- The Cardiopulmonary Case Scenario was revised and the link was updated.
- The last paragraph of this article was revised to include the date the final policy was published. The final policy will become effective following a 45 day notice period.
Valuable information allows providers to make predictions and decisions. The quality of the resultant predictions and decisions is dependent upon both the quality of the information used and the knowledge and experience of the decision-makers. Through its Going Beyond Diagnosis® educational initiative, Palmetto GBA is describing a role for the International Classification of Functioning, Disability and Health (ICF) in education, policy, and decision-support.
Palmetto GBA is already using Going Beyond Diagnosis® to highlight care pathways for individuals with End-stage Renal Disease, Amyotrophic Lateral Sclerosis (ALS), and Alzheimer's Disease and Behavioral Disturbances. The comprehensiveness of the ICF allows Palmetto GBA, home health and hospice providers to describe the complex interaction among factors contributing to an individual's health status. Health status is an important intervening variable between diagnosis and care outcomes. Failure to account for health status could result in care-recommendations not meeting an individual's needs.
With the above in mind, Palmetto GBA is proposing a new Hospice Local Coverage Determination (LCD) addressing Cardiopulmonary Conditions. The proposed policy provides guidance on a documentation strategy that recognizes the importance of both prediction and description. The policy suggests use of the ICF as a means for comprehensively describing the unique service needs of individuals with cardiopulmonary conditions. Such documentation would help promote the over-all goal of the right care for every person, every time.
A preliminary analysis, using information from the ICF, of the existing Hospice Heart and Pulmonary LCDs identified that important intervening variables were not completely addressed - among them secondary and comorbid conditions. Secondary and comorbid conditions often play an important role in care-planning and decision-making. Documentation strategies for hospice and palliative care services should therefore integrate this information into the health record, as appropriate.
Below is a Going Beyond Diagnosis® case scenario that helps illustrate the concepts described in Palmetto GBA's Draft Hospice Cardiopulmonary LCD - which began its notice period on January 25, 2008 and becomes effective Monday, March 17, 2008. The case scenario was described to illustrate the value of organizing clinical information using the ICF. Palmetto GBA is implementing ICF-based coverage policy and Web-based educational interventions ' each aimed at helping Medicare providers continuously improve their documentation and decision-making processes. To view this case scenario, select the hyperlink below.
Cardiopulmonary Case Scenario
You may access additional background information on Going Beyond Diagnosis® on the Palmetto GBA Web site by selecting the following link:
Going Beyond Diagnosis Series