What we write in the chart will have a direct impact on the DRG
applied to that episode of care, which will in turn affect the expected
length of stay. In addition, the more accurately we reflect the
patient's true condition - including all the patient diagnoses and
comorbidities - the higher the patient's expected mortality will be.
Accurate chart documentation is not gaming the system. It is an
essential piece of the system itself.
As far as ethics goes, intent
plays an important role. The medical literature already suggests that we
enroll patients into hospice too late. If the intent is to identify
hospice-appropriate patients early and to otherwise provide them with
the benefits of hospice longer by early enrollment, I think that is
fine. However, if the intent is to increase your exclusion pool by
recruiting questionable hospice patients and manipulating them into
enrolling into hospice - well then, that sort of speaks for itself,
doesn't it?
Franklin A. Michota, M.D., is the director of
academic affairs in the department of hospital medicine at the Cleveland
Clinic. He reported no relevant conflicts of interest.
