Oregon Hospice and Palliative Care Association September 25, 2018 Incorporating Palliative Care into your Hospice Organization Oregon Hospice and Palliative Care Association September 25, 2018 Presented By: Leslie Foren, MBA Palliative Care Provider & Consumer Outreach © 2018 Regence BlueCross BlueShield of Oregon, all rights reserved. Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association

Presentation Objectives: Working knowledge of the key components of Advance Care Planning (ACP) conversations. How to initiate the conversation, follow up and document goals of care. Learn key essentials to establishing effective hospice/palliative care provider – payer partnerships. Have a clear understanding and clarification on when and how to bill for palliative care services using “incident-to” professional services. © 2018 Regence BlueCross BlueShield of Oregon, all rights reserved

Key Components of Good Communication The Four Habits Model – Physician's Communication Tool Invest in the Beginning: Create rapport, Draw out patient concerns, Plan the conversation (even brief ones). Elicit the Patient’s Perspective: Ask for the patient’s ideas, Elicit specific requests, Explore the impact on the patient’s life. Demonstrate Empathy: Be open to patient and family emotions, Make at least one empathic statement, Convey empathy nonverbally, Be aware of your own reactions. Invest in the End: Deliver information, Provide education, Involve the patient in making decisions (and family if appropriate). Source: The Permanente Medical Group, Inc. Physician Education and Development © 2018 Regence BlueShield, all rights reserved. Private and confidential.

Key Components of ACP Conversations Establish the patient’s awareness of their medical condition “What is your understanding of what’s going on?”, or “What have they told you is the problem?” Establish goals “What’s the most important thing to you right now?” Determine support “Who do you turn to in times like these?” Connect the dots “Who should I check with or send records to for you?” © 2018 Regence BlueShield, all rights reserved. Private and confidential.

Key Essentials to Working with your Payer Communication Connecting with provider representative, consultants and contractors Understanding necessary requirements Licensing / Contracting / Credentialing Coming forward with a clear definition and realistic expectations about proposed pilot projects Defining your service, know what it costs and how to scale and share performance guarantees or standards Understanding of each others process and timelines Claims runout and data sharing Patience! © 2018 Regence BlueShield, all rights reserved. Private and confidential.

Palliative Care Reimbursement Medicare Advance Care Planning CPT codes Part A – Nursing, social work and spiritual visits Part B – some services and supplies to treat disease Medicaid Some treatments and medications, physician visits Private insurance/HMO’s/Managed Care Palliative care benefits – may be included in Disease Management, Care Management or Hospice programs © 2018 Regence BlueShield, all rights reserved. Private and confidential.

Incident To Billing Overview   Incident To Billing Overview APRN Incident To Billing Overview APRN Services are billed under physician’s NPI number. Performs health services under direct supervision. Must be an employee or independent contractor of a physician group if service is performed in a satellite office. Physician Initiates course of treatment and care plan for each new problem. Provides subsequent treatment. Must be physically present. Must initiate new course of treatment and care plan if a new problem arises. The Three Locations Incident To Billing IS allowed Office Patient’s home Office within an SNF Eligibility – patient Must be non-hospice (includes Medicare Hospice Benefit recipient) Incident To Billing NOT allowed Under Medicare Hospice Benefit In inpatient setting for Medicare patients When visits occur outside an office, home or SNF office OR for a hospice patient If the service occurs in a satellite office where no physician is present Services under Incident To Billing Transfer of Service Consultation/Initial Evaluation Subsequent Visits © 2018 Regence BlueShield, all rights reserved. Private and confidential.

Resources & Education The California State University free tool “The Ensuring Success Checklist” - https://csupalliativecare.org/organizations/roadmap/ensuring-success-checklist/ Center to Advance Palliative Care (CAPC) – www.capc.org Center for Medicare & Medicaid Services Incident To Billing information - https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/downloads/se0441.pdf © 2018 Regence BlueCross BlueShield of Oregon, all rights reserved.

Questions & Discussion Contact Information: Leslie Foren, MBA Palliative Care Provider & Consumer Outreach Leslie.foren@regence.com © 2018 Regence BlueCross BlueShield of Oregon, all rights reserved.