Regulatory Center
Addendum of Election of Benefits Statements - Impact
According to Catherine Dehlin, RN, BSN, CHPN, CHCM, COQS of Fazzi Associates, the addendum of election of benefits will place a significant operational burden on hospices that will require the addition and updates of policies and procedures that include the following:
• Make the changes to the Notice of Election (NOE) as required by CMS.
• Provide extensive training to staff to ensure understanding of the changes.
• Coordinate with their electronic health record (EHR) vendor to ensure the addendum can be integrated into the system.
The sooner hospices develop the addendum, make changes to the policies and procedures, collaborate with their EHR vendor to integrate the addendum into the system the sooner staff training can begin. Comprehensive training of staff about the implementation and use of the addendum will be the most time consuming yet essential aspect of ensuring the smooth transition to the use of the new NOE on October 1, 2020.
Wise Services
Education for 2020
On March 24, 2020 we will be offering the class “Alternate Routes of Drug Administration” at 10:30am Central Time. The class will be 60 minutes and will be online via our RingCentral platform. Registration may be coordinated through your education coordinator or by emailing David Bougher at dbougher@wiseop.com directly.
Class Objectives:
- List the alternate routes of drug administration most commonly used for hospice patients.
- Discuss the advantages/disadvantages to the use of each route.
- Recognize the challenges each method of administration poses to care givers.
- Incorporate the information learned in this presentation to enhance current practice
Client Service Metrics
Inbound Call Statistics
Data taken from Jan 1st – February 11th 2020
For your consideration
Cost Increase : Ondansetron/Zofran
Since many of our hospices use ondansetron/Zofran in their E-Kits we wanted to make you aware that price has been increasing since October 2019. At this point we do not know if this trend will continue but we will continue to monitor. The increase has occurred in both the tablet form and the orally disintegrating (ODT) form. The approximate prices range from $3.80/4mg tablet to $6.30/8mg ODT. The cost of ondansetron still remains less than the antiemetic suppositories; prochlorperazine/Compazine ($12.50/supp) or promethazine/Phenergan ($9.00/supp). Whenever you need to get a price for a medication you can always call our clinical consultation line (800-856-9757 ext #8) 24 hours/day.
Delirium - Under Recognized, Under Treated
Wise Hospice Options is developing a class that specifically looks at the diagnosis, prevention and treatment of delirium.
Why is delirium under recognized? Neglecting the baseline mental status assessment and not recognizing the risk factors: hypoactive delirium (70% of all delirium), age > than 80, sensory impairment, dehydration, global brain injury, organ failure, psychoactive medications, dementia. Clinicians should distinguish between delirium and other conditions such as dementia, depression, psychosis, opioid induced neurotoxicity and serotonin syndrome.
Delirium is characterized by an acute change in mental status and has an underlying physiologic cause. The cause(s) is usually reversible. Signs and symptoms are extensive and include rapid onset (minutes to days), agitation, altered level of consciousness, confusion, delusion, disinhibition, disorganized thinking, hallucination, inattention, irritability, labile affect and psychosis.
Delirium is often preventable and, if it occurs, may be reversible.
- Environmental management, including reduction of medication burden and attention to withdrawal, is foundational to prevention. Appropriate deprescribing.
- Routine use of a screening tool for high risk patients (over 65, dementia, renal/hepatic dysfunction, on multiple psychoactive medications, infected, severely ill) ensures early detection.
- Once detected, identify and attempt to reverse the underlying cause; consider clysis in appropriate cases.
- Pharmacologic management is a last resort for dangerously combative patients and those in the final hours of life.
- Palliative sedation may be appropriate for irreversible EOL delirium.
The above is a very brief overview of delirium. Stay tuned to this newsletter for updates on the development of this important class.
To request information regarding references for further information on the recognition, treatment and prevention of delirium contact David Bougher at dbougher@wiseop.com.
In Case You Were Wondering
Have you heard the terms “biologics” and “biosimilars” in reference to medications and wondered what they were? What are the differences between the two of them? How they compare to “generics”? Read on for a brief overview.
Generic drugs are copies of brand-name drugs that have the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. The FDA requires that generic drugs be as safe and effective as brand-name drugs. Generic medications came on the market in 1985 to expand patient access to medications and to encourage competitive pricing.
Biologic drugs are large, complex proteins made from living cells through highly complex manufacturing processes. Biologics include recombinant proteins, tissues, genes, allergens, cells, blood components, blood, and vaccines. The rheumatoid/psoriatic arthritis drugs (Humira- $8200/month and Enbrel-$7000/month) currently being advertised on television are examples of biologics.
Biosimilar drugs (sometimes referred to as “biogenerics”) are brand name products that are highly similar to an already existing brand name, original biologic, but unlike generic drugs, are not identical. Example of biosimilars, to Humiria, are AMJEVITA and Cyltezo, which have been FDA approved but are not available in pharmacies yet. Hyrimoz is the third Humira biosimilar but is waiting for FDA approval.
Biologic and biosimilar drugs are used to treat patients with cancer, renal disease and autoimmune diseases. According to the RAND Corporation, the use of biosimilar drugs will result in health care savings in the billions of dollars over the next 10 years.
Update
Newsletter Distribution Dates 2020
March 10th
April 14th
May 12th
June 9th
July 14th
August 11th
September 8th
October 13th
November 14th
December 8th
If you know of someone within your organization who would like to receive this newsletter please send your colleague’s name and email address to John Hilterman (jhilterman@wiseop.com) or David Bougher (dbougher@wiseop.com).
Updated
Drug Shortage List
These shortages are due either from manufacturing delays or shortage of raw ingredients. This is not an inclusive list, but the listed drugs may be used for hospice patients, especially in the inpatient setting. For a complete list of drugs on shortage follow this link:
https://www.drugs.com/drug-shortages/
NOTE: Any items marked with a pill icon are new from the previous month’s newsletter
To close click the X in the top right hand corner.
About the Author
David Bougher
Senior VP of Regulatory Affairs
David is a seasoned veteran of the hospice world and an essential member of the Wise Hospice Options clinical team.
Education:
RN, BSN
Experience:
- Former hospice COO
- 20 Years of education & training experience
- 10 Years of experience at Wise Hospice Options
Connect
- (800) 856-9757 Ext: 203
- dbougher@wiseop.com
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Wise Clinical Leadership
Deanna Rice
Vice President
Clinical Services
drice@wiseop.com
(800) 856-9757:
EXT. 216
Tino Vilches
Senior Vice President
Clinical Services
tvilches@wiseop.com
(800) 856-9757:
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Available
Wise Hospice Options Services
Please reach out to your account manager for assistance with maximizing your available services, or for potential upgrades to your current system.
EHR Interface Integrations
Demographic & medication interfaces with over 11 EHR's.
E-Prescribing
Web-based prescribing platform for Schedule II's.
24/7 Support
On-demand clinical or technical assistance fast.
EHR Medication Profiling
Med reviews done inside your EHR system.
Advanced Reporting
Drill down into your pharmacy utilization trends.
Clinical Education
Hospice oreiented courses designed for your hospice staff.
Pharmacy Network Access
Unrestricted access to every pharmacy within our network.
Web-based Refills
Send and identify available refills for your patient population.
