Every finding on record at Health at Home Hospice Columbus, LLC

Based on record review and interview, the agency failed to ensure volunteers provided a minimum of five percent of the total care hours of all paid hospice employees and contract staff. This had the potential to affect all 21 patients served by the agency. Findings include: --- Review of the report titled "2023 Volunteer Monthly Hours Report" revealed 1.3 percent cost savings for volunteers for the year with the highest month at 3.3 percent of cost saving in 2023. Review of the report titled "2024 Volunteer Monthly Hours Report" revealed the highest month was 2.1 percent of cost saving so far in 2024. During an interview on 05/08/24 at 12:35 PM, Staff C stated that they had been struggling to get the cost savings numbers for volunteers up. They have not hit the five percent cost savings requirement in the last year.

Based on medical record review, staff interview, and policy review, the agency failed to designate an interdisciplinary group or groups which, in consultation with the patient's attending physician, must prepare a written plan of care for four of five medical records reviewed (Patient #1, #3, #4, #5). The agency census was 57. Findings include: Review of agency policy titled, Interdisciplinary Group (IDG) Membership and Responsibilities, revised 11/21, revealed the hospice interdisciplinary group (IDG) collaborates with the patient's attending physician to develop and maintain a patient-directed, individualized plan of care. If the agency has more than one interdisciplinary group, it must designate, in advance, the group responsible for program oversight and the establishment of policies that govern the day-to-day provision of hospice care and services. 1). Review of the Interdisciplinary Comprehensive Assessment and Plan of Care Report for Patient #1 dated 03/03/22, 03/17/22, 03/23/22, 04/07/22, and 04/21/22 lacked evidence of a physician signature. 2). Review of the Interdisciplinary Comprehensive Assessment and Plan of Care Report for Patient #3 dated 03/03/22 lacked evidence of a physician signature. 3). Review of the Interdisciplinary Comprehensive Assessment and Plan of Care Report for Patient #4 dated 03/03/22, 03/17/22, 03/23/22, and 04/07/22 lacked evidence of a physician signature. 4). Review of the Interdisciplinary Comprehensive Assessment and Plan of Care Report for Patient #5 dated 02/03/22, 02/17/22, 03/03/22, 03/17/22, 03/23/22, and 04/07/22 lacked evidence of a physician signature. Staff E confirmed the above findings on 04/26/22 at 9:09 AM in an interview during the electronic medical records review. This deficiency substantiates Substantial Allegation OH00131239.

Based on medical record, staff interview, and policy review, the agency failed to ensure the medical director or physician designee reviews the clinical information for each hospice patient and provides written certification that it is anticipated that the patient's life expectancy is six months or less if the illness runs its normal course for three of five medical records reviewed (Patient #1, #4, #5). The agency census was 57. Findings include: Review of the policy titled, Certification of Terminal Illness, revised 04/01/22, revealed the purpose is to ensure physician certification of terminal illness and authorization of hospice services in accordance with applicable state and federal regulations and payor requirements. In order to meet eligibility criteria for the Medicare or Medicaid hospice benefit, a patient must be certified as terminally ill, meaning that the patient has a medical prognosis that their life expectancy is six (6) months or less if the illness runs its normal course. The initial certification of terminal illness must be completed by the Medical Director of the hospice (or other physician member of the hospice Interdisciplinary Group) and the patient attending physician, if the patient has chosen to have an attending physician. If a patient has chosen a nurse practitioner or physician assistant as an attending physician, the hospice Medical Director or physician member of the hospice IDG certifies the patient as terminally ill. 1). Review of the medical record for Patient #1 noted a verbal order for the certification of terminal illness dated 02/17/22 which lacked a physician signature to date. 2). Review of the medical record for Patient #4 noted a verbal order for the certification of terminal illness dated 02/14/22 which lacked a physician signature to date. 3). Review of the medical record for Patient #5 noted a verbal order for the certification of terminal illness dated 01/21/22 which was not signed by a physician until 04/18/22. An interview was conducted with Staff A on 04/26/22 at 1:58 PM who reported the agency transitioned the electronic medical records system on 02/01/22 and there were glitches in the system for the physician to electronically sign. The agency was currently working on getting caught up on the backlog of documents requiring a physician signature. This deficiency substantiates Substantial Allegation OH00131239.