Altruist Hospice, Inc.

“Based on record review and interview the agency’s Medical Director failed to complete and sign the certification of terminal illness in 3 of 5 patients whose records were reviewed. Citing Patient 2, Patient 3 and Patient 5. This failure could potentially subject patients to inadequate care that could result in poor outcomes and prevent timely funding for hospice care. Findings: Patient #2: Review of Patient #2’s Plan of Care revealed a start of care date of 7/27/2024 and a Certification Period of 7/27/2024 - 8/3/2024. Further review of the Plan of Care revealed a diagnosis of lung cancer. Further review of the Plan of Care revealed on page 3 of 4 a section titled, “Physician Certification Statement.” This section was blank and there was no physician signature or date. The Physician Certification Statement is the certification of the patient’s terminal illness. It is the attestation of a patient’s life expediency and helps determine the life expediency for hospice care as well as helping to establish enrollment for the Medicare/Medicaid hospice program. Patient #3: Review of Patient #3’s Plan of Care revealed a start of care date of 1/15/2025 and a Certification Period of 1/15/2025 - 1/21/2025. Further review of the Plan of Care revealed a diagnosis of colon cancer. Further review of the Plan of Care revealed on page 2 of 2 a section titled, “Physician Certification Statement. “This section was blank and there was no physician signature or date. The Physician Certification Statement is the certification of the patient’s terminal illness. It is the attestation of a patient’s life expediency and helps determine the life expediency for hospice care as well as helping to establish enrollment for the Medicare/Medicaid hospice program. Patient #5 Review of Patient #5’s Plan of Care revealed a start of care date of 8/16/2024 and a Certification Period of 11/14/2024 - 2/11/2025. Further review of the Plan of Care revealed a diagnosis of leukemia. Further review of the Plan of Care revealed on page 3 of 3 a section titled, “Physician Certification Statement.” This section was blank and there was no physician signature or date. The Physician Certification Statement is the certification of the patient’s terminal illness. It is the attestation of a patient’s life expediency and helps determine the life expediency for hospice care as well as helping to establish enrollment for the Medicare/Medicaid hospice program. A telephone interview was conducted with the agency’s Medical Director on 2/7/2025 at approximately 2:30 p.m. The surveyor inquired as to why the Certification of Terminal Illness had not been completed and signed on the Plans of Care for Patient #2, Patient #3 and Patient #5. The Medical Director stated “...It has been very difficult for me to sign the plans...I’ve been doing them outside the EMR then they can attach it. (The EMR) is a new system and working with it is difficult. ..” A telephone interview was conducted with the agency’s Administrator on 2/7/2025 at approximately 2:55 p.m. The surveyor inquired about the certifications not being done by the Medical Director. The Administrator stated that she did not know about it but maybe the Alternate Administrator knew about it. A telephone interview was conducted with the agency’s Alternate Administrator on 2/7/2025 at approximately 3:00 p.m. The surveyor inquired about the Medical Director not completing the certifications. The Alternate Administrator stated that the Medical Director had only emailed her one certification and that she would email it to the surveyor. The surveyor never received any emailed document by the end of the survey. Review of the agency’s policy titled “...PE.8 Certification/Recertification/Determination of Terminal Prognosis pages 1-2, JCC, dated 101215 Hospice...” Read, in part, “...Policy The agency will obtain written certification of a terminal illness. Procedure 3. Written certification will be obtained from the Medical Director...no later than 2 calendar days after the period begins...Note...If Agency is unable to obtain the written certification within 2 calendar days, it will obtain oral certification within 2 calendars days and written certification prior to submission of the claim...””

“Based on record review and interview the patient’s medical record did not contain physician’s certification or recertification of terminal illness in 3 of 5 patients whose records were reviewed. Citing Patient 2, Patient 3 and Patient 5. This failure could potentially subject patients to inadequate care that could result in poor outcomes and prevent timely funding for hospice care. Findings: Patient #2: Review of Patient #2’s Plan of Care revealed a start of care date of 7/27/2024 and a Certification Period of 7/27/2024 - 8/3/2024. Further review of the Plan of Care revealed a diagnosis of lung cancer. Further review of the Plan of Care revealed on page 3 of 4 a section titled, “Physician Certification Statement.” This section was blank and there was no physician signature or date. The Physician Certification Statement is the certification of the patient’s terminal illness. It is the attestation of a patient’s life expediency and helps determine the life expediency for hospice care as well as helping to establish enrollment for the Medicare/Medicaid hospice program. Patient #3: Review of Patient #3’s Plan of Care revealed a start of care date of 1/15/2025 and a Certification Period of 1/15/2025 - 1/21/2025. Further review of the Plan of Care revealed a diagnosis of colon cancer. Further review of the Plan of Care revealed on page 2 of 2 a section titled, “Physician Certification Statement.” This section was blank and there was no physician signature or date. The Physician Certification Statement is the certification of the patient’s terminal illness. It is the attestation of a patient’s life expediency and helps determine the life expediency for hospice care as well as helping to establish enrollment for the Medicare/Medicaid hospice program. Patient #5 Review of Patient #5’s Plan of Care revealed a start of care date of 8/16/2024 and a Certification Period of 11/14/2024 - 2/11/2025. Further review of the Plan of Care revealed a diagnosis of leukemia. Further review of the Plan of Care revealed on page 3 of 3 a section titled, “Physician Certification Statement.” This section was blank and there was no physician signature or date. The Physician Certification Statement is the certification of the patient’s terminal illness. It is the attestation of a patient’s life expediency and helps determine the life expediency for hospice care as well as helping to establish enrollment for the Medicare/Medicaid hospice program. A telephone interview was conducted with the agency’s Medical Director on 2/7/2025 at approximately 2:30 p.m. The surveyor inquired as to why the Certification of Terminal Illness had not been completed and signed on the Plans of Care for Patient #2, Patient #3 and Patient #5. The Medical Director stated “...It has been very difficult for me to sign the plans...I’ve been doing them outside the EMR then they can attach it. (The EMR) is a new system and working with it is difficult. ..” A telephone interview was conducted with the agency’s Administrator on 2/7/2025 at approximately 2:55 p.m. The surveyor inquired about the certifications not being done by the Medical Director. The Administrator stated that she did not know about it but maybe the Alternate Administrator knew about it. A telephone interview was conducted with the agency’s Alternate Administrator on 2/7/2025 at approximately 3:00 p.m. The surveyor inquired about the Medical Director not completing the certifications. The Alternate Administrator stated that the Medical Director had only emailed her one certification and that she would email it to the surveyor. The surveyor never received any emailed document by the end of the survey. Review of the agency’s policy titled “...PE.8 Certification/Recertification/Determination of Terminal Prognosis pages 1-2, JCC dated 101215 Hospice...” Read, in part, “...Policy The agency will obtain written certification of a terminal illness. Procedure 3. Written certification will be obtained from the Medical Director...no later than 2 calendar days after the period begins...Note...If Agency is unable to obtain the written certification within 2 calendar days, it will obtain oral certification within 2 calendars days and written certification prior to submission of the claim...””