In this Question of the Week, Tammy Stewart, Clinical Consultant, answers a question related to IDG Meetings.
Q: In looking at the IDG review of the plan of care and the IDG “meeting”, I have a couple of questions. Is an actual “all core disciplines in a meeting together to review the patient’s plan of care” the requirement?
We are looking at a spiritual counselor who would work later in the day (the IDG is always in the morning) and one of the concerns is that he would not be present to attend the IDG meeting – which has me digging into the regulations and wondering – is an actual “meeting” the requirement, or is the requirement collaboration, communication, review, and update?
A: A Chaplain/Spiritual Counselor must be in attendance to review and update the comprehensive assessment and POC at least every 15 days. Attendance may be conducted in person or remotely and their attendance must be documented. The regulatory language does not specifically include the terminology of a meeting, but it is required that all core IDG members attend the review/updates. If all 4 core members are not present during the IDG update, then it doesn’t meet regulations.
418.54(d) Standard: Update of the comprehensive assessment
The update of the comprehensive assessment must be accomplished by the hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) and must consider changes that have taken place since the initial assessment. It must include information on the patient’s progress toward desired outcomes, as well as a reassessment of the patient’s response to care. The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days.
Interpretive Guidelines §418.54(d)
Hospices are free to choose their own method for documenting updates to the assessment. The hospice should evaluate and document the patient’s response to the care, treatment and services provided, and progress toward desired outcomes. The purpose of updating the assessment is to ensure that the hospice IDG has the most recent accurate information about the patient/family in order to make accurate care planning decisions. Assessment updates should be easily identified in the clinical record.
418.56(a)(1) The interdisciplinary group must include, but is not limited to, individuals who are qualified and competent to practice in the following professional roles:
(i) A doctor of medicine or osteopathy (who is an employee or under contract with the hospice).
i. (ii) A registered nurse.
ii. (iii) A social worker, marriage and family therapist, or a mental health counselor.
iii. (iv) A pastoral or other counselor.
418.56(d) Standard: Review of the plan of care
The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) must review, revise and document the individualized plan as frequently as the patient’s condition requires, but no less frequently than every 15 calendar days.
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