Service Intensity Add-On: Why Your Hospice Is Missing It & How To Fix It

Nena Hart Author

Remember SIA? It's not just about extra reimbursement. Effective end-of-life care processes are crucial for achieving excellence.

The Service Intensity Add-On payment coincides with the quality measure for visits in the last days of life. To capture the extra Service Intensity Add-On Payments, it is critical that the hospice team have effective communication, processes, and a high level of collaboration.

Leaders at the hospice will need to fully understand the value of the service intensity add-on and how they can consistently capture it. Nurses and Social workers need a working knowledge of SIA and manageable caseloads with realistic productivity expectations to spend extra time with patients at end of life.

Why Does It Matter?

SIA is based on direct time spent in the last 7 days with the RN or SW. More direct care at the end of life benefits every patient and family. Here are a few of the obvious benefits of effectively utilizing these visits. https://pubmed.ncbi.nlm.nih.gov/28622481/

1. Reduce unplanned hospitalizations and revocations

2. Minimize after-hours calls due to unexpected changes in condition

3. Higher quality of care and symptom management at end of life

4. Improved CHAPS satisfaction surveys and family confidence in care delivery

5. Higher facilitation of the plan of care at end of life

Hospice Visit Patterns in the Last Seven Days of Life and the Service Intensity Add-On Payment

How Does It Work?

The Service Intensity Add On (SIA) adds billable units for direct care provided in 15-minute increments in the last 7 days of life for visits from the Registered Nurse and Social Worker at the Continuous Home Care rate in addition to the routine home care reimbursement rate. There are 16 possible units to capture and up to 4 hours per day. (See §418.302)

Why it’s still getting missed by many hospices:

1. Staffing challenges, caseloads are high or there is insufficient accountability from office leadership

2. Scheduling issues, frequencies aren’t changed - no established process in place or visit frequencies are inadequate to capture decline effectively

3. Communication between field and office breaks down and does not occur

4. New or unfamiliar staff covering visits don’t know the patient's baseline and signs of decline and changes in condition are missed

How to course correct:

1. Reinforce education with nurses and social workers on the importance of visits in the last 7 days to the quality of care and the operations of the hospice.

2. Establish expectations with weekend staff that visits are required for patients with a decline.

3. Clinical and operational leadership need to provide education and accountability for field staff and office clinicians who manage the scheduling

4. Have an intentional time at least daily when the office and the field connect on patient status changes

5. Create a communication standard to provide family education on how and why visit frequencies will change when the decline occurs

6. Ensure the IDT and plan of care are updated

7. Create space in caseloads for nurses and social workers to spend additional time on direct care in the last 7 days

8. If your hospice has productivity guidelines for social workers and nurses, consider how these visits are weighted and if they require a specific visit type

9. Make sure to review in your QAPI meeting! All quality indicators and other measures related to changes in condition, and visits at end of life including the number of RN and SW visits in the last 7 days

What has been your biggest challenge in capturing SIA?

If you aren't capturing SIA and you need help providing education and establishing processes reach out to me about how I can help at [email protected]

Categories: Operational Excellence