C o m p a s s i o n a n d D i g n i t y E v e r y M o m e n t o f L i f e

Is It Time to
Reimagine Your IDG?
A conversation about possibilities
with Bob, Erin and Leanna
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Objectives
1.Identify regulations related to the IDG and
the importance of having the meeting
transcend these basic requirements
2.Develop an IDG format that focuses on
the patient experience for improved
patient outcomes
3.Apply group facilitation methods that
improve communication and foster the
interdisciplinary process
4.Learn how you can have your cake and
eat it too!
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The IDG

Haven’t we
done this
already?!
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The IDG
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IDG Regulations
Conditions of Participation:
418.54 – 418.56 – 418.76 – 418.106 – 418.116
Meeting or conference mentioned: NO

CHAP Standards (current):

HII.4f: The Interdisciplinary Team/Group reviews and updates
the plan of care at least every 15 days during IDT/IDG
conferences which include…

CHAP Standards (rolling out soon):

Meeting or conference mentioned: One mention that is not
referencing IDG regulations
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What are surveyors looking for?

Evidence (documentation) that all members of the IDG are
actively involved in the comprehensive and ongoing
assessments as well as the care planning process:
1. Demonstrate how information is exchanged among staff and
patient/caregiver
2. Be proactive in developing each patient’s plan of care
3. Documentation from the group that the
patient/representative is involved, understands and is in
agreement with their plan of care
4. Ensure each patient’s individualized plan of care is reviewed
and revised if needed no later than 15 days from the
previous review
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The Rise of the EHR

• Less clinical prep time
• Viewable chart information
• Streamline processes
• Could stifle creativity
• Potential to interfere with best practice
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Considerations in Improving
Team Function
• Facilitator vs Scribe
• Involve all disciplines
• Strive for consistency
• Allow enough time
• Offer debriefing outside of the IDG
• Team building
• Encourage Hugs
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Opportunitie
s
• Have your IDG be
your petri dish for
new ideas, new
approaches
• Nurture your
organization’s
cultures
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So you don’t end up like this…

Let’s Stretch

Pair Up and Share

- What is one takeaway -
What is one question?
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Hospice Philosophy of Care

End-of-life care should emphasize

quality of life

The object is to treat the whole

person, and not just the disease
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Guiding Ethical Principles

• Upholding high standards of ethical conduct
and advocating for the rights of patients and
their family caregivers

• The hospice respects and honors the

rights of each patient and family it serves

• The hospice assumes responsibility for ethical

decision-making and behavior related to the
provision of hospice care

https://eol.nhpco.org/file.php/848/2_-_NHPCO_STANDARDS_2010_-_EBR.pdf
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Hospice Patients Rights:

• The patient’s wishes are respected and taken
into consideration when planning for the
patients care and are documented in the
clinical record

• When the needs/goals of the patient

differ from those of their family, the
hospice ensures that the preferences of
the patient are met and work with the
family to gain acceptance of the patients
goals.
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Person vs. Patient Centered Care

Caring for Patient
Person Patients Centered
Centered And Their Circle
of Support Provided to
Provided to patients
patients when the
Person
independent Centered care focuses
of care for a Care
solely on a
particular particular
disease Caring for the Caring for disease
Community Staff
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Medical Model vs. Experience Model

Medical Model
Also known as the disease-focused model.
Occurs when IDG members are only
assessing, focusing on “fixing” problems.
Focus is on what providers feel is the best
course of action

Leads to Moral Distress in IDG members

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Medical Model vs. Experience Model

Experience Model
Occurs when IDG members are asking
“what is important” to both patient and
their circles of support. Focus is on what
patient feels is the best course of action

Reduces Moral Distress in IDG Members

Hospice & Palliative Care Insights (2002) – Suncoast Hospice
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One Simple Question:

• What is most important to you today?
• Being pain free
• Going sailing
• Having dogs visits me instead of
more people
• Being in control of “my” plan of care
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Experience Model

Facilitate a dialogue to help the patient

and family define their end-of-life values,
goals, and life closure wishes. These
become the overriding goals of the patient
and family care plan to direct our services.
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Experience Model
Assessments by IDG Team:
• Goals

• Self-determined life closer

• Minimize or eliminate hindrances

• What is most important to you today?

• Understand this will likely change

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Our Reimagined IDG

Strong
Facilitators
are key!

www.greenchameleon.com 2007
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In Conclusion

To re-imagine your IDG

• Review the Regulations
• Calculate the Costs
• Take the leap!
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How will you re-imagine your IDG?

• Bring forward the idea

• Be a champion in your
workplace
• Beta test
• Don’t give up
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How much is an effective IDG

“worth”?
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How much is an effective IDG

“worth”?
• I don’t know how things are going at your
hospice, but in this world of flat (or reduced)
reimbursement and ever increasing costs, a
positive margin is getting harder and harder
to come by.
• No reasonable discussion of IDG can be
taken out of context from the cost of having
all those clinicians sitting in a room instead
of seeing patients!
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How much is an effective IDG

“worth”?
• IDG can have great value. It is a time for
clinicians to learn, communicate, gain trust,
decompress – not through idle chit chat, but
through teamwork.
• Continuity of care can be facilitated by
creating an IDG environment where
everyone is “on the same page.”
 C o m p a s s i o n a n d D i g n i t y E v e r y M o m e n t o f L i f e

How much is an effective IDG

“worth”?
• It is much more efficient to communicate
when everyone is in the same room (vs
tracking MDs and teammates down on your
phone from the side of the road).
• For facilitators it is an efficient opportunity
to hear the challenges of field clinicians and
to stay in touch with the work we do.
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How much is an effective IDG

“worth”?
• Complex cases serve as efficient, ongoing
education for the staff (especially if you
have a gifted teacher in your medical
director).
• Discipline silos are broken down when
clinicians hear first hand what amazing
work their colleagues are doing – and get
a taste of their professionalism and
knowledge.
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How much is an effective IDG

“worth”?
• Sometimes the patient centered culture
requires repeated application to steward
staff along in their thinking, as well as
reducing moral distress
• Patient centered focus = Storytelling
(the killer of the efficient IDG meeting)
• This process has proved to be organic
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Who should be at the table?

• Everyone!
o MD, nurses, social workers, spiritual
counselors, aides, volunteers, therapists
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Who should be at the table?

• $$ (ouch)?
o The whole team provides the most
accurate picture of eligibility (may mean
longer lengths of stay with varying
perspectives of decline, or reduced
ADRs with more data to support
discharge)
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What size should your IDG be?

• Large enough to gain the efficiencies of
group communication and education, but
small enough that clinicians aren’t waiting
too long for others to discuss their patients
• Our IDGs are run by team
o We have 4 teams for 160 patients
o Geographically isolated areas are split
out
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What size should your IDG be?

• Three of our four teams run about 2.5 hours, the

fourth runs 1.25 hours.
• This equates to 125 staff hours per week, at a
total cost of $5,462 before benefits.
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What size should your IDG be?

• If we were to only have two teams, the
total number of hours in IDG stays the
same, but the total staff hours balloons to
201 hours, at a weekly cost of $8,224.
• This is due to increased waiting while all
the patients are being discussed.
• This is a difference of $2,762 per week, or
$143,638 annually.
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 C o m p a s s i o n a n d D i g n i t y E v e r y M o m e n t o f L i f e

What size should your IDG be?

• We have also speculated about having

IDG every two weeks (allowed by the
COPs). I estimated a time savings of 5%
by discussing short stays as deaths
instead of admits.
• Added savings would be more efficient
preparation by staff, less travel, less
impact on visit frequency.
 C o m p a s s i o n a n d D i g n i t y E v e r y M o m e n t o f L i f e

What size should your IDG be?

• The every other week model produced a

$17,348 savings annually.
• In the interest of patient care however,
some system would need to be in place
to discuss complex admissions in the
middle of that two week stretch.
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One other thought – remote access to

IDG – does it make sense?
• If the technology is adequate to support
good communication.
• We use Secure Video on the Zoom platform.
• You will need a good microphone and a good
camera.
• The facilitator can grant control to clinicians
in the field, enabling them to sign into the
meeting
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Is it worth it?

• For the weekly four team model, at

$5,500/wk ($284,000 annually), this
equates to about 5% of our entire labor
budget.
• There are no benchmarks for this figure
that I can find.
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Is it worth it?

• If we eliminated LPNs and aides, that

would save $26K, or 9%.
• If we shaved 1 hour off the meeting, that
would save another $100K, or another
35%.
• This would reduce IDG to 3% of our labor
budget.
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Is it worth it?

• Since I started 2020 is as grim

this slide as it has ever
presentation, been.
we have • Do I still think
entered the it’s worth it?
2020 budget
season. The
fiscal picture for
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Is it worth it?
• What is the cost of:
• An ADR?
• Increased audit scrutiny?
• Decreased employee engagement?
• Decreased education?
• Decreased interdisciplinary
interaction?
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Is it worth it?
• It is subjective of course, but at this point,
we find the benefit outweighs the cost.
• I can’t say that next year we won’t
change to every other week as an
intermediate compromise.
• I challenge you to run the numbers and
see for yourself!
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Faculty
Bob Laws, BS, RN
Executive Director
Blaws@hospicenw.org
Erin Long, BA, AD
Volunteer Services Manager
Elong@hospicenw.org
Leanna Anderson, MSW, LICSW, APHSW-C
Clinical Manager Counseling Services & Integrative
Therapies
LAnderson@hospicenw.org