Hospice Patients Don’t Need to Revoke Medicare Hospice Benefit if They Visit ED

The 78-year-old gentleman you are treating again for episodes of acute heart failure tells you he was recently admitted to hospice. If the patient needs hospitalization, you ask your staff, how is this handled?

They tell you all hospice patients seen in the ED must revoke their hospice benefit. This troubles you. Whether or not your patient is hospitalized, he will need to be re-admitted to hospice to get follow-up care at home.

Although this happens all the time, there is a better way: A hospice patient receiving symptom management in the ED does not need to revoke, something you as his physician can help him understand.

The Medicare Hospice Benefit belongs to the patient, who voluntarily signs up for hospice with the understanding that he will receive palliative care in lieu of curative care for his terminal illness. The patient must revoke the benefit if he decides to receive curative care.

However, symptom management, like the care received in the ED for an episode of acute heart failure, is not considered curative care. It is covered under the Medicare Hospice Benefit, as is ambulance delivery and even hospital admission into a contracted hospice bed. The hospice may not be aware that their patient is in the ED for care management, but once informed, the hospice must pay for any palliative services that address the terminal diagnosis.

Hospices contract with hospitals for general inpatient beds or hospice units. Under Medicare policy, admission to such a bed is not a readmission; it is considered a transitional bed to manage acute symptoms and improve ED throughput—and it is paid for by the hospice. Only when there is no contractual agreement or when the patient revokes his hospice benefit is the care billed to the patient or the patient’s insurer. Revocations are not retroactive; any care provided prior to revocation is paid by the hospice.

Your ED patient should not revoke his benefit. Ideally, he will stay on hospice service and be returned home without being admitted, or be admitted to a GIP bed or inpatient hospice unit if the hospice has such an agreement.