Ten Hospice Basics Doctors Should Know

A patient eligible for the Medicare hospice benefit:

• Has Medicare Part A
• Is considered by two physicians to be within six months of death if the disease follows its normal course
• Has chosen to focus medical care on comfort, forgoing curative therapies

Reimbursement is per-diem for any of four levels of care. Payment covers the personal services of a licensed nurse, hospice aide, social worker and chaplain. It also includes all supplies and medications for comfort and treatment of the hospice diagnosis, durable medical equipment such as a hospital bed, oxygen or a wheelchair, and ancillary services, for example a dietician, if needed.

The referring physician may be the attending physician or another specialist, such as a hospitalist, who estimates that the patient’s prognosis is appropriately limited and who discussed the referral with the patient.

If a doctor would not be surprised to learn that a particular patient died in the next year, it would be appropriate to consider a hospice referral for that patient. Hospice eligibility depends on a prognosis of six months or less if the disease runs its natural or expected course.

The hospice team is made up of a physician, licensed nurse, hospice aide, master’s-level social worker, spiritual and bereavement counselors, volunteer and additional specialists, such as a dietician, as needed.

Medicare requires that for a minimum of 13 months following the patient’s death, members of the hospice staff keep in contact with the bereaved and provide or refer to professional counseling those whose grief seems unusually severe or unremitting.

Some hospices have the expertise to care for children who have severe developmental disabilities, cancer or, occasionally, untreatable conditions.

A nurse practitioner may serve as an attending for Medicare purposes, but is not able to certify a patient’s limited prognosis.

Recognizing when death is close and helping prepare the patient and loved ones for it physically, emotionally and spiritually are among the most rewarding aspects of hospice care. Preparations are taken to ensure dignity, comfort and care as it becomes evident that a patient is nearing death.

Yes. Most cost/benefit analyses favor either traditional care or hospice care by a small margin. Thus, at this point, hospice is generally considered revenue neutral.