Hospice Basics
March 16, 2017

Ten Hospice Basics Doctors Should Know

 Doctor showing woman information on clipboard

  1. Who is eligible for the Medicare hospice benefit?
  2. 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
  3. How is the hospice paid?
  4. 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.

  5. How are physicians involved in hospice care?
  6. 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.

  7. How is prognosis determined for the purpose of hospice eligibility?
  8. 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.

  9. Who provides the direct hospice care?
  10. 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.

  11. How is bereavement addressed?
  12. 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.

  13. Do hospice organizations care for children?
  14. Some hospices have the expertise to care for children who have severe developmental disabilities, cancer or, occasionally, untreatable conditions.

  15. Where do nurse practitioners fit in?
  16. A nurse practitioner may serve as an attending for Medicare purposes, but is not able to certify a patient’s limited prognosis.

  17. Are there special issues in palliative care as death approaches?
  18. 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.

  19. Is the Medicare hospice benefit revenue neutral?
  20. 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.


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