Hospice care focuses on quality of life for people diagnosed with terminal illnesses by providing them with superior pain and symptom management and professional support for their families.
When is hospice care right for my patient?
To be eligible for hospice care, your patient must have a life expectancy of six months or less if the disease runs its natural course. When curative treatment is no longer effective for your patient’s terminal illness or isn’t adding to quality of life, hospice care is an option.
There are guidelines and scales that help determine a patient’s current clinical status and anticipated disease progression that most likely will result in a life expectancy of six months: the CMS-issued hospice eligibility guidelines, Local Coverage Determination (LCD); FAST Scale; Palliative Performance Scale; and Karnofsky Performance Status.
Will I still be involved if I refer my patient to hospice?
Yes, attending physicians are encouraged to continue their relationships with their patients. You’re an integral part of your patient’s care team that includes The Washington Home & Community Hospices’ Medical Director and professional staff (RN’s, social workers, certified nursing assistants, chaplains and trained volunteers). You’re consulted about your patient’s care and pain/symptom management and kept updated on your patient’s status.
Am I reimbursed for my continuing services while my patient’s receiving hospice care?
Yes, as the attending physician of a hospice patient, you can be reimbursed for your patient visits under Medicare Part B as well as for the documented time you spend on Plan of Care oversight. The finance manager can help your staff prepare Medicare reimbursement claims.
What if my patient needs more care than s/he can get at home?
Your patient is admitted to hospice care at one of the following levels depending on your patient’s needs:
Routine Home Care – they come to where your patient is and control pain and symptoms with medications, medical equipment and visits from our Registered Nurses. Staff visit as often as they and you – the primary care doctor - determine your patient should be seen. A hospice nurse is available 24/7.
Inpatient Care – They care for your patient in one of our nearby partnering inpatient facilities, if her/his pain and symptoms can’t be managed well at home. Inpatient hospice care provides 24/7 on-site RN’s and aides, working with our team. Their goal is to get pain and symptoms under control so that your patient can return home.
Continuous Nursing Care – They come to your patient’s home when her/his pain and symptoms can’t be managed well there but s/he doesn’t want to go to an inpatient unit. An RN and an aide provide coordinated coverage for at least eight (8) hours daily for a brief period of time. This care is provided under most insurance plans.
Respite Care – if requested, a contract with a facility may be available where your patient stays for up to five (5) nights while her/his caregiver gets some much-needed time and rest. Then your patient returns to routine hospice care at home.
How do I talk about hospice with my patient and the family?
Most patients with terminal illnesses depend on their physicians to initiate discussions about their healthcare status and options but navigating end-of-life conversations is difficult for most physicians whose focus is on sustaining life.
A resource on this is Dr. Richard B. Balaban’s excellent article, “A Physician’s Guide to Talking About End-of-Life Care” (Journal of General Internal Medicine), provides a four-step approach to addressing end-of-life issues with useful scripts from faculty clinicians experienced in the care of dying patients.
For example, Step 1 Initiating Discussions, suggests dialogue that creates a caring connection by recognizing the stresses that serious illness creates for your patient and family:
“I know this is a very difficult time for you and your family.
You have never been this sick before, and I know that it
must be frightening to you. I want you to know that as
bad as it is, we will deal with it together.”