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Definition and Benefits

 

According to the NHPCO Clinical Practice Guidelines for Quality Palliative Care, 4th Edition (2018), hospice is defined as a specific type of palliative care for individuals with life expectancy measured in months, not years; care is focused on comfort, not cure.  Hospice care also includes those “not benefiting from curative or life-prolonging treatment and those that do not wish to continue treatment” (Center to Advance Palliative Care, 2019).

 

Benefits of hospice include in-home nurse visits to eliminate trips to the doctor’s office.  The nurse then relays the information to the hospice physician.  On call 24/7 help is available.  Assistance with personal care tasks such as bathing can also be available and may occur up to 3x per week.  Hospice can also provide support to families and caregivers of the patient, and counseling for end-of-life concerns as well as bereavement support after death for up to 13 months.  Services may also include respite care for up to 5 days at a time.  Should a patient have the opportunity to travel, the agency can arrange for services while away.  A patient can opt out of hospice care at any time.

 

Eligibility, Duration and Location

 

Eligibility for hospice services requires certification by two physicians that the patient has less than 6 months to live if the disease follows its normal course (Turn-Key Health, 2018). (The Center for Medicare Services states that in some states, this period may be 12 months.) Recertification of eligibility for services must occur every 6 months.  Mehta et al (2012) states that hospice is underutilized in advanced dementia. The author supports this claim by stating that in 2009, only 7-11% of hospice patients enrolled had dementia as their primary diagnosis.  NHPCO guidelines for qualification for hospice require a FAST score of 7c or greater as well as difficulties with ADL including intermittent or constant bladder or bowel incontinence.  (See the section on Clinical Staging Scales.)

 

The plan of care is determined by the hospice agency and the attending physician.   Services not deemed beneficial by the hospice team are not offered to the patient.  Even if services are offered, the individual may not qualify. All services must be ordered by the hospice team.  The same providers are included as on a PC team with the addition of bereavement counselors. 

 

Hospice services may be provided at home or at a residential facility or, in some cases, residential hospices.  Hospice can cover services including therapies while an individual is in a nursing home or other residential facility when such services pertain to the hospice diagnosis.  It does not, however, pay for room and board. 

 

Payment

 

A hospice agency must be certified by Medicare for patient fees to be covered.  When a patient enrolls in the Medicare Hospice Benefit (MHB) program with CMS, direct care is then planned and provided by the Medicare-certified hospice agency and the patient is not billed.  When electing MHB, Medicare Part A (hospital insurance) is signed off.  One or the other type

 of coverage must be elected at a time.  Care not related to the terminal illness or related condition(s) is not covered by hospice and must be paid through original Medicare.  Medicare will not pay for services that are not set up by the hospice medical team.  An example of how this works follows.

 

Mrs. T has an inoperable cancerous tumor and is on hospice.  She develops an illness unrelated to her cancer.  The hospice team decides she needs to be hospitalized for the illness.  She will be dismissed from hospice services under MHB when she is admitted to the hospital and readmitted to hospice upon discharge. 

 

Under MHB, the hospice agency receives a per diem rate for costs incurred by the patient.  These costs include prescriptions (usually covered at 100% but the patient may need to pay a copayment of no more than $5 per drug), equipment, nursing, social services, chaplain visits, and all other services deemed appropriate by the hospice agency.  Equipment can include use of a hospital bed, wheelchair, oxygen devices and other supplies including gloves and incontinence necessities.  Hospice approved inpatient respite care, up to 5 days at a time (and usually once per year or “on an occasional basis” per MHB) may require a patient payment of 5% of the Medicare approved amount for such care (NHPCO, 2018). 

 

Sources:

NHPCO Clinical Practice Guidelines for Quality Palliative Care, 4th Edition (2018) from the Center to Advance Palliative Care, 2019.

 

Mehta Z, Giorgini K, Ellison N, Roth ME.  Integrating palliative medicine with dementia care.  Aging Well, 2012;5(2):18.

 

Palliative care and hospice:  Understanding the differences part 1.  Turn Key Health, 2018.  Retrieved May 8, 2018 from https://turn-keyhealth.com/understanding-the-differences-of-palliative-care-and-hospice.