Unity Hospice®

Some Physician options for speaking with patients...

Considering  A Hospice Referral?

If your patient is facing a terminal diagnosis, you can next evaluate the patient's specific needs.  An affirmative response to one or more of the following questions would properly trigger a call to a hospice representative:

1.  Do the patient and family understand the seriousness of his or her prognosis.
2.  Are the goals of care changing, along with the treatments?  For example, if a patient's lung cancer is recurrent and life-prolonging therapies are no longer effective, would the patient prefer to spend more time at home with family and friends, pursuing activities while strong enough to enjoy them?
3. Are advanced care planning instruments in place and up to date?
4.  Are pain management and comfort needs being addressed?
5.  Is the home setting --- or nursing home --- conducive to good care for the patient?
6.  Do grief issues need to be examined?
7.  Does the family need a plan for additional support such as volunteers and homemakers as the illness evolves?

Medicare has developed specific guidelines to assist in determining prognosis.   But these guidelines should be used in conjunction with your judgment as the patient's physician.   In general, patients will qualify for hospice benefits under Medicare as long as they have had a recent decline in function and require assistance with ADLs or show reduced food intake without artificial feeding tube support.

The topics below may be of additional assistance.  

What Hospice Can Do For Your Patients?

When your patient’s illness has advanced to the point that curative treatments are no longer effective, hospice care gives you, your patient and the family another option.  Hospice services do not replace your care – they supplement and enhance your relationship with a patient.  Unity Hospice offers an array of services, including pain and symptom management, assistance with personal care, feeding and light housekeeping, medical supplies, equipment and medication, bereavement counseling, professional social work, emotional support and spiritual counseling.  Unity Hospice’s medical director will consult with you as the attending physician to develop a plan of care that will build on your knowledge of an individual’s situation .  These services are primarily provided in the patient’s home, and also in nursing homes or hospitals as needed.

When to Refer Patients to Hospice:

There is no one moment when a patient’s condition suddenly makes him or her hospice-appropriate.  The course of an illness can be quick or gradual, and both physician and patient need to understand the reasons behind a referral to hospice.

Cancer is certainly the most common illness referred to hospice, but by no means the only one.  In general, hospice-appropriate patients meet the following criteria:

*Patient and/or family realize the condition is terminal
*Patient and/or family have decided to pursue  palliative rather than curative   
  treatment
*Patient shows documented clinical progression of disease, declining functional
  status, or impaired nutritional status related to the terminal process.

Specific Medicare guidelines indicate when patients with various illnesses may be seen as hospice-appropriate.  These guidelines cover heart, pulmonary, liver and renal disease, dementia, HIV/AIDS, stroke and coma, and ALS. 

How to Talk About Hospice:

Most patients suffering a fatal illness have indicated that they want a realistic estimate of their remaining time.  Without undue bluntness or technical details, you can provide general estimates of how long a patient can expect to survive, and how their condition will progress.  Use several scenarios and general estimates of progress , such as weeks, months, years. 

Bringing up the hospice option is a way to address any fears or concerns of patients and their families.  Many terminally-ill people fear pain, helplessness and abandonment – you can describe how hospice specialists address these concerns.  Family members may feel inadequate to care for a dying loved one’s needs, or may agonize about the amount of time caregiving requires.  All these feelings are typical of hospice families, and Unity Hospice care team members excel in providing information, comfort and assistance.

Make sure your patient knows that you will continue to see them, and that you will help determine the best care possible.  By demonstrating how you will work in partnership with hospice, you can reassure both patient and family that moving into a palliative treatment plan can be a positive step.    

Why You Remain Part of the Care Team:

Once you have referred your patient to Unity Hospice, you will become a valued member of the home care team.  You will sign an initial certification order, review the hospice plan of care, prescribe medication for comfort care, schedule clinic visits, and sign the death certificate.  The hospice nurse or medical director will be in regular contact regarding pain and symptom management, changes in the patient’s condition and any needed visits or phone calls.  

With the regular visits of nurses, nurse aides, social workers, volunteers and counselors, the patient and family receive significant education in the treatments and medications you prescribe.  Side effects or complications can be noted immediately, and changes ordered with your input.

The costs of hospice services – medications, lab tests and other non-physician services --  are billed directly through insurance, Medicare and Medicaid by Unity Hospice.  As attending physician, you will continue to bill insurance and Medicare Part B for professional services – home, inpatient, or nursing home visits.  You may also bill for care plan oversight, at the rate of one physician visit per month involving 30 or more minutes of your time.

Under CPT code 99375, care plan oversight does not include telephone calls to patients and family members, but does include review of reports, coordination and communication with hospice team members, adjustment of medical treatments and development or revision of the care plan.

Where To Go for More Help:

For specific questions about your patients or about Unity Hospice, contact the Admissions Coordinator at your local office.