Physicians Guide to
Hospice
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issue of On the Horizon, our Physicians Newsletter, - click on
Winter, 2005
Overview
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Horizon offers these
special features: |
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- Established in 1978, we are Chicago's
first hospice, with more than a quarter century of experience and expertise
in end-of-life care.
- Strong physician support. Our patients receive
physician visits within days of admission. Our Medical Director, Joanna
Martin, MD, is a full-time
Horizon employee, board-certified in Internal Medicine and in Geriatrics.
- Involvement in
palliative care consultation at local hospitals.
- Contractual relationships with 10
community hospitals.
- An educational commitment to
physicians and other healthcare professionals caring. We
offer hospice rotations to about 100 physicians-in-training and nursing
students each year.
- Liberal patient admissions criteria.
- Care plan developed in cooperation
with primary physician; excellent communication and follow-up.
- Medicare/Medicaid-certified; JCAHO-accredited.
- Referrals welcome within city limits and beyond.
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Considering Hospice Referral:
If your patient is likely to
die within six months, 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?
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| 4.
Are pain management and comfort needs being addressed?
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| 5.
Is the home setting --- or nursing home --- conducive to good care for the
patient?
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| 6.
Do grief issues need to be examined?
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| 7.
Does the family need a plan for additional support such as volunteers and homemakers as the
illness evolves? |
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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. Horizon 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. Horizon
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 (see Circle
of Care Services for complete services). 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:
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 Horizon 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 Horizon 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 Horizon 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 Horizon Hospice, contact the Admissions
Coordinator at 312-733-8900.
