Physician’s Guide to Hospice

CONFIDENCE IN YOUR CHOICE

Hospice cares for more than 1.56 million Americans, and their families/caregivers, every year … a number that continues to grow.

Physicians Guide - Hospice Care

What do your patients want?

  • A Gallup poll reveals that close to nine in ten adults (88%) would prefer to die in their homes, free of pain, surrounded by family and loved ones: Hospice works to make this happen.
  • National Hospice and Palliative Care Organization research shows that 94% of families who had a loved one cared for by hospice rated the care as very good to excellent.
  • U.S. Department of Health and Human Services has indicated that expanding the reach of hospice care holds enormous potential benefits for those nearing the end of life, whether they are in nursing homes, their own homes, assisted living facilities or in hospitals.
  • National Hospice Foundation research shows that the top four services Americans feel are most important for a loved one who has less than six months to live are:
  1. Someone to be sure that the patient’s wishes are honored;
  2. Choice among the types of services the patient can receive;
  3. Pain control tailored to the patient’s wishes; and
  4. Emotional support for the patient and family.

Hospice works to honor the wishes of those individuals with terminal illness who prefer to die in their own homes and on their own terms.

*Statistics from the National Hospice and Palliative Care Organization (www.nhpco.org)

How to Transition Home Health Patients to Hospice

  • Physician refers to home health agency with order to contact St. Joseph Hospice for Palliative Care Consultation.
  • St. Joseph Hospice will educate patient and family on support options offered.
  • St. Joseph Hospice will cooperate with the patient’s home health agency to ensure a smooth transition into hospice.
  • Board Certified Hospice and Palliative Care physicians are available for consultation 24/7.

Physician Update on Medicare/Medicaid Hospice

From the Department of Health and Human Services Center for Medicare and Medicaid
Services (CMS):

  • The Medicare program recognizes that terminal illnesses do not have predictable courses; therefore, the benefit is available for extended periods of time beyond six (6) months provided that proper certification is made at the start of each coverage period.
  • Physicians, hospitals, and skilled nursing facilities are urged to recommend hospice care to beneficiaries whom they determine may benefit from it.
  • The certification of terminal illness of an individual who elects hospice shall be based on the physician’s clinical judgment regarding the normal course of the individual’s illness.

Referenced from: Quality of Life Matters, End-of-Life Care News and Clinical Findings for Physicians. Vol. 6, Issue 4, Feb/Mar/Apr 2005.

Physician Liability

Hospice re-evaluates each patient every 60 to 90 days to determine continued eligibility for the hospice benefit.

Face-to-Face Encounters

Beginning in 2011, a face-to-face evaluation will be required for all patients entering their 3rd certification period and each subsequent certification period.  St. Joseph Hospice will provide for these face-to-face evaluations.

Other Physician Billing

GV/GW modifier codes must be added to a Medicare/Hospice bill to assure payment.

Medical Director employed by hospice for hospice related care.

  • Bills the hospice for medical services
  • Hospice needs to verify dates and services before billing

Medicare Part A

  • Hospice is paid 100% of allowable fee schedule
  • Hospice pays physician per contractual agreement
  • Hospice is required to obtain a physician billing number from Medicare

Attending Physician billing for hospice related care if NOT employed by Hospice.

  • Bill Medicare Part B using CPT and ICD Codes
  • Use 80% of allowable fee schedule
  • Use HCPC modifier Code GV (not employed by hospice)
  • Use HCPC modifier Code GW (if NOT related to terminal DX)

How to Talk to Patients about Hospice

  • Be prepared by confirming medical facts and providing an appropriate environment.
  • Establish what the patient and family know about their condition by using open-ended questions.
  • Determine (in advance) how the patient and family want to receive information.
  • Deliver the information in a straightforward manner.
  • Respond to emotions of the patient and family.
  • Establish goals for care and treatment possibilities when possible.
  • Formulate an overall plan with patient.

“I wish we had known about hospice sooner.”

–Most frequent feedback from family members.

“Why should I choose St. Joseph Hospice?”

Fewer phone calls from patient/family are necessary

  • St. Joseph Hospice Medical Directors are available 24/7, many of which are Board Certified in Hospice and Palliative Medicine
  • Evening shift nurses are available to see patients and handle the crisis in person
  • Information is provided on St. Joseph Hospice’s website which helps to empower the patient and family and make them more confident

Consistent patient management with St. Joseph Hospice “On Call Solution”

  • Large Physician group benefits from prompt response of 24/7 Board Certified Hospice and Palliative Care physician
  • Hospice Medical Director can cover ALL calls if referring physician prefers
  • Evening shift nurse instead of “on call” rotation equals familiar face in the evening and fresh nurses during the daytime for patients

Weekend Support = Less Crisis

  • The St. Joseph Hospice Weekend Team (nurses, social workers, chaplains) are available to perform admits, provide evening visits, and alleviate fears
  • St. Joseph Hospice Board Certified Hospice and Palliative Care physicians are available on weekends
  • The full medical support provided by St. Joseph Hospice reduces readmits to hospital

Robust Continuous Care Staffing/Availability

  • When a patient or family is in a crisis situation, St. Joseph Hospice is equipped to place caregivers at bedside, around the clock

Thorough Informational Support

  • Videos provided to the patient and family help to increase confidence
  • Website that helps to answers questions
  • Ongoing education and support by nurses, social workers, and chaplains which helps to alleviate fears

“What does hospice require from me if I make a referral?”

  • Physician order to admit to hospice
  • History and physical
  • Signed certification of terminal illness which states a probable prognosis of 6 months or less if disease follows its natural course (may remain in hospice >6 months if patient continues to decline)

“How do I identify a potential hospice patient?”

  • Terminal diagnosis with probable prognosis of 6 months or less
  • Frequent hospitalizations or emergency room visits
  • Recurrent infections in last 6 months
  • Weight loss of 10% or more in last 6 months
  • Patient refuses hospitalization, aggressive treatment, or PEG tube placement
  • Home health patient in declining status

“Can I still see my patients and be reimbursed?”

GV/GW modifier codes must be added to a Medicare hospice bill to assure payment.

Attending Physician billing for hospice related care if NOT employed by hospice

  • Bill Medicare Part B using CPT and ICD Codes
  • Use 80% of allowable fee schedule
  • Use HCPC modifier Code GV (not employed by hospice)
  • Use HCPC modifier Code GW (if related to terminal DX)
  • Use 07 code (if not related to hospice diagnosis)