Dear Barbara, our hospice needs some educational information to share with laymen on doctor determination for admission and how two doctors may not agree on a patient meeting criteria. Basically, how can one hospice find a patient appropriate and admit them, and another hospice not admit the same patient.
You ask a very important question about different hospices accepting and not accepting the same patient. With a large number of hospices operating in the same area the competition has become fierce. If one hospice refuses to take a patient the doctor just hangs up and calls another hospice until he finds one lenient enough to take the person on. It isn't the way service was intended but is what is happening throughout the country--to the determent of what the hospice philosophy originally intended.
How can you educate the public? Newspaper articles about hospice and the services it provides are good but don’t happen often. What you can do is make frequent community education presentations to Senior Centers, local civic organizations, and church groups. Make your presence known to the community so you aren’t just relying on physician referrals.
What are some resources to help physicians understand admission criteria? The National Hospice and Palliative Care Organization, The American Academy of Hospice and Palliative Medicine, and The National Association for Home Care and Hospice are organizations that may have literature to offer physicians and the community. However, I think doctors already know the guidelines for placing a person on the hospice program. Hospice Medicare has been around long enough that everyone working in the medical field knows hospice accepts people who are estimated to have six months or less to live and are not receiving treatment for their life threatening illness. It is that simple. All the rest . . . just details. It isn’t really about physician education. It is about knowing when to stop active treatment, when to say “I can’t fix you”, when to think about quality of living instead of quantity of breathing.
What can you as an agency do about agency competition for referrals? Keep your integrity. Be the best hospice you can possibly be, provide the highest quality of care with the most compassionate, caring staff your area has to offer. Build a reputation within the community not of how many patients you serve but what kind of compassionate, “we go the extra thousand percent for our patient”, care you provide. Build a reputation within the community that makes people want to be taken care of by YOUR hospice, not just any hospice.
Something more about... A Hospice With Integrity
Hospices all over the country use my 25 minute film, NEW RULES for End of Life Care to educate families about end of life and hospice. They show the film at Nursing Homes, Assisted Living Centers, Churches, Community Centers, Kiwanis meetings, etc. to say, when the time comes, THIS is how we will care for you. In other words, the film is used as a conversation starter and as a calling card to their hospice.
9 comments
Cheryl
I used to be a hospice nurse, I went out to do a readmission on a patient, she had come off service as she had improved. I walked in, she came walking out of her room, went to the kitchen got a glass out of the cabinet then used the ice/water in door Refridgerator, this was a dementia patient, i asked family what had changed since discharge, they told me nothing. I did not admit, the hospice I worked for agreed
I used to be a hospice nurse, I went out to do a readmission on a patient, she had come off service as she had improved. I walked in, she came walking out of her room, went to the kitchen got a glass out of the cabinet then used the ice/water in door Refridgerator, this was a dementia patient, i asked family what had changed since discharge, they told me nothing. I did not admit, the hospice I worked for agreed
Methoda
Great comments. Very helpful.
Great comments. Very helpful.
Barbara
Hi Shannon, thank you so much for the info on charging protocol. You’ve taught me something. Blessings! Barbara
Hi Shannon, thank you so much for the info on charging protocol. You’ve taught me something. Blessings! Barbara
Shannon
I can think of a couple of situations in which a hospice could bill a patient directly. If the individual has a co-pay or deductible with their private insurance. Another situation could be if the hospice is out of network.
A hospice has 3 days to inform an individual if they are out of network or if there is a deductible and what the charges would be. If an individual chooses to stay on after those 3 days, then they would be responsible for the charges. If an individual comes off hospice before those 3 days, then hospices usually don’t charge for those 3 days.
I can think of a couple of situations in which a hospice could bill a patient directly. If the individual has a co-pay or deductible with their private insurance. Another situation could be if the hospice is out of network.
A hospice has 3 days to inform an individual if they are out of network or if there is a deductible and what the charges would be. If an individual chooses to stay on after those 3 days, then they would be responsible for the charges. If an individual comes off hospice before those 3 days, then hospices usually don’t charge for those 3 days.
Nancy Buckingham
My husband came home from the hospital and then rehab facility and in two weeks our home health suggested hospice. He was on hospice for 11 1/2 months. My brother was living with us and he helped me take care of my husband daily and nightly. I could not have done it without him. I quit work and so glad I did so I could spend all my time with him. We had been together for almost 30 years, he transitioned to Heaven May 14th, just 3 weeks ago. I miss him terribly, I am lost, I really did love taking care of him. We fell in love all over again and our love went to a level I did not know existed. It was a beautiful year, difficult, but beautiful. Thank you for all your info. Families need more info about hospice. Thank you again
My husband came home from the hospital and then rehab facility and in two weeks our home health suggested hospice. He was on hospice for 11 1/2 months. My brother was living with us and he helped me take care of my husband daily and nightly. I could not have done it without him. I quit work and so glad I did so I could spend all my time with him. We had been together for almost 30 years, he transitioned to Heaven May 14th, just 3 weeks ago. I miss him terribly, I am lost, I really did love taking care of him. We fell in love all over again and our love went to a level I did not know existed. It was a beautiful year, difficult, but beautiful. Thank you for all your info. Families need more info about hospice. Thank you again
Barbara
Hi Nancy, in regard to your question about patients and families being charged for hospice services: if the hospice is medicare certified (and most in this country are) then services are paid by medicare and most insurance policies. Services include nursing, bathing, social work, chaplain, physical therapy, occupational therapy and payment of medications that relate to the life threatening illness. These services are determined appropriate by the hospice. The patient is not charged for these services. The only exception I can think of where the patient/family is charged for anything would be if there was a hospice house and the patient stayed under private pay when the inpatient time frame ended. Most hospices, however, do not offer that payment and stay opportunity. Nursing facilities often offer hospice services. There should be no charge for hospice but there would be the continued room and facility care charges. I am wondering if that is what has happened here because it does not make sense that there are direct charges to the patient and family from just a hospice. Thank you for reaching out to me. Blessings! Barbara
Hi Nancy, in regard to your question about patients and families being charged for hospice services: if the hospice is medicare certified (and most in this country are) then services are paid by medicare and most insurance policies. Services include nursing, bathing, social work, chaplain, physical therapy, occupational therapy and payment of medications that relate to the life threatening illness. These services are determined appropriate by the hospice. The patient is not charged for these services. The only exception I can think of where the patient/family is charged for anything would be if there was a hospice house and the patient stayed under private pay when the inpatient time frame ended. Most hospices, however, do not offer that payment and stay opportunity. Nursing facilities often offer hospice services. There should be no charge for hospice but there would be the continued room and facility care charges. I am wondering if that is what has happened here because it does not make sense that there are direct charges to the patient and family from just a hospice. Thank you for reaching out to me. Blessings! Barbara
Patrice Kreitler
Thank you Barbara for writing about this very interesting topic. As most hospice professionals I have seen this for years. We have discharged a patient for extend prognosis and 5 minutes later is on another hospice. Part of the problem is hospices are hiring physicians that don’t know the hospice regulations or criteria for admission. Plus certain referral sources want the service and threaten to transfer their patients. I have a list of things I have seen all too often. Your advice is spot on. Hire quality staff, train them well, provide excellent care and lastly hold your head high in the community. It took me awhile but I have that respect at running a hospice that will always do it the right way.
Thank you Barbara for writing about this very interesting topic. As most hospice professionals I have seen this for years. We have discharged a patient for extend prognosis and 5 minutes later is on another hospice. Part of the problem is hospices are hiring physicians that don’t know the hospice regulations or criteria for admission. Plus certain referral sources want the service and threaten to transfer their patients. I have a list of things I have seen all too often. Your advice is spot on. Hire quality staff, train them well, provide excellent care and lastly hold your head high in the community. It took me awhile but I have that respect at running a hospice that will always do it the right way.
Nancy Mattson
I’ve not checked and don’t know how to. Folks were charged for hospice. Is this true? Doesn’t the individual’s heath insurance cover the expenses? Can the services be duplicated particularly medicines by doctor and hospice?
A patient was just accepted into hospice but died before he received the services somehow his savings was depleted. Could be they are blaming hospice since I can’t check out the story but a number of years ago, a patient complained that they got a huge bill from hospice. Thanks for taking my question. nancy mattson
I’ve not checked and don’t know how to. Folks were charged for hospice. Is this true? Doesn’t the individual’s heath insurance cover the expenses? Can the services be duplicated particularly medicines by doctor and hospice?
A patient was just accepted into hospice but died before he received the services somehow his savings was depleted. Could be they are blaming hospice since I can’t check out the story but a number of years ago, a patient complained that they got a huge bill from hospice. Thanks for taking my question. nancy mattson
Gary Yepsen
Thank you for your input Barbara. As a hospice chaplain you insight is always welcome.
Take care,
Gary
Thank you for your input Barbara. As a hospice chaplain you insight is always welcome.
Take care,
Gary