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5 Wishes

Physician's Guide to Hospice

CONFIDENCE IN YOUR CHOICE

What your patients Want:

83% of Americans want to die at home, cared for by loved ones and supported by in-home health care professionals, according to the findings of a national survey (Hospice and Palliative Care Organization - November 2004).
88% of respondents said they would consider using hospice if they or someone they knew were terminally ill.
98% of respondents whose family had previously been served by hospice said it was a positive experience. Respondents said the most important aspects of a good death were:
1. Dying with family members present
2. Dying with dignity
3. Dying pain free
4. Dying with benefit of spiritual counseling

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.

Of all deaths in America in 2003, 50% died in a hospital. In comparison, only 9% of all hospice deaths occurred in a hospital.

How to Transition Home Health Patients to Hospice

Physician refers to HHA 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 Home Health for smooth transition into hospice.
Board Certified Hospice and Palliative Care Physician is available for consultation through St. Joseph Hospice.

Physician Update on Medicare/Medicaid Hospice

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

"The Medicare program recongizes that terminal illnesses do not have predidctable 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. Vo. 6, Isssue 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.

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 needs 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 related to terminal DX)

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

"I wish we had known about hospice sooner"

Most frequent feedback from family members.

Why St. Joseph Hospice?

"Why should I choose St. Joseph Hospice?"

Less phone calls from patient/family in the evening
~ St. Joseph Hospice Medical Director availability 24/7, board certified in Hospice and Palliative Medicine
~ Evening shift nurse available to see patients and handle the crisis in person
~ Available information empowers confident family through www.stjosephhospice.com

Consistent patient management with St Joseph Hospice "On Call Solution"
~ Large MD 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
~ St. Joseph Hospice Weekend Team (nurses, social workers, chaplains) to perform admits, provide evening visits, and alleviate fears
~ St. Joseph Hospice Board-Certified Hospice and Palliative Care physician available on weekends
~ Weekend full medical support reduces readmit to hospital...smooth transition

Thorough Informational Support
~ Videos given to families produce confidence
~ Website www.stjosephhospice.com answers questions
~ Ongoing education and support by nurses, social workers, and chaplains alleviates fears

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

MD order to admit to hospice
History and Physical
Signed certification of terminal illness which states that patient has a 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)

Palliative Care Program

We find that many terminal patients need the pain and symptom management that hospice can provide, but they do not qualify because they have not completed their course of treatment for their illness.
Our goal is to offer solutions to patients and their families as they complete their treatments of radiation, chemotherapy, dialysis, and other aggressive therapies.
This team approach supports you- the physician, by educating patients and their families about their end-of-life options.
By making a referral to St. Joseph Hospice, we can provide the information patients and families need to make an informed decision about their options.
If the patient decides to continue aggressive forms of treatment, or if they are not ready to accept hospice services, the patient can be referred to STAT Home Health and receive services from our Palliative Care Team.
Patients referred to the Palliative Care Team will be assigned a hospice trained nurse and CNA to provide services through the Palliative Care Pathway with STAT Home Health.
The nurses and social workers will educate patients/families and help them to accept the appropriate end-of-life care with realistic goals for the patient.
Most of all, this team approach offers information so families can decide which service may offer the most peace and comfort to the patient.
When appropriate, STAT Home Health will obtain an order from the physician and refer the patient back to St. Joseph Hospice.
This provides a smooth transition from home health to hospice using the same nurse and CNA that the patients have grown to know and trust.
This team approach allows our team to care for the patient in the most appropriate setting, and allows the patient and family to take their time in making some very important end-of–life decisions.
call St. Joseph Hospice 769-4810 or STAT Home Health 769-4764 for more information.