Today, I review, link to, and excerpt from CORE IM‘s Hospice 102: Practical Tips and Nuances.*
*Posted: October 16, 2024
By: Dr. Mahathi Komaragiri, Dr. Shreya P. Trivedi and Dr. Harry Han
Graphic: Dr. Jesse Powell
Audio: Jerome C. Reyes
Peer Review: Dr. Charlotte Grinberg, Dr. Helen Knight, Dr. Mara Feingold-Link
All that follows is from the above resource.
Play podcast in seperate window.
Time Stamps
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Show Notes
Transitioning to hospice
- A hospitalized patient elects to enroll in hospice, now what?
- Determine which level of care you think this patient needs.
- Notify your hospital’s discharge planning team and case manager so a referral can be placed.
- What treatments are typically covered by hospice ?
- Normally covered by hospice:
- Treatments focused on symptom management to address pain, nausea, vomiting, agitation, anxiety, dyspnea, constipation, etc.
- This can be medications, DME, medical supplies, therapy, counseling.
- Not covered by hospice: disease directed treatments
- Might be covered by hospice:
- Artificial nutrition, IVF, antibiotics, transfusions, palliative procedures (radiation, paracentesis, thoracentesis).
- This is usually a case by case basis and may end up being a time limited course.
- What medications to continue and discontinue?
- Think through these questions:
- 1) is the medication providing symptomatic benefit to the patient or will the medication maintain/improve quality of life?,
- 2) What is the harm on QOL if we continue the medication, and
- 3) What is my patient’s anticipated prognosis and their overall goals?
- Know that hospice will do their own review of the medications and work with the patient deprescribe overtime
- Code status in hospice
- DNR/DNI is not required for hospice by Medicare guidelines.
- However, GIP facilities are often unable to run codes and these patients are often DNR/DNI or even DNH.
- Approaching the hospice patient coming back to the hospital
- Be curious for their reason:
- Change in philosophy of care
- Hospice sent them for an abbreviated evaluation (ex. For eval for a fall/fracture)
- Expedited symptom management
- Misunderstanding of hospice care
- Hospice enrollment and re-enrollment is voluntary.
- Patients can elect to re-enroll on hospice services after hospitalization if their goals of care continue to align with hospice and the agency agrees the patient meets criteria.
References
- University of California San Francisco. ePrognosis Calculator.
- Centers for Medicare & Medicaid Services. Hospice Determining Terminal Status.
- Estell MH, Whitford KJ, Ulrich AM, Larsen BE, Wood C, Bigelow ML, Dockter TJ, Schoonover KL, Stelpflug AJ, Strand JJ, Walton MP, Lapid MI. Music Therapy Intervention to Reduce Symptom Burden in Hospice Patients: A Descriptive Study. Am J Hosp Palliat Care. 2024 Mar 19:10499091241237991.
- Centers for Medicare & Medicaid Services. Hospice Coverage.
