Prognosis of Pulmonary Disease Based On Hospice Admission Criteria

What follows is the prognosis for pulmonary disease based on hospice admission criteria. If a patient meets these criteria he or she is eligible for hospice care which means that he or shee has six months or less to live.

To meet the CMS Disease Specific Criteria For terminal (less than 6 months) pulmonary disease, the patient must meet:

A patient is eligible for hospice services if he
meets these three criteria:
1) has a Palliative Performance Scale of less than 70% [Resource (2)]
2) is dependent on at least two Activities of Daily Living [Resource (3), and
3) meets the Disease Specific Guideline for pulmonary disease [Resource (1)] below:

Pulmonary Disease
Patients will be considered to be in the terminal stage
of pulmonary disease (life expectancy of six months or
less) if they meet the following criteria. The criteria refer
to patients with various forms of advanced pulmonary
disease who eventually follow a final common pathway
for end stage pulmonary disease. (1 and 2 should be
present. Documentation of 3, 4, and 5, will lend supporting
documentation.)

1. Severe chronic lung disease as documented by both a
and b:
a. Disabling dyspnea at rest, poorly or unresponsive to
bronchodilators, resulting in decreased functional
capacity, e.g., bed to chair existence, fatigue, and
cough; (Documentation of Forced Expiratory Volume
in One Second (FEV1), after bronchodilator, less than
30% of predicted is objective evidence for disabling
dyspnea, but is not necessary to obtain.)
b. Progression of end stage pulmonary disease, as
evidenced by increasing visits to the emergency
department or hospitalizations for pulmonary infections
and/or respiratory failure or increasing physician home
visits prior to initial certification. (Documentation
of serial decrease of FEV1>40 ml/year is objective
evidence for disease progression, but is not necessary
to obtain.)

2. Hypoxemia at rest on room air, as evidenced by pO2
less than or equal to 55 mmHg, or oxygen saturation less
than or equal to 88%, determined either by arterial blood
gases or oxygen saturation monitors, (these values may be
obtained from recent hospital records) OR hypercapnia, as
evidenced by pCO2 greater than or equal to 50 mmHg.
(This value may be obtained from recent [within 3 months]
hospital records.)

3. Right heart failure (RHF) secondary to pulmonary disease
(Cor pulmonale) (e.g., not secondary to left heart disease
or valvulopathy).

4. Unintentional progressive weight loss of greater than
10% of body weight over the preceding six months.

5. Resting tachycardia >100/min.

Resources:

1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014

2. The Palliative Performance Scale For Determination Of Hospice Eligibility
Posted on March 29, 2018 by Tom Wade MD

3. Instruments For The Assessment Of The Activities Of Daily Living [ADLs]
Posted on March 30, 2018 by Tom Wade MD

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