Answers to Questions Physicians Often Ask About Hospice Care

Most physicians know that hospice is designed to help terminally ill patients and their families with relief from cancer pain and other symptoms. But here are answers to questions physicians often ask about hospice care and how it can help busy physicians and their office staff cope with the demanding problems seriously ill patients can present.

1. Only about 20% of patients die of cancer and most of those are seen by oncologists. What about the other 80% of medical illnesses seen in my practice.

The National Hospice Organization has published Medical Guidelines for Prognosis in Non-Cancer Diseases. We use these to help primary care physicians and specialists manage patients with end-stage heart, lung, Alzheimer's, and other non-malignant conditions.

2. Is hospice mostly psychosocial "hand-holding," or is it really medical care?

We teach our staff to be the eyes, ears, and hands of the physician so that we can extend your treatment into the patient’s home. This involves medical management, but also careful attention to family dynamics, which are often disrupted when a family member is dying.

3. Can I bill Medicare or commercial insurance for services once my patients are referred to hospice?

Yes, you can. Primary physicians continue to bill Medicare Part B and other carriers for the patient’s regular office visits or for all covered services. New billing codes are also available for care plan oversight, so reimbursement can be obtained for telephone calls to nurses, as well as patients, attending physicians can still bill Medicare related to the hospice care plan.

4. Do commercial insurance plans have hospice benefits?

The National Hospice Organization has published Medical Guidelines for Prognosis in Non-Cancer Diseases. We use these to help primary care physicians and specialists manage patients with end-stage heart, lung, Alzheimer's, and other non-malignant conditions.

5. Will staff call me too often, or not often enough, to keep me informed?

Hospice staff are trained to assess patients and report findings to the attending physician so that treatment decisions can be made. There is considerable flexibility built into this arrangement. For example, the physician can make all treatment decisions independently and convey them to the nurse case manager, or the nurse case manager can suggest methods of pain and symptom control for the physician to approve. Communication can be by phone or fax, at any time of the day the physician selects. The only exceptions are emergencies, in which case our nurses are instructed to report to the physician immediately. Any dissatisfaction with over– or under-reporting should be reported to the Creekside Hospice Clinical Supervisor, who will correct the problem.

6. Is there any such thing as "cutting edge" knowledge in pain management?

Studies show about 90% of all cancer-related pain can be relieved completely with oral medication, with minimal or no toxicity. The same goes for other symptoms such as nausea and dyspnea. Our nurses are taught state-of-the-art techniques to manage these problems.

7. Do you offer a Hospice Evaluation Service?

Yes. Creekside Hospice staff are available to meet with, evaluate, and educate patients and families who you believe are appropriate for hospice services. There is no fee for this service. If, during the evaluation, your patient chooses hospice care and you approve of this decision, admission to the program can start right away.

Considering Hospice Referral:

If you think your patient is likely to die within six months, you next evaluate the patient’s specific needs. An affirmative response to one or more of the following questions would properly trigger a call to a Creekside Hospice:

1. Does the patient and family understand the seriousness of their prognosis?
2. Are the goals of care changing? Would the patient prefer to spend more time at home with family and friends, pursuing activities while strong enough to enjoy them?
3. Are pain management and comfort needs being addressed?
4. Do grief issues need to be examined?