Ask the Physician

Do you have a question for our Physicians? Submit your question in the form below and one of our qualified Physicians will answer. Be sure to check the previously answered questions below to see if your question has already been addressed.

Previously Asked Questions

How do I know if a patient is eligible for hospice services? 

Ultimately, to certify a patient initially as being eligible for the hospice benefit from Medicare, two physicians must clinically judge that the patient has a 6 months prognosis or less, if the natural expected course of their underlying disease or disorder takes its normal course.   This is typically one physician from the hospice staff  (a medical director) and the referring physician (may be a primary care MD or specialist).  While medicare has provided guidelines for determining prognosis for the most commonly referred patients, the “bottom line” clinical judgement for the referring physician is to ask him/herself this question:  “would it surprise me if this patient died in the next 6 months?”.  If the answer to that question is no, then they are an appropriate referral.

If you have any doubts or questions about a potential referral, you can always refer the patient for an evaluation.  We will send one of our staff nurses to evaluate the patient and help assist you in your clinical judgement and the medicare guidelines.  Our Chief Medical Officer, Dr. Tim Short, is also always available to discuss any potential referrals with you.

What is the difference between a palliative care referral and a hospice referral?

Hospice referrals must meet the Medicare criteria and result in the patient electing the Medicare Hospice benefit (a benefit that covers 100% of costs related to caring for the admitting diagnosis, including medications and DME).  The patient must have an estimated 6 months prognosis and must elect not to pursue curative or aggressive medical treatment.

Palliative care compliments any other medical care at any point in the trajectory of the illness.  One can still be pursuing aggressive or curative care, and request a palliative care consult.  Palliative care emphasizes symptom management and helping patients/families clarify their goals of therapy.  Sometimes a palliative care consult results in a hospice referral if that is the patient’s desire and they are an appropriate candidate.    Most of the time, however, a palliative care consult results in improved symptom management so that quality of life is enhanced, care is centered on the patient’s goals, and autonomy and independence are preserved.

What happens to my hospice patient when they live longer than 6 months?

The hospice benefit does not expire at 6 mos.  Patients may continue under the benefit if their course is one of decline and that the ongoing assessment by the medical director at the hospice is that the patient continues to have an expected 6 month prognosis.  Sometimes, this is difficult to predict and thus we have patients on our hospice services for over a year or more.  Occasionally, with the skilled care that our patients receive from our team of caregivers, their condition stabilizes and improves and they no longer can be assigned a 6 mos prognosis.  In these instances, we celebrate a graduation from hospice services and offer an open door to them whenever their condition might change to warrant a new referral.

Are there any general guidelines for timely referrals of patients to hospice services?

Yes, there are three domains that generally correlate better with prognostication than any one diagnosis.  These domains are valid indicators across all diagnoses:  function, nutrition, and cognition.  In an elderly, frail population (anyone over 75 or 80 with significant co-morbidities), the following “red flags” are excellent indicators to consider referral to hospice services.

• Unexplained weight loss of more than 10% body weight in the past 6 or 12 months
• Inadequate nutrition/hydration with a “steep/acute” curve of decline
• Spending more than 50% of the day in bed in the setting of dependence of other ADL’s
• Cognitive decline in the setting of other morbidities (dementia as a primary diagnosis does have some specific criteria)