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Video: How Clinicians Can Identify Hospice Appropriate Patients Sooner

Posted by Denise Galbraith on February 01, 2016

identifying_a_hospice_patient_.pngAs our Clinical Transformation Consultant, Carleen assists Medalogix in furthering the development of Medalogix’s end-of-life analytics technology solution—Medalogix Bridge. Carleen has 20 years of palliative care experience in hospice clinical and operational leadership, healthcare informatics management and consulting. She’s here to share some tips to help clinicians identify patients who may be appropriate for hospice earlier.

It’s a little easier to find a hospice patient in the last days or weeks of their life, but the Hospice Medicare benefit is for patients who are expected to live six months or less. By identifying patients earlier in their disease trajectory for hospice means they will get more time to use the benefits they are entitled to.

In this video, Carleen reviews Medicare’s hospice guidelines and then breaks down specific ways to identify a hospice patient by his or her diagnosis. (For your convenience, text summaries and timecodes are posted below. This way, you can navigate to the specific point in Carleen’s presentation that’s most interesting to you.)

Time Code Guide:

  • What are the Medicare conditions/LCD guidelines for hospice appropriateness? - 0:44
  • Cardiac disease - 3:14
  • Pulmonary disease - 4:41
  • Neurological diseases - 6:12
  • Discussion review - 8:19

Summaries:

What are the Medicare conditions/LCD guidelines for hospice appropriateness? (0:44)

The Medicare conditions and LCD guidelines help give parameters for a clinician to decide if this person is eligible for hospice. We’re going to talk through some of the general criteria as well as focus in on some of those more difficult or high priority diagnoses such as cardiopulmonary or patients with neurological conditions - what do those patients look like six months before passing away?

Remember, the only hard and fast rule is that you must have a physician's certify that the patient has six months of left to live. In addition, we’re looking to see if patient is in a declining state with a terminal diagnoses. Focusing in on the following areas can help you to understand better if a patient is in a state of decline.

Some questions to ask yourself are:

  • Is this patient losing weight?
  • Are their lab values going down? Would it help to establish a baseline?
  • Have they had recent infections?
  • Have they  had recent hospitalizations or visits to the Emergency Room?

Hospice appropriateness for a patient with Heart Disease (3:14)

Patients who qualify as hospice appropriate with a heart disease diagnosis are patients that have already been optimally treated with ACE inhibitors and diuretics, yet they are still having symptoms even at rest. In Hospice, The New York Heart Association scale is used to determine the severity of the patient’s symptoms. If they are a class IV after being treated optimally, they may be eligible for hospice services.  

Some questions to ask yourself are:

  • Are they out of breath talking to you?
  • Are they out of breath getting out of a char?
  • Are they out of breath while eating?

Hospice appropriateness for a patient with Pulmonary Disease (4:41)

We’re going to look at pulmonary disease very similar to the way we looked at heart disease as well as take in those Medicare guidelines we discussed earlier. These could be your patients that are listed as having COPD, emphysema, CHF, or atrial fibrillation.

Some questions to ask yourself are:

  • Does this patient have dyspnea at rest?
  • Has this patient had recent URIs? Pneumonia?
  • Has this patient had recent visits to the Emergency Room?
  • Are they losing weight?

Hospice appropriateness for a patient with Neurological Disease (6:12)

Dementia patients are very difficult to determine when they are eligible for hospice due to the nature of their disease trajectory. For the neurological conditions such as dementia, alzheimer's, parkinson's, or huntington's we’ll be focused in on patients who can no longer function on their own, such as dressing or toileting. We’re also going to be looking at contributing health factors and comorbidities.

Some questions to ask yourself are:

  • Does this patient have pressure ulcers?
  • Does this patient engage in meaningful conversation?
  • Are they losing weight?
  • Have they had any aspiration pneumonia? Have they had trouble swallowing that could lead to an aspiration event?
  • Have they had frequent UTIs?
  • Are they incontinent of bowel and/or bladder?

Wrapping Up (8:19)

This summary provides some things to look for when looking at patients who may be eligible for hospice, as early as possible so they can maximize their hospice benefit that they’re entitled to if it’s appropriate for them. 

It’s important to focus on the fact that above all, everyone deserves to have a conversation about their end of life goals. If your patients have these signs and symptoms, it’s our responsibility as clinicians to have the conversation with the patient to determine what is right for that patient and that family.

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