Medicare Hospice Benefit

Question 1

Palliative vs Hospice

Answer 1

• Palliative care aims to relieve suffering in ALL STAGES of disease, and can be provided at the same time as curative or life-prolonging treatments.
• Hospice care is part of palliative care concerning for patients AT THE END OF LIFE.

Question 2

GOALS

Answer 2

To provide comprehensive interdisciplinary team-based palliative care, focusing on preventing and relieving suffering and on supporting the best possible quality of life, for patients and their families facing serious illness.

Question 3

What does palliative care service provide

Answer 3

1. Symptom management
2. Establishing goals of care based on the patient’s values and preferences
3. Care coordination; communication.
4. Providing support: Psychosocial, spiritual, and bereavement support

Question 4

Medicare HOSPICE team?

Answer 4

1. Hospice physician: both a medical and administrative role.
2. RN: primary case manager and skilled nursing care.
3. Social worker
4. Chaplain
5. Home health aides and attendants provide assistance to caregivers in the home, including personal care, food preparation and shopping.
6. Volunteers provide extra support for patients and families such as reading to patients, visiting, and assisting with errands

Question 5

Levels of care

Answer 5

1. Routine home care (95%). 135/days
2. Continuous home care: 790/days
3. Respite care: a short-term inpatient care to relieve the family/primary caregiver. LIMITED to 5 days. 150/days
4. General in-patient: symptoms cannot be adequately addressed at home, unsafe home environment or during the active dying phase; 600/days

NOT COVER: Continuous nursing assistance, or nursing home room and board charges.

Question 6

GIC criteria

Answer 6

1. UNCONTROLLED symptoms.
2. Psychosocial problems (e.g. unsafe home environment or imminent death where family can no longer cope
   at home).

Question 7

MEDICARE

Answer 7

Eligibility

• Older than 65 y/o
• More than 2years disability
• ON dialysis regardless of their age.

Question 8

MEDICARE

Answer 8

Coverage

• Part A primarily pays for inpatient, SNF and hospice.
• Part B covers outpatient services
• Part C (“Medicare + Choice”, “Medicare Advantage” )
• Part D, a pharmacy benefit.

Question 9

MEDICARE HOSPICE Eligibility

Answer 9

1. Eligibility for Medicare part A but AGREE to choose hospice care.
2. DNR is NOT required.
3. BOTH PMD and the hospice medical director certify a terminal (less than 6mo) illness. In addition, the patient must be willing to forego life-sustaining treatment related to their hospice admitting diagnosis.

Question 10

Reimbursement

Question 11

Who takes care of the patient after hospice-enrollment?

Answer 11

Patient can choose; however the primary physician is responsible for working with the hospice team to determine appropriate care.