Palliative Care...what is the referring criteria?

  1. Hi:
    I am currently researching the area of palliative care in the U.S. I have run into a lot of literature that talks about the topic abroad (Britain, etc...), but not a whole heck of a lot here at home...for you experts out there...

    Is there such a thing as standardized referral criteria to help healthcare workers identify patients who would be most appropriate for palliative care services???

    Thank you all!
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  2. 8 Comments

  3. by   doodlemom
    The only criteria is that the patient have a need for symptom management. Pt's do not necessarily have to have a "terminal" diagnosis, although most of the time this is what is seen in palliative care.
  4. by   leslie :-D
    the American Academy of Hospice & Palliative Medicine states...

    www.aahpm.org/positions/definition.html

    must have life-limiting illness but life-prolonging treatment is covered by medicare benefit.
    many services covered in supporting pt to live w/illness, as comfortably as possible.

    leslie
  5. by   nurselearner


    When is a patient appropriate for hospice care?
    http://www.aurorahealthcare.org/serv....asp#Karnofsky
    Last edit by nurselearner on Sep 20, '06
  6. by   doodlemom
    It should be noted that palliative care and hospice do not mean the same thing. The guidelines for hospice care refer to hospice care - not palliative care. Hospice falls within within the realm of palliative medicine but palliative medicine encompasses more than hospice care. There is no defined "criteria" for palliative care. Many palliative care physicians can and do practice palliative medicine without being associated with a hospice and their patients may have years of life left in them. Palliate = to relieve the symptoms of a disease or disorder.
  7. by   leslie :-D
    Quote from doodlemom
    It should be noted that palliative care and hospice do not mean the same thing. The guidelines for hospice care refer to hospice care - not palliative care. Hospice falls within within the realm of palliative medicine but palliative medicine encompasses more than hospice care. There is no defined "criteria" for palliative care. Many palliative care physicians can and do practice palliative medicine without being associated with a hospice and their patients may have years of life left in them. Palliate = to relieve the symptoms of a disease or disorder.
    there are many ambiguities in palliative care.
    and yes, hospice is under the umbrella of palliation.
    if you look at the different criteria, the commonality is a life-threatening illness w/unlikeliness of a cure.
    yet one can still be treated in hopes of being cured, even if considered futile.
    whatever makes the pt most comfortable in their remaining months, yrs of the disease, is the defining criteria.
    for instance, someone with mod-late copd would be an ideal candidate, even though they could live a matter of yrs.
    it's approved on a case by case basis, with much flexibility.

    leslie
  8. by   doodlemom
    However, there is no medicare criteria in order for it to be covered by them - of course many PPO's or HMO's require referrals from PCP's just as they would any specialist. A palliative care physician is a specialist - just as a pulmonologist or a cardiologist is.
  9. by   leslie :-D
    Quote from doodlemom
    However, there is no medicare criteria in order for it to be covered by them -
    exactly-that's why i was trying to emphasize a case by case basis.
    yet hospitals that are opening these units, clump them together as hospice/palliative care.
    and i think palliative care is so much more comprehensive.

    thinking about it, why wouldn't a hospice pt (by all qualifying criteria) use the palliative care benefit instead?
    even if they weren't looking for a cure, they'd be entitled to more services that hospice doesn't cover.
  10. by   doodlemom
    There is really no such thing as a palliative care "benefit". Nursing homes will get a slightly higher medicaid rate if they put a patient on a palliative care bed (depending on what state you are in.) If a pt is on a palliative care unit at a hospital or in a nursing home palliative care bed, the patient is not necessarily getting the same services as if they were in a hospice bed. If it is an inpatient hospice unit, the hospital can do as much as they want to the patient and Medicare/insurance is only going to pay them whatever the going rate for inpatient hospice care is. The hospital that I used to work for had a palliative care unit and the only thing different between them and the rest of the hospital was the focus. There was no difference in their insurance reimbursement than in any other bed in the hospital. The patients were not getting hospice services - just acute care services. The palliative care physicians billed just the same as a cardialogist would bill. There is no home palliative care benefit except that a palliative care doctor/nurse practitioner can have a home based practice and many do make home visits. The doctors are paid by Medicare part B or other insurances - just as any doctor is paid. There is no inclusive benefit that includes spiritual support, SW, etc...Really only the doctor is a covered expense. There are some hospices that have separate palliative care programs that they are running on the patients's home health benefit and raising money to pay for some ancillary services the patient may need besides nursing - I've seen this done with several pediatric palliative care programs. The patient is still able to use their insurance for chemo or other treatments.

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