Kabin

What's the norm for home hospice pt's going to the hospital for something related to the terminal diagnosis? It seems complicated. Sometimes it's unfair for the hospice agency to cover hospitalization costs and other times it borders on being unfair ...

We can't forget healthcare is a limited resource. Cost will always be important. Hospice is all about dying with dignity, comfort, and support. And if med changes don't support those goals you're doing something wrong.

Once again that doesn't mean the hospice agency needs to cover it without first trying formulary meds. And there's almost always a few more cost effective meds to try. This has been standard operating procedure for years.

Most hospices would try other neuropathic meds within formulary before trying exotic meds. There should be many old school and cost effective choices to try first (TCAs, anticonvulsants, local anesthetics, etc). If they don't work THEN one can consid...

Yep, unless you need it. On the other hand, med coverage will soon be more complete and cost effective for most patients and families. It's probably more accurate to say the key is to not start a hospice business today.

Yes there are several. It just depends what it's being used for (neuropathic pain, antidepressant).

Although it will be less often, there'll still be cases where the patient may have to pay out of pocket. The patient has to be willing to play ball. If the patient refuses to try hospice formulary meds first then the patient will assume financial lia...

"Hospice has been a good business." Too good. Too many start ups falling over themselves to get in while the gettin' was good. What other business could one start and not experience the traditionally high new business start-up failure rate? Probably ...

Yes, hospice has been a good business. CMS probably wouldn't mind seeing a few hospice agencies fail from reasons other than medicare fraud.

Another round of layoffs at Banner (AZ). http://www.azcentral.com/arizonarepublic/business/articles/2009/01/15/20090115biz-banner0115.html

Exactly. Few seems to understand how far reaching this change is. It's more than covering the terminal diagnosis, it's bundling secondary diagnoses and conditions that contribute to the pt's decline, it's more cost burden on the hospice agency, and t...

One of the larger hospice agencies, top 10.

In times like this it's probably best to be involved with hands on clinical. Try to avoid fluff programs, overhead assignments, and middle management jobs.

Hospice bundling in the past was only around the terminal diagnosis and included many caveats. Soon it will be bundling coexisting and additional diagnoses related to the term condition or related conditions worsening the terminal prognosis. Hospice ...

As with many, we've been covering everything related to the primary term diagnosis for years and now just beginning to do the ground work in prep for covering any related illness. We're being instructed to look for at least 2 related illnesses to the...

Sorry, I wish I could delete it. That was a misleading new site.

It will get ugly for many hospice agencies very quickly. Hospice conditions of participation are pretty clear that hospice agencies can't cherry-pick patients. The patient is either hospice appropriate or not. Cost isn't an admission criteria. We've ...

Thanks, that's good input. The other thing is the interpretation of 'aggressive treatment.' It can be twisted to suit the hospice agency's purse strings. For better or worse, there's just not enough auditors out there to catch everything.

Thanks for the input. It's complicated with many different company procedures. I did a quick Google and saw a couple references to backdating being a no-no. I guess that makes sense.

It's interesting you say that cause that's what I was getting at! It seems like a red flag but I'm trying to picture how else it could be done. Until hospital treatments are decided there's really little way of knowing if and when the hospice agency ...

Sometimes, in the case of not revoking, the hospice agency picks up the hospital tab. Of course the hospice agency negotiates a nicely discounted rate with the hospital.

The power is suppose to be on the patient's side within reason of choosing hospice versus aggressive treatments. Revocation of the Hospice Medicare Benefit | National Hospice and Palliative Care Organization

Community docs regularly ask for hospice nurse recommendations for hospice patient med treatments and that includes pain management. This is what we do every day unlike most community docs. Sam, if you're really interested in learning more you shou...

Fentanyl might not work as well for cool skin temps or little adipose tissue. Steroids can be a useful adjuvant for bone mets. http://endoflife.stanford.edu/M11_pain_control/appendD_m01.html

And sometimes we are asked to not say 'hospice' or wear a company badge. Of course many times the gig falls apart as the family forgets or speaks out loud about the disease, utters the word hospice, or tires of the charade.