Who can order Hospice

[Mamanurse62]

Where in medicare regs does it tell who can order hospice? We have lengthy discussions about this in my office. I work in South Carolina and have always been under the impression that only MDs or DOs can order a patient to be on hospice, but now I am hearing from corporate that we can accept an order from a nurse practitioner and even an office nurse to assess and admit a patient to hospice. Help! Thanks

[tewdles, RN]

Where in medicare regs does it tell who can order hospice? We have lengthy discussions about this in my office. I work in South Carolina and have always been under the impression that only MDs or DOs can order a patient to be on hospice, but now I am hearing from corporate that we can accept an order from a nurse practitioner and even an office nurse to assess and admit a patient to hospice. Help! Thanks

I have participated in referrals which came from family members. The daughter or son has called the hospice agency and requested an evaluation. In those cases the agency may meet with the family and discover the facts of the situation, often meeting and assessing the patient in those visits. The agency may then contact the MD and discusses the family's desires with the MD. In other cases, the agency has encouraged the family to meet with the physician and discuss the case and their thoughts about hospice prior to the hospice visit.

The bottom line is that there must be 2 physicians who are willing to sign a certificate of terminal illness. We prefer that one of those physicians is a medical doctor who has an ongoing relationship with the patient. If the primary or family physician is in a state of denial about the status of the patient, we will accept the signature of a hospitalist, or specialist who is familiar with the case, particularly when it is clear that the patient is terminally ill. It is the desire of hospice to create a comfortable and dignified "end of life" process for the patient and family. This requires honesty and integrity and trust. Many times it involves the ongoing medical relationship with the doctor who has provided their medical care for years and we (hospice) want to encourage that when we can.

[Mamanurse62]

Thanks for your reply. This was very helpful