The following excerpts were taken from a directive letter written for Physicians from the Director of CMS (Center for Medicare and Medicaid Services) regarding hospice care:
Should I recommend hospice care?
“Physicians, hospitals and skilled nursing facilities are urged to recommend hospice care to beneficiaries when it is determined that the patient has six (6) months or less to live and may benefit from it.”
Who makes the decision on terminality and how?
“The certification of terminal illness of an individual who elects hospice shall be based on the physician’s or medical director’s clinical judgment regarding the normal course of the individual’s illness.”
What if the patient lives longer than six months?
“The Medicare Program recognizes that terminal illnesses do not have predictable courses; therefore the benefit is available for extended periods of time beyond six (6) months provided that proper certification is made at the start of each coverage period.”
Identification of hospice appropriate patients:
- Patient has a life limiting illness with prognosis measured in months
- Weight loss of 10% or more in six months or less
- Recurrent infections in last six months
- Frequent hospitalizations in last six months
- Patient or family refuses PEG placement (Prior PEG does not exclude patient)
- Patient refuses hospitalization or other aggressive treatments
- Patient has optimal treatment, but continues to exacerbate
- Significant decline in overall health due to multiple medical and functional problems
Guidelines for non-cancer Diagnoses can be found on our “diagnosis guidelines” page.
These guidelines are not meant to be inclusive. They are examples of criteria requirements set forth by the National Hospice Organization. A consultation would be necessary to make a definitive determination regarding hospice appropriateness.