Though Medicare has upped its spending on hospice care, some primary care physicians remain uncertain about how and when to refer patients to such services, Medical Economics reports.
Physicians continue to have difficulty discussing advance care, much less disentangling new payment policies from the Centers for Medicare & Medicaid Services (CMS) aimed at improving end-of-life care, recent reporting by FiercePracticeManagement suggests. In general, there’s little reason for the new rules to affect referring physicians, according to Joan Harrold, M.D., vice president of medical services at Hospice & Community Care in Lancaster, PA. That’s because the majority of physicians refer their patients too late to hospice care, rather than too soon, she says.
While Medicare has tightened its auditing practices around hospice claims, Harrold says a failure to meet the clinical criteria set by CMS for hospice care doesn’t necessarily mean that care is unwarranted. Furthermore, she notes that primary care physicians are “in a unique position to see a patient’s decline over months.” That makes doctors key advocates for their patients, particularly when a hospice determines a patient is ineligible for care, at which point Harrold suggests physicians step up and provide the hospice with additional information on the patient’s history and medical conditions.
Primary care physicians also may not know the extent to which they can remain involved in a patient’s care after making a hospice referral, says Harrold. Robert L. Wergin, M.D., board chair of the American Academy of Family Physicians, recommends doctors continue to act as attending physicians for patients after referring them to hospice. This approach allows physicians to facilitate communications between the patient and the hospice care team, and to ease the transition via continued office visits and home visits, acts Wergin says make a significant difference for dying patients.
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