Alamo Hospice is so honored to be joining NSIdE Md. over the next several months, this column will exam- ine the opportunities and challenges associated with end-of-life care.

In the past five to ten years, the utilization of hospice has grown exponentially in the United States. according to statistics supplied by the National Hospice and Palliative care organization ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ), in 2006, more than 1.3 million people received hospice services in the United States, a 162% increase in ten years. In Bexar county, on any given day, there are at least 1,000 to 1,500 patients receiving hospice care. cancer accounts for roughly 46% of hospice patients. The remaining 54% fall into several categories: heart disease, lung disease, stroke or coma, kidney disease, liver disease, HIv/aIdS, debility unspecified, and dementia including alzheimer’s and motor neuron diseases. approximately 87% of hospice reimbursement is provided by Medicare. These statistics clearly demonstrate that at some point, almost everyone in our healthcare community will play a role in end-of-life choices for someone. and, our aging population, including the aging baby boomers, will certainly add to the frequency with which those of us delivering healthcare are faced with these decisions and choices.

Hospice, unfortunately, has become associated with a number of myths over the years. Some of these are rooted in the unique set of circumstances that gave birth to the Medicare hospice benefit in 1983. others find their genesis in misinformation, a lack of knowledge, a bad experience, or an overzealous representation of what hospice provides. dismantling these myths about the Medicare hospice benefit may be the starting point for those who are considering adding hospice to the choices available to patients facing end-of-life healthcare decisions.

The first myth we want to examine is that hospice is not a part of the healthcare continuum. It is in fact an integral part of the continuum. Medicare Part a provides the beneficiary with four treatment options: hospitalization, home health, skilled nursing facility and hospice. Medicare views hospice on an equal footing in this quartet. The hospice benefit has some unique characteristics which are designed to ensure that patients electing this benefit know how medical care, pharmaceuticals, dME, supplies and counseling services are paid for. But, the unique characteristics do not place it outside of the continuum. Rather, they simply provide an alternative to the physician faced with guiding a patient whose options are diminishing. Hospice should be viewed on the same page as every other consultant available in the physician’s arsenal to maximize the care choices for the patient. The hospice program should provide the physician with demonstrable expertise in having the hard conversation with patients and their families, explaining the hospice benefit, and guiding the patient and caregiver to understand the difference between curative and palliative approaches to their disease symptoms. Ultimately, the decision to choose hospice, like all other serious healthcare decisions, should be guided by the patient’s desires, his or her physician’s recommendations, and input from consultants and specialists.

The second myth we want to look at this month is that once a patient chooses hospice, he or she can no longer receive care from their primary care physician or specialist. again, because hospice is a part of Medicare Part a, the relationship of physicians to their hospice patients is really no different from their relationship to any other patient who has been referred for specialty consultation. diagnostic Related Group prefixes have been estab- lished by cMS for physicians seeing patients on hospice. If the physician is not an employee, contractor, or volunteer of the hospice, the physician may bill their Medicare Part B carrier for the professional and administrative services provided to a hospice patient. Professional services include cPtcode designated services, such as actual procedures, billable care plan oversight, physician consultation or interpretation of an x-Ray, ct scan, MRI and physician interpretation of a laboratory test. administrative services include participation in the establishment review and updating of the patient’s plan of care.

The last myth that we will examine this month is that once a patient elects the hospice benefit, he or she cannot return to more traditional medical treatment. When a patient chooses hospice, they sign an election of benefits under Medicare. at any time while they are under the care of a hospice, they have the option to sign a revocation of the hospice benefit and return to more aggressive and curative treatment.

Next issue we will take a look at another topic related to providing quality end-of-life care. Hopefully this discussion and the ones to come will help make the case that hospice is a dedicated part of our local medical community and that hospice is a valuable and necessary resource for our community. In the meantime, feel free to contact us with any questions you have.