Disproportionate spending on the care of individuals as they approach the end of life is an issue that is generating significant discussion among legislators, healthcare payers and the private sectors.
For too long, care has primarily focused on applying curative care approaches for those with advanced illness with little regard to the patient’s wishes or emotional and social needs. With 30 percent of Medicare dollars being spent during the last 12 months of life, many conclude that it’s time to rethink our approach to caring for those with serious illness.
Although the concepts of hospice and palliative care both address these issues, there are distinct differences:
Defining Hospice Care
Hospice care is the model for quality compassionate care for people facing a life-limiting illness. It focuses on pain and symptoms, and attends to the patient and family’s emotional and spiritual needs. Sometimes patients are admitted to hospice in the hospital or go for inpatient care, but it’s usually provided in nursing homes and offered to those who would rather spend their last months and days of life in their own homes.
Hospice programs utilize a multidisciplinary team approach to patient care to improve the quality of life of the patients and their families. Relying on input from physicians and in coordination with the patient-centered medical home, nurses, chaplains, social workers, psychologists and other clinicians develop and implement a plan of care that is formulated to relieve anxiety and suffering in all areas of a patient’s life. This approach allows the hospice team to address physical, emotional, spiritual and social concerns that arise with advanced illness.
Here are seven important facts about hospice:
- Helps people who are terminally ill live comfortably
- Isn’t restricted to people with cancer
- Focuses on comfort, not on curing an illness
- Provides care for the “whole person”
- Includes physical care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions
- Is provided in the home
- Supports family caregivers
Key Differences Between Hospice and Palliative Care
The biggest difference between hospice and palliative care is where the patient is in their illness related to prognosis and their goals/wishes regarding curative treatment. Palliative care also takes an interdisciplinary approach using highly trained professionals including physicians, nurse practitioners, nurses, social workers, chaplains, other disciplines, and may be offered where and when the patient first sought treatment for a condition.
While palliative care is appropriate earlier in the disease, consultation is often not sought until late in the disease process. Based upon FFS billing through Medicare Part B, most community-based palliative care programs utilize nurse practitioners and physicians for home visits. Other disciplines, such as nurses and social workers, cannot bill Medicare for palliative home visits.
Goals of Services provided:
- Focus is on relief from physical suffering and caregiver burden for patients who are living with a chronic disease that may or may not be terminal
- Addresses the patient’s physical, mental, social, and spiritual well-being
- Appropriate for patients in all disease stages
- Accompanies the patient from diagnosis to cure
- May use life-prolonging medications
- Non-medical personnel help patients and families deal with the emotional fallout from serious illness and associated issues, such as providing meals, transportation to and from doctor and other appointments, dealing with finances and payment of rent, mortgage, and other bills.
- Patient may continue with curative/active disease management
- Uses a team approach with specially trained professionals, and typically offered when the patient first seeks treatment.
- Available to terminally ill Medicare participants with up to six months to live and forgoing curative care
- Patient comfort
- Preparing for end of life
- Does not use life-prolonging medications
- Relies on a family caregiver and a visiting hospice nurse
- Is offered at a place the patient prefers such as in their home, a nursing home, a hospital, or a hospice facility
Hospice care is reserved for people at the end of life who meet eligibility requirements and elect a comfort approach to care. Hospice covers all services and care related to the terminal illness and related conditions through Medicare, Medicaid, and most commercial insurance. The Medicare Hospice Benefit (MHB) requires that two physicians certify that a patient has less than six months to live if the disease follows its usual course. However, this does not mean that if a patient is still living after six months he or she will be discharged from hospice.
When a patient elects hospice, they sign off their Medicare Part A (hospital insurance) and enroll in hospice under the MHB. From that point on, direct care is provided by a Medicare-certified hospice agency.
Under terms of the MHB, the hospice agency is responsible for the plan of care and may not bill the patient for services. The hospice agency, together with the patient’s attending physician, is responsible for determining the plan of care. All costs related to the terminal illness are paid from a per diem rate that the hospice agency receives from Medicare. This per diem rate includes all drugs and equipment, nursing, social service, chaplain visits and other services deemed appropriate by the hospice agency. Care not related to the terminal illness or related conditions continue to be paid for through original Medicare.