Hospice Eligibility

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“As Medicare spending on hospice care has grown steadily in recent years—reaching $15.1 billion annually—the government has stepped up its regulatory scrutiny of hospice enrollment practices to make sure that only eligible patients are being admitted. Some primary care physicians might wonder then, how and even whether to utilize hospice care for the benefit of their patients who experience advancing illnesses. ”

To be eligible for hospice services, Medicare guidelines say a person must receive a hospice evaluation order from a physician stating they have a life-limiting illness and will likely live 6 months or less. A completely accurate terminal prognosis can sometimes be hard to determine. Doctors can see a patient who’s progressively getting worse and still fails to meet this Medicare criteria. However, a primary physician, because they see the patient most regularly, can help in sharing the patient’s history and medical issues related or unrelated to the terminal prognosis. Anyone with a  progressive, life-limiting illness or condition (not just cancer), may be appropriate for hospice.  Alzheimer’s, dementia, ALS, liver disease, renal disease and stroke just to name a few. Sadly, a lot of individuals who could benefit from hospice care never receive it or it’s introduced in the last days of someone’s life. Those admitted onto hospice are reviewed regularly. Doctors approve hospice services during each certification period (2-90 day periods and then every 60 days thereafter) and can cancel services if a patient improves. Patients themselves can also revoke hospice services at any time if they choose and wish to seek aggressive treatment.

Hospice is about LIVING. Talk to your family and doctor about your diagnosis and your options, decide what’s right for you.

Click on the link below to watch a short video explaining eligibility with our Community Education Nurse, Julie McIntosh.

Hospice Eligibility Introduction – CompassionCare Hospice


Sources: Article on medicaleconomics.com: Top facts primary care physicians need to know about hospice care