New Medicare rule could cost hospice providers more and limit their reach

Source: Journalnow.com
By RICHARD CRAVER

A new Medicare rule requiring a doctor or nurse practitioner to visit patients in person after 180 days of hospice care is likely to raise staffing costs for providers and could limit the reach of assistance in rural areas.

The rule, which goes into effect today, requires a face-to-face visit before a hospice patient can continue to receive care after two 90-day periods. However, Medicare agreed Dec. 23 to postpone enforcing the rule until April 1 to give providers more time to meet its requirements.

The primary functions of the visit are to make sure that the patient still needs end-of-life care and that the care is appropriate for the person’s needs.

The goal of hospice care is to provide comfort to a patient who is close to dying rather than to continue treating the patient to extend his or her life. Some hospice care is provided in facilities, and some involves visits to patients’ homes. Care is provided by medical professionals and lay volunteers.

Local and state officials said the rule would affect about 9 percent of North Carolinians who receive hospice care.

Where the cost comes into play is that Medicare will not allow a provider to bill for the doctor or nurse practitioner visit. It’s considered an administrative requirement, so the bill must come out of Medicare’s per diem rate of about $130 a day.

“It’s going to stretch all of us, no question about it, more so with the smaller hospices,” said JoAnn Davis, the president and chief executive of Hospice & Palliative CareCenter, which is based in Winston-Salem and serves 13 counties.

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There’s a lot to do after bringing someone home from the hospital. The obvious goal is continued recovery. But roughly 20% of older adults are rehospitalized within 30 days because of problems that develop at home.

Research shows there are three things you can do to prevent a backslide. It’s important to get going on them even before your loved one is discharged.

- Understand the new medication schedule. Meet with the discharge planner to review medications. Bring a list of what your loved one was taking before hospitalization. If any of these drugs are not on the current list, ask if they should be restarted. Review each new medication. When should it be taken? How long should it be taken? Any side effects? Have new prescriptions phoned in to the pharmacy before you leave the hospital.

- See the doctor for follow-up within a week. Find out what doctor(s) your loved one should see. Request that the hospital forward records to all of them. Before you leave the hospital, call the doctor’s office to set up an appointment for the next week. You may need to be firm with the receptionist and explain that your loved one has just been hospitalized.

- Know the signs and symptoms of problems. Before leaving the hospital, consult with the discharge planner about what to expect. Ask them to group symptoms as “green light,” normal recovery. “Yellow light,” early signs of a possible problem. And “red light,” a significant problem. Find out what to do and who to call in case of yellow or red light symptoms.

Focusing on these three tasks can significantly speed recovery and reduce your family member’s chance of rehospitalization. If you are confused about any of these tasks, insist on having your questions answered before you leave the hospital.

For more, visit http://www.hospicecarecenter.org!

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Dying at home, surrounded by family
Source: CNN.com
By Madison Park, CNN

Elizabeth Edwards died Tuesday, after doctors had told her further cancer treatment would be “unproductive.” She was at home, surrounded by people who loved her.

Next to picking a life partner or becoming a parent, there isn’t a more personal decision than how to die for those who get the opportunity to choose.

When the limits of modern medicine are reached, it’s a heavy consideration for terminally ill patients. For some, making the conscious decision to end treatment is tantamount to giving up or giving in. They worry about disappointing the people who care about them.

But one end-of-life expert sees it differently, noting that a growing number of patients are choosing hospice, so they can be made comfortable in familiar surroundings with family and friends close by.

“People in hospice don’t want to die. They want to live, and they want to live well,” said Dr. David Casarett, associate professor of medicine at the University of Pennsylvania. “They want to use whatever time they have to live the best way they can. I don’t think it’s giving up. It’s making a careful choice.”

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