Hospice
Hospice is a team approach
to health care that helps patients at the end of life either
at home, or in a hospice or hospital setting. Hospice care
provides physical, emotional, and spiritual comfort for the
patient, and education and support for the patient and family.
It is possible for dialysis patients to receive hospice care.
Hospice is paid for through
the Medicare Hospice Benefit, Medicaid Hospice Benefit, and
most private insurers. If a person does not have insurance
coverage, hospices will work with the person and his or her
family to ensure needed services are provided. Hospice is
available to all persons regardless of age, race, or religion.
Underutilization of hospice
in the end-stage renal disease (ESRD) population may be fostered
by confusion with regard to eligibility and variability of
providers to accept ESRD patients. A patient with ESRD may
receive Medicare coverage for hospice services. Medicare coverage
for both dialysis and hospice services is available under
separate benefits for ESRD and hospice. ESRD patients are
not required to withdraw from dialysis to be eligible for
the Medicare hospice benefit.
ESRD patients who choose to
withdraw from dialysis may receive Medicare coverage for services
via the hospice benefit. In this situation, ESRD may be considered
the terminal diagnosis and all services related to ESRD would
be covered under the Medicare hospice benefit.
ESRD patients may elect to
use the hospice benefit under a diagnosis of ESRD as the terminal
diagnosis. In this situation, the hospice provider must be
responsible for all dialysis and supplies as part of the care
for the terminal diagnosis and palliation. This must be reflected
in the plan of care. Under these circumstances, the Medicare
hospice benefit would be engaged without the Medicare ESRD
benefit. A diagnosis of ESRD may be used as the terminal diagnosis
only when 1) the hospice provider accepts responsibility for
dialysis and non-dialysis renal related services or 2) a patient
chooses to withdraw from dialysis.
ESRD patients with a terminal
diagnosis other than ESRD who choose to continue dialysis
for palliative reasons may receive the Medicare hospice benefit
for services related to the terminal diagnosis. Hospice services
not related to the terminal diagnosis are not covered under
the hospice benefit. Thus, Medicare coverage for services
related to ESRD (including dialysis and non-dialysis renal
related services) would continue under the ESRD benefit.
Additional information on
the Medicare Hospice Benefit is available by visiting the Centers
for Medicare & Medicaid website. This resource has
been developed to incorporate all Medicare Fee-for-Service
Hospice information in one location. It includes billing and
payment information, CMS Manuals, and educational resources.
Caring
Connections is a program of the National Hospice and Palliative
Care Organization (NHPCO). It is a national consumer engagement
initiative to improve care at the end of life, supported by
a grant from the Robert Wood Johnson Foundation. It provides
free resources and information to help make decisions about
end-of-life care and services, including hospice.
Educational Tools for Dialysis Facility Staff and
Hospice Providers:
*NEW* End
Stage Renal Disease: When Is It Time for Hospice? (PowerPoint
Slide Presentation) This presentation addresses the Medicare
hospice benefit available to ESRD patients. Presented to the
National Hospice & Palliative Care Organization in May
2007, this presentation has 3 components:
- Introducation &
Background, presented by Perry Fine, MD
- ICD-9-CM 585.6
End Stage Renal Disease, presented by Harry Feliciano,
MD, MPH. This presentation addresses coding and payment
and is directed at hospice agencies (for companion case
study, click this link: ICF-Enhanced
ESRD Case Scenario (PDF))
- The Hospice-ESRD
Patient-Dialysis Center Interface, presented by
Malene Davis, RN, MSN, MBA
*NEW* Renal Palliative
Care Bibliography (PDF)
Did this patient
die with hospice? New questions in caring for patients with
ESRD (Slide Presentation PDF)
Hospice in ESRD:
To Withdraw or Not to Withdraw (Slide Presentation PDF) |