Differentiating Between an Emergency and the Need for Hospice

What are best practices for terminally ill patients who frequent the emergency department? What do patients, families, hospitals and payers want? What is your role? What is the role of hospice?

The Hospital Readmissions Reduction Program is a Medicare value-based purchasing program that was developed by the Centers for Medicare & Medicaid Services (CMS) for a reason. Consider the fact that one third of Medicare patients are readmitted within 90 days, and about 20% of Medicare patients are readmitted within 30 days. At Precious Hospice, we can admit patients whose status are appropriate for hospice directly from the emergency department.

Partnering with Precious to Achieve Key Goals

When a hospital partners with Precious, patients with end-of-life needs get the appropriate care, and the hospital can achieve the following objectives: 

• Reduced ED overcrowding, readmissions and observation periods
• Improved ED throughput and bed cycling
• Seamless transitions to post-acute care
• Improved family-satisfaction metrics

Hospitals are reprimanded for decreased “core measure” quality outcomes and reduced patient/family satisfaction scores.  Furthermore, seriously ill patients do not want to readmit. When surveyed, their preferences and main areas of concern include pain and symptom management, improvement of their relationships with family rather than an increased burden on their loved ones, not lengthening the dying process, and the development and maintenance of a sense of control.  Unfortunately, readmissions are often due to a lack of planning regarding discharge or inadequate community-based or outpatient care, in addition to severely progressive illness.  Patients who are readmitted typically do not have follow-up plans, and oftentimes are not able to voice their diagnosis or medications. Once these types of situations are identified, however, such issues are easy to mitigate.

Indicators that a Patient Might be Eligible for Hospice Care:

• Frequent readmissions to the emergency department, hospital or intensive care unit
• Ongoing symptoms continue regardless of suitable, quality treatment
• Decline of functional abilities
• Decrease and/or consistent declining of renal function
• The utilization of inotropes
• Goals of the patient are centered in their quality of life
• Response to the question: “Would you be surprised if this patient died in the next 6–12 months?” is NO

When a patient is referred to hospice care as soon as it is fit, patients are able to receive the clinical and psychosocial care needed to control their pain and symptoms, and ultimately improve their quality of life. The interdisciplinary team provides care in the comfort of the patient’s home, and continuous care is provided when medically necessary, keeping the patient from having to go to the hospital.