Eli's Hospice Insider

Published on Sun Nov 21, 2010 PDF

You can prevent terminally ill patients from feeling 'abandoned' and 'ignored.'

Hospices looking for a new educational outreach area should put emergency departments (ED) on their radar.

Many terminally ill patients must seek emergency care, but ED staff often lack the training necessary to treat them, according to a recent report in the Annals of Emergency Medicine. In interviews with researchers, patients, families, and staff members said that patients felt abandoned or ignored by emergent care providers who are more focused on resuscitating patients who've experienced traumatic or sudden injuries.

"Patients and their families receive a lot of attention and support in the emergency department when there is an unexpected acute medical illness or a sudden, often traumatic event that results in death," said lead study author Cara Bailey, MD, adult nursing lecturer at the College of Medical and Dental Sciences at the University of Birmingham in the UK.

The study as found that more than 66 percent of end-of-life patients die in the hospital -- not at home. Further, their deaths occur in the first few hours of seeking care in the ED, the report says.

Bottom line: "Generally, the ED staff did not feel prepared for caring for the dying in the ED," Bailey stated. This highlights a critical need for collaborative effort among healthcare professionals to improve end-of-life care in the emergency department, the study concluded.

• If you have to change your hospice patient's benefit period dates on the certification form after the physician has signed it, just marking out the old date and putting in a new one isn't enough, according to regional home health intermediary Palmetto GBA in its most recent Ask the Contractor Teleconference (ACT) minutes.

Sometimes the dates have to be changed when the common working file is updated due to a submitted bill, a hospice told Palmetto.

"If a provider needs to make a change to a form that has already been signed, Medical Review (MR) suggests the provider obtain a verbal order from the physician that signed that form (in this case, the certification of terminal illness) to reflect the change that is to be made," Palmetto says in the ACT minutes on its website.

"For MR purposes, we would expect this to be signed and dated prior to billing the claim to Medicare for payment," Palmetto clarified.