Hospice care is all about helping the terminally ill to be as comfortable as possible as the end of life draws near. One of the most comforting aspects of hospice is that services can be provided wherever a patient lives, be that a private Cleveland home, a residential care center or a local hospital. Care providers come to the patient – but can individuals on hospice care still go see their regular doctors?
There is a great deal of confusion surrounding this issue, even among medical professionals, but the short answer is yes. That being said, the Medicare hospice benefit has limitations on outside medical care. Here’s what patients in Cleveland, Ohio, need to know.
Medicare Allows Hospice Patients to Appoint an Attending Physician
Upon choosing hospice care, patients can select an attending physician, or the doctor who will be responsible for overseeing their medical care. This individual works closely with the other members of the hospice team to meet the patient’s physical, emotional, social and spiritual needs – and yes, the attending physician can be the patient’s regular doctor.
Medicare will permit a hospice patient to continue seeing their own doctor, but only if that individual is the appointed attending physician. Under the Medicare benefit, only one doctor not employed by hospice can receive payment for medical care related to the hospice diagnosis.
What does that mean?
Every hospice patient has a primary diagnosis, whether it’s congestive heart failure, lung cancer, dementia or some other end-stage disease. When it comes to care related to that diagnosis, only the attending physician gets paid by Medicare. If a patient sees a different doctor for treatment connected to their terminal illness, Medicare will not pay.
Can Hospice Patients See Other Doctors for Urgent Care?
As we’ve explained above, only one physician not employed by hospice can bill Medicare for medical care that is related to a patient’s primary diagnosis. But what about services that aren’t part of the hospice diagnosis? Does Medicare pay other doctors when they provide urgent care to a Cleveland hospice patient?
Yes, but in the event of a medical emergency – such as an accidental fall resulting in a broken arm or a cut that requires stitches — patients are expected to contact the hospice care team instead of calling for ambulance transportation or heading to a local hospital. The team then calls 911, explaining that the patient they are about to assist is in hospice care.
Why is the Medicare-approved approach?
The reason for having the hospice care team make the necessary arrangements is to keep emergency medical services (EMS) personnel from attempting to treat symptoms related to the primary diagnosis. If the hospital or urgent care staff isn’t informed, they may provide care that isn’t covered by Medicare. And in that case, billing claims for those services are likely to be denied.
Why Does Medicare Have these Conditions for Hospice Patients?
Medicare pays a bundled rate for services related to the hospice diagnosis – all of the medications, medical equipment and medical supplies a patient requires are covered, as are care services meant to meet the individual’s physical, mental, spiritual and social needs.
Having Medicare pay all of the costs of hospice care is certainly advantageous for patients, as it saves them a great deal in co-pays and deductibles. At the same time, the bundled benefit is the reason Medicare isn’t willing to pay other doctors for services associated with a patient’s terminal illness.
How is that the case?
Simply put, when someone enters hospice care, the Medicare benefit covers the full cost of the services they require. As they’re already paying the hospice a bundled fee, Medicare isn’t going to pay other medical professionals for those same services – that would result in duplicate payments, something the Centers for Medicare & Medicaid Services (CMS) is always trying to avoid.
Hospice Care and Doctor Visits – Everything You Need to Know
If you were recently diagnosed with a terminal illness, you need to know about hospice care to make informed decisions moving forward. We’ve mentioned that Medicare covers everything from medications to medical services, and if you happen to have Medicaid or private insurance, you’ll be relieved to know that hospice care is typically a covered benefit.
However, we realize that the whole doctor visit situation is somewhat confusing. So, we’d like to highlight the key points to remember:
- If you want to continue seeing your regular doctor for care related to your terminal illness, you can do so after entering hospice care – but only if you name them as your attending physician.
- If you sustain a serious injury or have a medical emergency while on hospice care, a hospital visit may be warranted – but instead of calling for an ambulance, you’ll need to call the hospice team.
Also, we would be remiss in failing to talk about house calls. The truth is, most Cleveland doctors don’t visit patients whenever and wherever they’re in need. Hospice physicians do, and that’s an important detail to know when it comes to the decision on whether or not to stay with your regular doctor.
Would you like more information on hospice care? The professional team at Suncrest is always happy to help. Contact us online or give our office in Cleveland, Ohio, a call today.
