Physicians and Hospice: A Partnership for Patients

Hospice as Part of Your Continuum of Care

VITAS Healthcare manages the care and challenges posed by high-risk, high-need patients, resulting in superior healthcare for hospice-eligible older adults.

Serving as an extension of your care, VITAS honors your patients' goals, values, and wishes for care. All VITAS care plans incorporate resources to ensure patients die in their location of choice (e.g., home).

This care, in turn, improves quality metrics and care satisfaction when death occurs while the patient is receiving hospice services. It also reduces unnecessary hospital and ED visits, keeping your patient at home, where they prefer to be.

VITAS: Your Care Transitions Expert

The increased complications experienced by patients with serious illness result in an increased need for a care team that proactively coordinates care on a patient-by-patient basis.

This is the interdisciplinary team approach used by VITAS. The care we coordinate goes beyond the clinical: it also involves psychosocial, educational, and holistic care provided by advanced illness specialists.

VITAS serves as a single entity responsible for ensuring the coordinated care of our patients. This means we are accountable to share information with our patient’s primary providers, keep our patients and families informed, manage timely transitions between care settings, and provide the right care in the right place at the right time.

In addition, VITAS has a team of dedicated representatives who provide customized service levels and reporting based on the needs of your practice.

Our goal is to lead safe, effective, comprehensive care in the home and prevent unnecessary, burdensome hospital visits and admissions.

When is the Right Time to Refer a Patient to Hospice?

Consider hospice if a patient meets 2 or more:

• Dependent in 2-3 of 6 ADLs
• SOB or fatigue at rest/minimal exertion
• Multiple ED visits or hospitalizations
• 10% weight loss in 6 months
• Recurrent falls with injury
• Decreased tolerance in physical activity

The Medicare Hospice Benefit is a 6-month benefit, yet the median hospice stay is only 17 days. VITAS supports timely access to hospice care across the most common causes of death in the US—heart disease, cancer, lung disease and dementia. Patients diagnosed with one or more of these conditions can greatly benefit from high quality end-of-life care.

All hospice-eligible patients should have the opportunity to access hospice in a way–and for a length of time–that allows them to fully benefit from this unique care model.

Timely Hospice Lowers Healthcare Costs

A study conducted by NORC from the University of Chicago found that in the last year of life, hospice stays of six months or more add value to Medicare¹.

• For those who spent at least 6 months in hospice in the last year of their lives, spending was 11% lower than the adjusted spending of beneficiaries who did not use hospice.
• For 90% of hospice stays evaluated, hospice spending is less than half of total cost of care.

Disease-Specific Guidelines for Hospice Eligibility

A cancer patient who may be ready for hospice services does not look like a patient with end-stage COPD. Their signs of clinical decline are very different.

VITAS provides hospice eligibility guidelines for the most frequent diagnoses. You’ll find them in our mobile app.

• ALS—Two factors are critical in determining prognosis: ability to breathe and ability to swallow.
• Alzheimer’s and dementia—When your patients can no longer move around, get dressed, bathe or speak, they may be eligible for hospice care.
• COPD and lung disease—Look for dyspnea at rest or with minimal exertion.
• Heart disease—Characteristics include NYHA Class III or IV.
• HIV and AIDS—Your patient has low CD4 counts and decreased performance on the KPS scale.
• Liver disease—Look for persistent symptoms of hepatic failure.
• Oncology—The biggest predictor is your patient’s functional status on the ECOG scale or PPS.
• Renal disease—Any patient who does not choose rehabilitative dialysis is eligible.
• Sepsis and concomitant end-state disease—Any patient with advanced illness and a clinical complication of sepsis is eligible.

Your Responsibility as the Attending Physician

At VITAS, you can be as involved in the end-of-life care of your patients as you wish, depending upon your availability.

VITAS care plans are dependent upon the attending physician’s approval. If you refer to hospice a patient who then designates you the attending physician, you can retain control and bill for care you provide related to the terminal diagnosis.

As the attending physician for the patient(s) you refer to VITAS for hospice services, you are an integral member of our interdisciplinary team, which has overall responsibility for managing and providing hospice care to these patients. VITAS will handle any after-hours emergencies.

To provide hospice care to your patients, VITAS must obtain, at the time a patient is admitted to hospice care, a certification that, based on your clinical expertise, the patient's prognosis is for a life expectancy of six months or less if the terminal illness runs its normal course.

Contact us to learn how VITAS can help you care for your patient.

¹NORC at the University of Chicago (2023). Value of Hospice in Medicare. Available at: https://www.nhpco.org/wp-content/uploads/Value_Hospice_in_Medicare.pdf