Some physicians perceive that the Medicare hospice benefit requirement for “a prognosis of six months or less if the illness runs its normal course” means that patients who live longer than six months must either be automatically discharged from hospice or that a hospice that cares for such a patient will become de-certified. Neither of these is true: If the hospice makes a thoughtful determination based on accepted prognostic standards, it is not required to discharge a patient who lives longer than six months. There are clear guidelines for prognosis and there are guidelines for re-certification.
Although palliative care is appropriate for patients with non-cancer diagnoses, and there is increasing research and education in this area, we remain hesitant to use it. In 2003, cancer accounted for 49% of all admissions and heart disease for only 11%. Yet in 2002, heart disease remained the leading cause of death in the United States.
Seriously, any Medical Professional who has questions on how hospice works should read this article. It will answer some very big questions and deal with a couple of the biggest myths of hospice care.