Last year, a hospice medical director in Pennsylvania, was convicted of Medicare fraud for false certifications of the clinical eligibility of patients for hospice care. The wrongdoing involved appears to be fairly black and white. However, another more nuanced area of regulatory oversight of physicians is looming on the horizon.
Every hospice physician has experienced difficulties in assessing “gray” patients. These are the ones who, at admission, do not have a principal diagnosis or terminal story that leaps out from the record, although for many of these patients, the physician is able to answer “no” to the “would you be surprised if your patient dies within the next six months” question.
- Are these patients truly terminally ill?
- Is a period of seeming stabilization sustainable?
- Should these patients be evaluated for discharge due to extended prognosis?
May I be the first to acknowledge that I am certainly not a poet! Let me also be clear that this is written with the utmost of respect for the sacred responsibility that we elect in accepting the privilege of caring for those at the end of their lives. However, in the stressful times in which we are living, with increasing regulatory and public scrutiny, burdensome processes (e.g., The Hospice Item Set, CR 8358, etc.), and unclear guidance (e.g., Medicare Part D), my hope is that a small dose of humor might help in palliating some of the symptoms of confusion, frustration and disempowerment. And so yes, this blog post is ‘related’!