Education, Care Coordination Key to Preventing Unnecessary Revocations of the Hospice Benefit 

Hospice News | By Jim Parker

Revocations of the hospice benefit can have serious adverse effects on patients and families, as well as providers. Understanding the causes and repercussions of these incidents can help operators prevent them, when appropriate.

Live discharges can occur for a number of reasons, including the patient or family changing their minds about receiving hospice care, or the patient improves and no longer needs those services. A patient may choose to resume curative treatment, or they might move out of the hospice’s service area.

In some cases, a frightened patient or a patient in crisis may call an ambulance or visit and emergency room, prompting revocation of the Medicare Hospice Benefit in order to receive hospital care.

Causes of Revocations

When it comes to revocations, fear and a lack of education about hospice are often significant factors, Sara Sprague, manager of clinical quality improvement, for Providence Hospices of Orange County in California, said at the National Hospice and Palliative Organization’s (NHPCO) Annual Leadership Conference.

“Families don’t fully understand hospice and the scope of hospice, what it provides. There’s also a lack of clarity on disease progression and prognosis, caregiver burden, distress, or difficult to manage symptoms,” Sprauge said at the conference. “You also have caregivers’ reluctance to administer morphine, and the response time of the hospice when compared to 911, and the family’s difficulty in accepting the patient’s own mortality. What’s interesting here when you look at these items is that some of them are within the control of hospice.”

About 15.4% of patients who were discharged from hospice in 2020 did so while they were still alive, according to NHPCO. Of those, 5.7% were due to revocations, and 2.2% transferred to a different hospice.

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