Healthcare Providers

Collaborative Approach to End-of-Life Care

As the first hospice in Wisconsin, you can rely on Unity to provide the highest quality end-of-life care to your patients and families.

Our collaborative approach to care enables attending physicians to oversee symptom management while Unity’s care team, consisting of Registered Nurses, Licensed Practical Nurses, Social Workers, Certified Nursing Assistants, Grief Counselors, Chaplains and volunteers, assess and assist with ongoing medical, emotional and spiritual needs. Together we can maximize patient comfort and family support while minimizing hospital visits.

The Referral and Admission Process

When your patient has a prognosis of 6 months or less …

  • Document why your patient is ready for hospice. (Documentation matters as hospices are audited routinely. Call the hospice medical director if you have questions.)
  • Examples of information that supports a six-month prognosis from the perspective of CMS:
    • Cancer – Imaging abnormalities, particularly metastatic cancer
    • Cardiac – NYHA Class IV and Echo abnormalities, particularly EF<20% and/or severe diastolic dysfunction.
    • Pulmonary – PFTs with FEV1 <30%, Pulse oximetry on RA <88%, Resting tachycardia
    • Labs – Decreasing albumin / severe anemia / Cr >8.0
    • Recurrent hospitalizations, especially for infection disease reasons
    • Weight loss greater than 10% body weight in 6 months
    • Pressure sores stage 3 or 4 despite good wound care
    • Worsening function – ADLs / falls / mobility / dysphagia
  • The patient’s medical information is gathered by the hospice.
  • The hospice medical director verifies hospice eligibility.
  • The hospice medical director determines hospice diagnosis(es).
  • The patient is informed they are eligible for hospice services.
  • The patient chooses an “attending” provider who gives medical care until death (typically the provider making that hospice referral).
  • The attending and hospice medical director sign a “Certification of Terminal Illness (COTI).”
  • The hospice team completes the admission process and begins providing care.

Patient Benefits

About Patient Benefits

Early referral is key to a better hospice experience. The National Hospice and Palliative Care Organization (NHPCO) states that referring your patients to hospice at least three months prior to death, they will have access to the full range of benefits including:

  • Better quality of remaining life
  • Longer life
  • Improved symptom control
  • Assistance for caregivers
  • More time at home
  • Reduced medical expenses
  • Support for family and caregivers

Hospice care provides:

  • DME and select supplies
  • Medications related to terminal illness
  • Oxygen
  • Respite care
  • Care provided by an interdisciplinary team of Attending Physician, Registered Nurse, Licensed Practical Nurse, Social Worker, Certified Nursing Assistant, Chaplain, Grief Counselor and Trained Volunteers.

Patient Eligibility

Hospice is a Medicare benefit, so patient eligibility is strictly regulated. Your patient is eligible for hospice care if:

  • They have a prognosis of six months or less to live
    • If disease runs its usual course
    • And is determined by two physicians (hospice medical director and attending physician)
  • They may not be seeking curative treatment (unless under age 21)

Though some diagnoses are not eligible, hospice care is available to more than just cancer patients. Hospice eligibility is also not determined by age. If a patient is under 21, he/she can seek curative treatment while in hospice care. Lastly, eligibility is not determined by a patient’s living situation. Unity provides care wherever a patient calls home including their residence, a hospital, skilled nursing facility, community-based residential facility, residential care apartment complex and Unity’s Jack and Engrid Meng Residence.

Four Levels of Care

In the U.S., 80% of all hospice care is covered by the Medicare Hospice Benefit which specifies four levels of hospice care to meet the diverse needs of patients and families. As dictated by Medicare Law, the level of care provided is determined by a custom plan of care developed by the hospice team and attending physician. The four levels of hospice care as defined by Medicare are:

  • Provided within the patient’s home or eligible residence.
  • Provided to all patients regardless of reimbursement source.
  • No time limit if patient continues to meet hospice admission criteria.

Formerly known as acute care

Brief inpatient care to manage acute or chronic symptoms that cannot be managed in other settings.

  • May be required for procedures to control pain or symptoms.
  • May be provided in contracted hospitals.

For Unity to be the guarantor, the patient must have a general inpatient care benefit included in the hospice benefit. Medicare and Medicaid have this benefit. Insurance patients are most often hospitalized using his/her major medical insurance benefit; the insurance company may have requirements for pre-certification.

Medicare hospice benefit has a limit of 20% of total hospice days of care that can be provided at an inpatient level of care (includes both general inpatient care and respite care).

  • To provide a rest period or break for the caregiver.
  • Care will be provided for a minimum of three days and a maximum of five days per occurrence.
  • No limit on the frequency respite care is used, but it is expected that it would be used only occasionally.
  • Available to patient and family based upon reimbursement source.
  • Provided at the patient’s residence during a short-term, temporary period of crisis.
  • Requires a minimum of eight hours of care per day and a need for skilled nursing. The nurse (RN or LPN) is required to be present for over half the continuous care hours. A CNA, homemaker, companion sitter, social worker or chaplain may be present when a nurse is not.
  • All nursing and CNA hours must be included. CNA hours cannot exceed nursing hours.
  • Available to all patients regardless of reimbursement source (payment varies according to reimbursement source).

Reimbursement for Hospice Care

A common misconception held by many attending providers is that they lose out on Medicare reimbursements when their patient is admitted to hospice. This is not true. Medicare reimburses physicians and nurse practitioners for qualified time spent overseeing the care of patients in hospice. Medicare also reimburses providers for care addressing health conditions unrelated to a patient’s hospice diagnosis. Learn more from the Centers for Medicare & Medicaid Services.

Hospice Resources

Review Unity’s educational literature for more information.