Rearranging the toes on my baby: Full-time physicians making routine visits as part of the hospice home care team

Abstract

Objectives * Explain the rationale for a full-time physician as a member of a home hospice team. * Describe the outcomes of an effort to put physicians on home hospice teams. * Describe barriers to implementation. Facts and Assumptions. Hospice care is proven to be the best care for the dying. The “sweet spot” for value is 90-120 days. All patients expected to die should receive hospice care, leading to the need to manage more patients who are more complex in their homes with a less experienced staff. 70% of referring physicians don’t want to remain the attending physician. Regulatory changes require “doctor” documentation; teaching nurses to think and document like physicians is a fool’s errand. Sick patients need to see a physician every 30 days and as needed. Current patterns of late referral are partially a result of hospices teaching local communities what is the “right” hospice patient and time for referral. Hypothesis. A doc on a team will improve care, permit hiring less experienced nursing staff, improve referring relationships that will lead to earlier and more referrals. Billing for direct patient care services plus $3 per patient day from the per diem will cover the costs of the added physicians. Results. Hospice teams have fixed cultures that are hard to change. Sustained effort and time is needed to manage the change. Support for a physician practice must be built within the hospice infrastructure. Financial results have continued to improve over the time course of the implementation phase. A qualitative assessment of achievements and challenges are discussed with interdisciplinary members of a home hospice team.