Rearranging The Toes On My Baby: Full-time Physicians Making Routine Visits As Part Of The Hospice Home Care Team.
Title
Rearranging The Toes On My Baby: Full-time Physicians Making Routine Visits As Part Of The Hospice Home Care Team.
Creator
Von Gunten C
Identifier
DOI: http://dx.doi.org/10.1016/j.jpainsymman.2015.12.269
Publisher
Journal Of Pain And Symptom Management
Date
2016
Description
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.
Vol. 51 No. 2 February 2016 Schedule with Abstracts 389
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.
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.
Vol. 51 No. 2 February 2016 Schedule with Abstracts 389
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.
Rights
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Citation List Month
March 2016 List
Citation
Von Gunten C, “Rearranging The Toes On My Baby: Full-time Physicians Making Routine Visits As Part Of The Hospice Home Care Team.,” Pediatric Palliative Care Library, accessed April 24, 2024, https://pedpalascnetlibrary.omeka.net/items/show/10581.