It is estimated about 10% of all physicians care for 50% of patients requiring hospice services. This is partially due to the fact not all physicians deal with patients with end of life issues. There are several factors that come to play when a doctor makes a hospice referral. Here is what you need to know when it comes to hospice referrals from doctors.
Probability of Referral
Where you live may affect whether or not you can get a doctor referral for hospice. If there are not many PCPs (primary care physicians) in your area, you may be more likely to receive a referral to a specialist. Specialists have a higher rate of acceptance with hospice referrals.
In other cases, your PCP may have a higher referral rate because of the surrounding population. If your physician ranks in the top 10% of doctors who refer to hospice, then you stand a greater chance of being accepted. This is actually the strongest factor in gaining a referral, including other factors used in determining eligibility. In fact, the doctor’s history of referrals ultimately carries more weight in the decision than the health of the patient.
Physicians usually offer a list of hospice services available to their patients. This is standard procedure. However, in areas with limited resources, there may be only one service available. Doctors are not allowed to receive any kind of hospice referral payment or bonus; but many may refer to facilities and services with which they are more familiar, or he may make the referral based on your health insurance network membership.
Because of the ACA, or Affordable Care Act, doctors are given some leeway in referring within their own networks in order to keep fees “in house.” With the increase in the number of staff doctors as opposed to doctors who independently own their own practices, this means that referrals to hospice services may be limited to a branch of the same network. This is fine if the hospice service offers the care you need, but can be limiting if you need (or want) to go out of network.
In some ways, this is a matter of convenience for the physician. If he has a history with this service, he is comfortable with the quality of care they provide and sees no reason to search elsewhere.
On the other hand, the hospice referral he recommends may not provide the services or times that are most convenient for you or the patient. It’s a good idea to ask the doctor why he prefers this hospice over others.
The patient has the right to know why a physician is referring him to a particular hospice. Patients should listen to what others have to say about the hospice referral. The opinions of other doctors and nurses, as well as the experiences of other patients, can give you a clearer picture of the quality of the hospice service.
Has the referring doctor communicated with the patient’s PCP? Your PCP may be your following physician for the services, which means that he or she needs to be apprised of your condition, prognosis, and the goals of care.
Another aspect of communication is between the patient and the referring physician. The patient needs to know how the physician sees the status of the patient’s condition and what he expects in the future. The patient also needs to be aware of his physician’s recommendations for any new treatments that might become available. Find out from the doctor how soon the hospice service will perform an intake visit, and if he will be coordinating prescriptions with the service.
There are many questions and insecurities associated with hospice referrals and this time of life. If you need help talking with a physician or specialist about your needs, contact a Hospice Specialist at Grace at 844-472-2323 today.