Hospice care focuses on comfort and quality of life for individuals with a terminal illness, usually defined by a life expectancy of six months or less. While a hospice patient can be admitted to the hospital, the decision involves complex considerations regarding the goals of care and payment coverage. Understanding the fundamental differences between acute and palliative care helps clarify the necessary steps for hospital admission.
The Difference Between Acute and Palliative Care Goals
The decision to pursue a hospital stay depends entirely on the patient’s goals for treatment, which differ fundamentally between acute and palliative care models. Acute care, the standard delivered in a hospital setting, focuses on aggressive, curative, or life-prolonging treatments. This philosophy aims to reverse a condition, stabilize a medical crisis, or pursue interventions like surgery or chemotherapy to restore health.
Palliative care, the philosophy underlying hospice, shifts the focus from cure to comfort, prioritizing symptom management and quality of life. Hospice care accepts the progression of the underlying disease and does not include treatments intended to prolong life. If a patient’s goal changes from comfort to aggressively treating the terminal illness, their hospice enrollment status must change to align with the new objective.
The Requirement to Revoke the Hospice Benefit
To receive curative or life-prolonging care for their terminal diagnosis in a hospital, a hospice patient must formally revoke their hospice benefit. Revocation is the administrative action of legally canceling the election of the Medicare Hospice Benefit or other insurance coverage. This voluntary choice must be initiated by the patient or their legally authorized representative.
The process requires the patient or representative to provide the hospice agency with a signed, written statement indicating the intent to revoke the benefit and the effective date. This action immediately terminates hospice coverage, meaning the individual forfeits any remaining days in that current election period. The patient immediately resumes the standard insurance coverage they had prior to electing hospice. While re-election is possible later, the patient must meet the eligibility criteria again, including certification of a terminal illness.
Financial Responsibility for the Hospital Stay
Once the hospice benefit is revoked, financial responsibility for the hospital stay shifts to the patient’s standard health insurance, such as Medicare Part A, private insurance, or Medicaid. The patient becomes responsible for standard cost-sharing requirements, including deductibles, co-pays, and co-insurance for the hospital admission. The hospital stay is billed under the terms of the patient’s regular insurance plan, unlike the hospice benefit which typically covers care with little cost.
The change in coverage also impacts services previously managed by the hospice agency. Medications and durable medical equipment (DME) related to the terminal illness are no longer covered by hospice. The patient’s insurance, such as Medicare Part D, resumes responsibility for covered medications. The patient must also manage the transition of any borrowed DME, like hospital beds or oxygen equipment, which the hospice will arrange to have removed. The hospice is required to coordinate this transition to ensure continuity of care.
When Hospice Teams Recommend Hospitalization
A hospice patient may be admitted to a hospital without revoking the benefit if the purpose is purely for acute symptom management that cannot be safely achieved elsewhere. For example, if a patient experiences sudden, severe, and uncontrolled symptoms like intractable pain, a pathological fracture, or a catastrophic bleed, the hospice team may arrange for immediate hospitalization.
This higher level of care is referred to as General Inpatient Care (GIP) and is paid for by the hospice agency as a hospice service. GIP is designed for short-term stabilization, aiming to manage the acute crisis and return the patient to their home or facility once symptoms are controlled. The hospice team must contract with the hospital for these services, and the patient remains under the hospice benefit, maintaining a focus on palliative care.