Hospice care is a specialized form of palliative care focusing on comfort and quality of life for individuals with a terminal illness and a prognosis of six months or less. This philosophy emphasizes symptom management over aggressive, curative treatments. Whether a patient can still see their outside doctor depends entirely on the nature of the medical visit and the condition being treated.
Care Provided by the Hospice Team Doctor
Once a patient elects the hospice benefit, a dedicated interdisciplinary team assumes primary responsibility for all care related to the terminal diagnosis. This team includes a hospice physician or medical director who oversees the entire plan of care. The hospice physician coordinates the management of pain, symptoms, and medications, working closely with registered nurses, social workers, and other specialists. Care is provided wherever the patient resides, such as a private home or skilled nursing facility.
The patient is generally not expected to see their previous primary care physician (PCP) for issues directly connected to the terminal illness. Medicare allows the patient to select an “attending physician” to supervise their care, which can be their regular doctor if they agree to coordinate with the hospice team. This attending physician is paid by Medicare to manage the patient’s terminal condition, while the hospice physician acts as a consultant. This structure ensures all medical efforts align with the goal of comfort, rather than cure.
Seeking Treatment for Conditions Unrelated to Hospice Diagnosis
A hospice patient can seek treatment from any outside physician for medical conditions separate from their terminal diagnosis. This distinction between “related” and “unrelated” conditions is the key factor in determining permissible outside doctor visits. For instance, a person receiving hospice care for end-stage heart failure can still visit a dermatologist for a new skin rash or an ophthalmologist for a routine eye examination, as these issues are not connected to the heart failure.
The outside provider must be informed that the patient is receiving hospice services to ensure the visit is accurately documented as unrelated to the terminal illness. If the unrelated condition requires a more extensive intervention, such as orthopedic surgery for a broken bone, the patient can pursue this care without revoking the hospice benefit. The hospice team must be notified of all outside care to prevent accidental billing for curative treatment of the primary diagnosis.
How Insurance Covers Non-Hospice Medical Visits
The Medicare Hospice Benefit covers all services, medications, and equipment related to the terminal illness, usually at 100% coverage. For any medical services, office visits, or hospital stays for conditions deemed unrelated to the terminal diagnosis, the patient’s standard insurance—such as Medicare Part A and Part B, or a private insurance plan—will continue to cover the costs. This process is known as concurrent billing, where the hospice benefit covers one set of services and the standard insurance covers the other.
The outside doctor must correctly code the medical claim to reflect that the service was for a condition separate from the terminal diagnosis. If the outside provider fails to demonstrate that the issue is unrelated, Medicare may deny the claim, and the financial responsibility could fall to the patient or family. The patient may still be responsible for customary out-of-pocket costs, such as co-pays or deductibles, for this non-hospice care.
Resuming Curative Care
If a patient wishes to pursue aggressive or curative treatments for their terminal illness, they must formally end their hospice benefit through revocation. Revocation involves signing a written statement to the hospice provider, which immediately terminates the coverage. This action signals the patient’s choice to return to a focus on life-prolonging measures and allows them to freely see any doctor or specialist for treatments intended to cure the disease.
Once revocation is complete, the patient immediately resumes all standard Medicare or private insurance benefits that were previously waived for the terminal diagnosis. The patient is then responsible for all medical costs, including co-pays and deductibles, just as they were before electing hospice. If the patient later determines that the aggressive treatment is no longer desirable, they can re-elect the hospice benefit, provided they still meet the eligibility criteria of having a six-month or less prognosis.