For Providers
Who Should be Referred for Hospice Care?
San Diego Hospice and The Institute for Palliative Medicine (SDHIPM) provides comprehensive physical, emotional, and spiritual care for adults, children, and infants faced with an advanced or life-limiting illness.
Patients of all ages, with any of the following illnesses, may be appropriate for a hospice referral once eligibility criteria are met:
- Amyotrophic Lateral Sclerosis
- Cancer
- HIV/AIDS
- Severe birth defects
- Stroke
In addition, patients with the following end-stage diseases may also be hospice-appropriate:
- Alzheimer’s
- Cardiovascular disorder
- Dementia
- Renal diseases
- Liver disease
- Lung disease
Please note that these are not exhaustive lists. To explore options, SDHIPM will meet with patients and their loved ones at no charge to discuss possible hospice care.
Reimbursement for Services
Medicare, Medicare HMOs, MediCal and private insurance plans based in the state of California have a hospice benefit that covers most costs associated with hospice care.
The following benefits are covered when related to the hospice diagnosis:
- Home visits by the hospice team, which can include:
- Community physician
- Hospice physician
- Hospice case manager nurse
- Certified home health aid
- Social worker
- Homemaker
- Chaplain
- Bereavement counselor
- Hospice volunteer
- Pharmacist
- Medications related to the hospice diagnosis
- Medical equipment / supplies
- Respite care
- Inpatient or crisis care
- Bereavement services
- Physical, speech and occupational therapy
- Dietary counseling
San Diego Hospice & Palliative Care believes that everyone should have access to appropriate care. For patients without insurance or the ability to pay, San Diego Hospice offers the services of Patient Financial Advocates to assist patients and families in exploring other possible resources.
The following reference materials are intended to help clarify billing issues faced by healthcare professionals and terms associated with hospice service:
Link to Billing Reference Guide
Link to Physician Reference Guide
Palliative Care Consultation Service
Palliative Medicine Consultation Services are available to assist community physicians. Upon request, a palliative medicine trained specialist will make a patient visit to assess complex symptoms and discuss findings and suggestions with the requesting physician.
These consultations are available for all patients, regardless of age, and are not limited to those patients considered hospice-appropriate. Consults may be performed wherever a patient calls home, including RCFE’s and skilled facilities.
Consultations by San Diego Hospice and The Institute for Palliative Medicine physicians will emphasize aggressive symptom management and utilization of appropriate psychosocial and spiritual support systems to enhance the outcomes of comfort and self-determination.
Indications:
- Pain and symptom management
- Diagnosis and prognosis discussions
- Developing goals of care
- Preparation and management of the dying process
- Advance care planning
- Issues with other aspects of care that are affecting quality of life
Who pays for this service?
- Medicare
- MediCal
- HMO – requires prior authorization from PCP
- Private Insurance
We provide care to those in financial need as well.
Guides for Hospice Eligibility
Eligibility Criteria
Patients must meet the following eligibility criteria to be appropriate for hospice care:
- Adults, children and infants with a prognosis of six months or less if the disease runs its normal course
- Hospice can continue after six months as long as the patient continues to meet eligibility criteria
- Prognosis is certified by community and hospice physician
- Patient and family desire palliative care as opposed to curative treatment
San Diego Hospice & Palliative Care provides its services to eligible individuals throughout all of San Diego County regardless of age, race, religion, sexual orientation, diagnosis, financial status or ability to pay.
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