Hospice Recertification for Multi-System Disease
Primary Eligibility Assessment for COPD
- Disabling dyspnea at rest that significantly limits activity and responds poorly to bronchodilators is the cornerstone criterion for COPD patients, according to the American Thoracic Society 1, 2
- Disease progression indicators for COPD patients must include at least one of: two or more exacerbations per year despite adequate treatment, previous hospitalizations, severe airflow obstruction despite optimal therapy, or hypoxemia/hypercapnia on ambient air 2, 3
Recertification Requirements
- Joint certification by both the treating physician and hospice medical director that the patient's prognosis remains terminal is required for hospice recertification, as recommended by the National Hospice and Palliative Care Organization 2, 3
- Evidence of continued decline through documentation of progressive symptoms, functional deterioration, increasing healthcare utilization, or new complications is necessary for hospice recertification 3
Addressing Prognostic Uncertainty
- Current hospice criteria for non-cancer illnesses have limitations in accurately predicting 6-month mortality, according to the American College of Chest Physicians 3
- The BODE index provides prognostic information but has not been validated for 6-month mortality determination, as stated by the American Thoracic Society 1, 3
Common Pitfalls to Avoid
- Do not delay recertification due to prognostic uncertainty - the combination of advanced COPD with CNS hemorrhage and cardiovascular disease provides sufficient evidence of terminal illness, as recommended by the American College of Chest Physicians 5, 3
Symptom Management Priorities During Recertification Period
- Dyspnea management with opioids, oxygen therapy, fans, and positioning is a priority for hospice care, as recommended by the National Comprehensive Cancer Network 4
- Anxiety control with benzodiazepines when dyspnea is associated with anxiety is necessary for hospice care, according to the American Psychiatric Association 4
- Depression and anxiety treatment with antidepressants is necessary for palliative COPD patients, as recommended by the American College of Physicians 4