Patient Questions and
Hospice Myths
Presented by: XXX
Introductions
Local Project Hospice
Lead(s)
• Insert from Speaker Notes
Stratis Project Team
Stratis Health Staff
 Janelle Shearer, RN, MA, CPHQ, Program
Manager
 Laura Grangaard, MPH, Research Analyst
Subject Matter Experts
 Barry Baines, MD
 Lores Vlaminck, RN, BSN, MA, CHPN
Objectives
• Overview of the TRUE project
• Explore strategies for discussions with your
physician regarding your serious illness
• Describe the Medicare hospice benefit and
services
Targeting Resource Use
Effectively (TRUE)
Goals:
– Increase appropriate referrals to hospice
– Increase the length of stay of hospice patients
(days of care)
How: By forming multidisciplinary community
based teams to implement strategies to
address barriers to optimal hospice use
in the XXXXX community
THE REALITY, THE PROBLEM,
AND THE RESULT
Is There an Elephant in the
Physician’s Exam Room?
The Gap: Having The Talk
• Patients and their families think that if they have
a serious illness, their doctor will start the talk
about hopes and goals for care
• Doctors say that they will have these talks if their
patients bring up the topic first
• Doctors and their patients both think that having
these talks are important
Reality
Problem
Result
Persons have a
Serious illness
Neither the patient nor
the physician are
talking about it
Frequently, these
talks aren’t taking
place or they happen
in a crisis situation
Opportunities:
Having
“The Talk” Sooner
• For Patients:
– Encourage patients to ‘ask their doctor’ if they
have a serious illness
– Provide a list of specific questions to initiate “the
talk” (see patient brochure)
If you have a serious
illness, you need to
have a talk with your
doctor to identify
your hopes and
goals in dealing
with your illness.
Then you and your
doctor can talk about
treatment options
and decide on the
best choice for you.
This information was produced in support
of Stratis Health’s Targeting Resource Use
Effectively project (TRUE). Project TRUE
is intended to help eligible patients get
into hospice care sooner, and to increase
appropriate referrals to and utilization
of hospice in Minnesota through the
leads collaboration and innovation in health
care quality and safety, and serves as a
trusted expert in facilitating improvement for
people and communities. TRUE is a special
innovation project funded by the Centers for
Medicare and Medicaid (CMS).
This material was prepared by Stratis Health,
the Minnesota Medicare Quality Improvement
Organization, under a contract with the Centers
for Medicare & Medicaid Services (CMS), an
agency of the U.S. Department of Health and
Human Services. The contents presented do
10SOW-MN-SIP TRUE HOSPICE-14-26 030614
Is Your
Serious
Illness the
Elephant in
Your Doctor’s
Examining
Room?
This is how to start.
You can ask your doctor:
ts and
Is Your Serious
the Elephant
canIllness
work
in Your Doctor’s
Room?
to Examining
move
Here’s the situation:
hant” out
amining
d make
everyone
Here’s the problem:
can have
mportant
sations
w.
Patients and their families think
that if they have a serious illness,
their doctor will start the talk.
Doctors say that they will have
these talks if their patients bring
Doctors and their patients both
think that having these talks are
important.
Doctors and patients are each
waiting for the other to start the
conversation.
Because of this, these talks may
not take place at all. Or, they
may take place during a health
crisis or emergency, when it’s
very stressful for everybody.
Do I have a serious or life-limiting
illness?
This is how to start.
Can my illness be cured?
You can ask your doctor:
If my illness can’t be cured, are
Do I have a serious or life-limiting
there treatments
that
can
slow
illness?
Patients and
Can my illness be cured?
down
my
illness?
If my illness can’t be cured, are
doctors can work
What kind of care is available to there treatments that can slow
together to move
down my illness?
focus on making me comfortable? What kind of care is available to
the
“elephant”
If my
illness
keeps out
getting worse, focus on making me comfortable?
If my illness keeps getting worse,
ofisthe
when
it aexamining
good time to think
when is it a good time to think
about getting supportive and
about
getting
and
room
andsupportive
make
comfort focused care?
comfort
focused
care?
Will you be the one to tell me when
sure that everyone
contact hospice?
Will you be the one to tell me when to
Will you stay involved with my care
involved can have
even when I am no longer looking
to contact hospice?
these
important
Will you
stay
involved with my care for treatment for my disease?
Although your doctor doesn’t know
even conversations
when I am no longer lookingexactly how you are going to respond
to a treatment, it is important to make
for treatment
for my disease?
now.
sure you have enough information to
an informed choice about what
Although your doctor doesn’t know make
you want.
exactly how you are going to respond
to a treatment, it is important to make
sure you have enough information to
make an informed choice about what
you want.
Patient Questions:
• Do I have a serious or life-limiting
illness?
• Can my illness be cured?
• If my illness can’t be cured, are there
treatments that can slow down my
illness?
• What kind of care is available to focus
on making me comfortable?
Patient Questions:
• If my illness keeps getting worse, when
is it a good time to think about getting
supportive and comfort focused care?
• Will you be the one to tell me when to
contact hospice?
• Will you stay involved with my care
even when I am no longer looking for
treatment for my disease?
Shared Decision-Making
Between Physician and Patient:
• Physician’s Responsibility: Inform
and recommend best treatment
option(s)
• Patient’s Responsibility:
To choose or refuse treatment
option(s)
A BIT ABOUT HOSPICE
MYTHS AND REALITIES
ABOUT HOSPICE
Myth
Reality
• I have to give up my
primary physician
upon hospice
enrollment
• Hospice encourages
you to keep your
primary (usual)
physician
Myth
Reality
• All my medications
and treatments will
be discontinued
• The hospice team,
along with your
primary physician
reviews all medications
and treatments to
meet your wishes
for comfort.
Myth
Reality
• I have to pay for
hospice
• For those that meet the
hospice eligibility
criteria for Medicare,
Part “A” covers hospice
at 100% without a copay or deductible. Most
health plans do the
same..
Myth
Reality
• Hospice is a place I
must go to.
• Hospice is a team of
professionals and
volunteers that come
to the place you call
“home.” They bring
their expertise, care
and supplies to you.
Myth
Reality
If I enroll in hospice,
I will die sooner.
Actually, research
shows people with
some diseases live
longer if they are
enrolled in hospice than
if they aren’t.
MORE BITS ABOUT HOSPICE
Who Qualifies for
Hospice Care?
• Terminally ill persons whose life
expectancy is six months or less given
the current progression of their disease
process (any age-any diagnosis)
• Patient is seeking palliative care rather
than curative treatment
Hospice Team Members
Core Team Members
•
•
•
•
•
Medical Director/Attending Physician
Nurses (RN on-call 24/7)
Social Worker
Chaplain/Counselor
Volunteers (Active and Bereavement)
Hospice Team Members
•
•
•
•
Hospice Aide
Therapies (PT/OT/ST)
Registered Dietician
Pharmacist
– Ancillary/Complimentary Therapies
Medical Supplies
Supplies related to the
terminal illness are
covered
Examples may include:
• Wheelchair
• Walker
• Oxygen
• Wound care
• Incontinent products
• Dressings
• Ostomy supplies
• Other
Medications and Treatments
• All medications and
treatments related
to the terminal and
“related” conditions
are covered as
approved by
hospice
Who Pays for Hospice Care?
• Medicare
• Medical Assistance
• Most Insurance
Plans
• Private Pay
• Several Long Term
Care Insurances
The Reality as Expressed
by Many Patients
• “I wish I had enrolled in hospice sooner”
• “I didn’t realize all the support hospice
offered”
• “Why didn’t my doctor tell me about
hospice?”
• “Why didn’t I know about hospice?”
The Reality as Expressed by
Many Families
• “ I didn’t realize all the support hospice
could offer me”
• “The value of being able to contact a
nurse 24/7 was such a comfort”
• “I had no idea hospice would provide
my family with grief support”
Questions
Contact Information
• XXXXXXX
• XXXXXX
Stratis Health is a nonprofit organization based in Minnesota that leads
collaboration and innovation in health care quality and safety, and serves as a
trusted expert in facilitating improvement for people and communities.
This template was prepared by Stratis Health, the Quality Improvement Organization for Minnesota,
under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of
Health and Human Services. The contents presented do not necessarily reflect CMS policy.
10SOW-MN-SIP TRUE HOSPICE-14-30 031114