Multiple Chronic Conditions Blog

Differentiating Palliative vs. Hospice Care

Monday, 04 April 2022 18:27 / by Dr Kim Kuebler

ATTRIBUTES

PALLIATIVE CARE

HOSPICE CARE/EOL

Primary Objective

To effectively manage symptomatic advanced conditions by reducing disease exacerbation, hospitalization and maintain physical functioning

 

Goal Engage in Life

To provide comfort of pain and symptoms associated with a terminal condition and provide support until death

 

 

Goal Comfortable Death

Prognosis

Initiate palliative care with a diagnosis of a non-reversable condition (e.g., heart failure, chronic obstructive pulmonary disease, chronic kidney disease etc.)

 

Debilitated not Terminal/Dying

Admission into hospice requires provider referral with a 6 month or less prognosis

 

 

 

Terminally Ill and Dying

Origin

Palliative care originated by medicine with a focus on the clinical aspects of disease and symptom management – research based

 

Medical

Hospice care originated by social work and nursing with a focus on pain relief and comfort until death

 

 

 

Social Work/Nursing

Reimbursement

Routine reimbursement from third party payers, Medicare, Medicaid on underlying conditions and associated symptoms. Fee for service

 

Bill Routine CPT/ ICD-10 Codes

Hospice care Benefit from third party payers, Medicare, and Medicaid. Capitated daily reimbursement based on geographical cost of living

 

 

Capitated Daily Fee

Care Limitations

No restrictions or limitations on the clinical management of patient needs. Appropriate referrals, diagnostics, and pharmacological and nonpharmacological interventions based on patients’ underlying etiology

 

No Limitations or Restrictions

Discontinuation of routine medications not covered by hospice benefit. Limited access and utilization of clinic or hospital. Patient receives medication box of opioid, benzodiazepines, anticholinergics etc.

 

Medication/Care Access Limited

Disease Trajectory

Palliative care initiation at onset of an advanced chronic or malignant condition. No prognostication. Focus on symptom management. Palliative interventions intensify as the patient approaches death and appropriate referral to hospice team

 

Earlier Access > 6 Months

Hospice care initiation occurs at the end-of-life. Average length of stay in US hospice care is 77 days

 

 

 

 

 

Limited Care < 6 Months

Multidisciplinary

Palliative care recognizes the complex care of the patient and family and utilizes an interdisciplinary team to address these needs:

 

Utilization of Healthcare Team

Hospice care team is employed at the onset of patient admission into services.

 

 

 

Full Hospice Care Team

Clinical Practice Guidelines

Majority of guidelines are for cancer and come from different countries (UK, Canada etc.).

 

Medical societies and associations offer guidelines on symptom management. CDC 2016 pain management guidelines are currently under revision

 

International Guidelines/US Medical Associations, CDC

2018 Clinical Practice Guidelines for Quality Palliative Care 4th edition- National Coalition for Hospice and Palliative Care. No clinical management on symptoms. Provides the nurse with comfort and communication guidance

 

 

 

Guidelines Do Not Include Clinical Symptom Management

Dr Kim Kuebler

Dr Kim Kuebler

Dr. Kim Kuebler DNP, APRN, ANP-BC, FAAN, Founder and Director Multiple Chronic Conditions Resource Center, CEO Advanced Disease Concepts, LLC., Award winning author of 8 textbooks on chronic conditions and palliative care. Multiple appointments to Federal and state initiatives on pain, chronic conditions and palliative care. Clinician, educator, researcher and patient advocate.