Clinical Pearls

Live Discharges and the Medicare Hospice Benefit

Edward W. Martin, MD MPH HMDC FACP FAAHPM

JB, a 73-year-old man with end-stage COPD, is being treated at home with hospice care. He is able to sit in a chair with assistance and requires 4 liters of O2 by nasal cannula continuously. His dyspnea at rest improves with low-dose morphine. After a fall, JB's family calls 911 and he is taken to the hospital with a left hip fracture. The hospice nurse is on the way to the hospital to meet with the patient and family. The hospice medical director wants to be sure to follow the appropriate regulations before proceeding.

Live discharges may be initiated by the hospice agency or by the patient or their surrogate. Hospice medical directors may struggle over the complex regulations around live discharges from hospice.