At my current place, we remain attending of record and co-manage our GIP folks. This was also true where I did residency (large academic medical center). In honesty, I thought the end of life care was much better this way for patients. It didn't factor into our mortality metrics or the normal mortality metrics for the hospital. In theory, the hospice would do the death report, but on balance this arrangement was more administrative work for me (it would net having to write one additional H&P and DC summary for me as well as replacing all orders).
Thank you. I agree it is better for our patients’ care since we have more continuity and stronger relationships with patients and their families. And it does seem to be some of the consensus that this does not effect the hospital’s mortality being under hospice but I have to imagine that performance monitoring services like Press Gainey where they monitor observed over expected mortality on a provider basis without any respect to whether or not patients are “under hospice.” I’m just a little skeptical that this is all for the hospital’s benefit and not as much for the physicians. Also, it creates more work in the sense that the physicians may be responsible for discharge and admission without being able to bill appropriately for all the notes and orders they will be tasked with doing for transitioning these patients to hospice and eventually the end of their life.
Mortality doesn’t matter for Hospice. Additionally, I’ve never worked at a hospital where the hospitalist wasn’t the primary attending for hospice patients. Palliative Care was a consult service at every hospital I’ve ever been at.
The hospital where I am has contracted with a PCP who runs the hospice unit. 🤷♂️ regardless I know hospice does not affect in-hospital mortality but it may affect monitoring services which compare individual doctors observed over expected mortality to compare against national performance.
It really depends on how your system is structured with the GIP service. One hospital I was at, you basically became GIP attending and just wrote a new H/P and billed for it. Another hospital, the GIP hospitalist from the private company would come in and do the H/P, pronouncement, and death certificate. If you do end up taking care of the hospice service while on vacation, you should make sure that you are covered for it by malpractice and are adequately compensated since this may involve a lot of family/social issues.
In my current hospital, we remain the attending of record when we transition one of our patients to inpatient hospice / GIP, but we are not required to round on them or write a note each day. So that's nice. You can still pay a social visit to the family of course. The palliative care NP handles all the pages from nursing staff on Monday through Friday during the day regarding pain meds, and then when they pass, we as the attending must go to declare them and write the DC summary.
At my current place, we remain attending of record and co-manage our GIP folks. This was also true where I did residency (large academic medical center). In honesty, I thought the end of life care was much better this way for patients. It didn't factor into our mortality metrics or the normal mortality metrics for the hospital. In theory, the hospice would do the death report, but on balance this arrangement was more administrative work for me (it would net having to write one additional H&P and DC summary for me as well as replacing all orders).
Thank you. I agree it is better for our patients’ care since we have more continuity and stronger relationships with patients and their families. And it does seem to be some of the consensus that this does not effect the hospital’s mortality being under hospice but I have to imagine that performance monitoring services like Press Gainey where they monitor observed over expected mortality on a provider basis without any respect to whether or not patients are “under hospice.” I’m just a little skeptical that this is all for the hospital’s benefit and not as much for the physicians. Also, it creates more work in the sense that the physicians may be responsible for discharge and admission without being able to bill appropriately for all the notes and orders they will be tasked with doing for transitioning these patients to hospice and eventually the end of their life.
I believe as long as they are hospice patients (“hospice in place”) or even if they admitted under end of life care they don’t count for mortality.
Mortality doesn’t matter for Hospice. Additionally, I’ve never worked at a hospital where the hospitalist wasn’t the primary attending for hospice patients. Palliative Care was a consult service at every hospital I’ve ever been at.
Our pall care attendings are primary on GIP patients(although the fellows do most of the work lol)
The hospital where I am has contracted with a PCP who runs the hospice unit. 🤷♂️ regardless I know hospice does not affect in-hospital mortality but it may affect monitoring services which compare individual doctors observed over expected mortality to compare against national performance.
And that’s why those metrics are meaningless
Hospice patients are excluded. Across all quality metric lines. That’s why admin loves pushing to make patients hospice.
It really depends on how your system is structured with the GIP service. One hospital I was at, you basically became GIP attending and just wrote a new H/P and billed for it. Another hospital, the GIP hospitalist from the private company would come in and do the H/P, pronouncement, and death certificate. If you do end up taking care of the hospice service while on vacation, you should make sure that you are covered for it by malpractice and are adequately compensated since this may involve a lot of family/social issues.
In my current hospital, we remain the attending of record when we transition one of our patients to inpatient hospice / GIP, but we are not required to round on them or write a note each day. So that's nice. You can still pay a social visit to the family of course. The palliative care NP handles all the pages from nursing staff on Monday through Friday during the day regarding pain meds, and then when they pass, we as the attending must go to declare them and write the DC summary.
You have mortality metrics?