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The Key to Preventing Your Hospice Patient’s Trip to the ER

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The Centers for Medicare and Medicaid (CMS) scrutiny of hospice care continues. Spending, discharge trends, emergency room (ER) visits, and the frequency of skilled visits that hospice patients received in the last days of their care are the focus of recent Medicare technical reports.

To help hospice administrators better understand how this might impact payment policies, the National Hospice and Palliative Care Organization (NHPCO) and the Hospice Action Network (HAN) asked Avalere Health, a company that provides data-driven analysis of payment policies and their effect on health care, to take a look.

Statistics on Hospice Patients & ER Visits

The Medicare reports looked at ER visits made by hospice patients and found:

  • 93.3% of hospice episodes don’t make an emergency room visit
  • 6.7% had at least one emergency room visit
    • Of those, the majority (76%) had only one visit
    • 16% had 2 visits
    • 5% had 3 visits
    • 4% had 4 or more

ER Visits for End-Of-Life Care Are Expensive

Although the ER visit numbers are good overall, it’s well known that ER visits for end-of-life care can be common and expensive. A 2012 Study found that of 4,158 patients who died, 51% had visited the ER in the last month of life and 75% went to the ER in the last 6 months of life. Medicare won’t cover ER care or ambulance transportation unless it was arranged by hospice care providers, so patients and their families who resort to ER care are responsible for paying the entire cost of those expenses.

Prevent ER Visits by Providing Care & Comfort

Improving communication with patients and their families is key to reducing ER visits. This is especially true after hours–late at night or on weekends–when telephone answering services may be taking calls from patients or caregivers. Telephone answering service providers vary widely in the type of professional support they can provide to patients and hospice providers. Some answering services only take messages, while others are staffed by professional RN’s specifically trained in hospice and palliative care.

The positive effect of telephone triage by professional nurses has been the subject of several international studies. They’ve found that telephone triage by clinically trained nurses provides comfort and support for patients and families in times of anxiety and perceived crisis. A registered nurse as the first point of contact can provide calming reassurance to patients and caregivers, which can prevent unnecessary 911 calls and trips to the ER, as well as reduce the need for some visits from the on-call staff.

To learn more about the benefits of professional after-hours telephone triage and how it can help reduce unnecessary ER visits, download our free guide, 5 Keys to Better After-Hours Hospice Care.

Finding after-hours support is easier and more cost-effective than you think. See how AfterHours Triage can extend your services without extending your staff: contact us or call 888-260-8460.

Source:
Smith A, et al. Half of Older Americans Seen in Emergency Department in Last Month of Life; Most Admitted to Hospital, and Many Die There. Health Aff (Millwood). 2012 Jun; 31(6):1277-1285

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