Core IM | Internal Medicine Podcast #162 Hospice 102: Practical Tips and Nuances
Oct 16, 2024
Dr. Harry Han, a palliative care expert, dives into the nuances of hospice care, discussing the practicalities clinicians face when transitioning patients to hospice services. He addresses critical issues like managing medications, navigating financial concerns, and the surprising reasons patients may return to the hospital while on hospice. The conversation also highlights the emotional challenges of opting for hospice and encourages a shift in perception to focus on celebrating life, rather than just the end.
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Medication Management in Hospice
- When considering medications for hospice patients, group them into four categories: normally covered, not covered, depends, and unrelated.
- Discuss coverage specifics with the hospice agency, as interpretations of Medicare guidelines vary.
Exclusions from Hospice Coverage
- Disease-directed treatments (chemo, immunotherapy) are generally not covered by hospice.
- Expensive medications like Donepezil or continuous infusions for pulmonary hypertension also fall under this category.
Deprescribing in Hospice
- When deciding whether to continue a medication, consider if it improves quality of life, potential harm, prognosis, and patient goals.
- The hospice agency reviews the medication list and develops a plan, so the initial list doesn't have to be perfect.