Info for Healthcare Providers

Medicare coverage of hospice care depends upon a physician's certification of an individual's prognosis of a life expectancy of six (6) months or less if the terminal illness runs its normal course. Recognizing that determination of life expectancy during the normal course of a terminal illness is difficult, these criteria form a reasonable approach to the determination of life expectancy based on available research and may be revised as more research becomes available.

 

Heart Disease

Primary Factors

  • Symptoms of recurrent Heart Failure, Angina at rest, discomfort with any activity (NYHA Class IV);
  • Patients already optimally treated with Diuretics and vasodilators (e.g., Angiotensin-converting enzyme inhibitors);
  • Ejection fraction equal or less than 20%;
  • Symptomatic Arrhythmias;
  • History of Cardiac Arrest and CPR

Pulmonary Disease

Primary Factors

  • Disabling Dyspneas at rest;
  • Progressive Pulmonary Disease (e.g., increasing ER visits or hospitalizations for Pulmonary infections and/or Respitory Failure);
  • Hypoxemia at rest on Supplemental O2
  • PO less than or equal to 55mm Hg on supplemental O2
  • PO2 Saturation less than or equal to 88% on supplemental O2
  • Hypercapnia with PCO2 greater than or equal to 50 mm Hg

Dementia

Severity of dementia greater than or equal ro FAST Stage 7C

  • Unable to walk, bathe or dress without assistance;
  • Urinary or fecal incontinence;
  • Unable to speak more than six legible words per day;
  • Severe comorbid conditions within the past six months;
  • Aspiration, Pneumonia;
  • Pyelonephritis;
  • Septicemia;
  • Multiple Progressive Stage 3-4 Decubiti;
  • Fever after Antibioitcs;
  • Unable to maintain luid/caloric intake to sustain life;
  • If feeding tube in place, weight loss > 10% in six months or Serum Albumin < 2.5g/dl

Liver Disease

  • End stage Cirrhosis; not a candidate for liver transplant;
  • Prothrombin time >5 sec over control or INR > 1.5 and Serum Albumin < 2.5 g/dl;
  • At least one of the following:
  • Ascites despite diuretics and low Sodium Diet,
  • Spontaneous Bacterial Peritonitis
  • Hepatorenal Syndrome
  • Hepatic Encephalopathy despite treatment
  • Recurrent Variceal Bleed

Renal Disease

  • Chronic Renal Failure: coming off or not a candidate for Dialyis;
  • Creatinine Clearance 15 cc/min) and Serium Creatinine > 8.0 mg/dl (for Diabetes . 6.0 mg/dl)
  • Uremia: Nausea, Pruritus, confusion or restlessness;
  • Oliguria: output < 400 cc/ 24 hours;
  • Uremic Pericarditis;
  • Hepatorenal Syndrome

Stroke and Coma

Acute phase following CVA

  • Coma or persistent vegetative state > 3 days;
  • Any one of the following on day 3 for coma:
  • Abnormal Brain Stem response
  • Absent verbal response
  • Absent withdrawl to pain stimulus
  • Serum Creatinie > 1.5 gm/dl
  • Chronic phase of CVA

Any one of the following:

  • Age > 70 years
  • Post stroke dementia FAST score >7 (unable to toilet, dress, or bathe without assistance; unable to speak more than six different intelligible words per day; and occasional urinary or fecal incontinence)
  • Karnofsky less than or equal to 50%