General Decline
What is the general prognosis requirement for hospice eligibility?
Answer: Life expectancy of 6 months or less if the disease runs its normal course.
What NYHA class is typically required for hospice eligibility?
Answer: Class IV (symptoms at rest).
What oxygen saturation level at rest supports eligibility?
Answer: ≤88% on room air.
Hospice eligibility requires FAST stage ___ or greater for Alzheimer's Disease.
Answer: FAST stage 7.
Essential Criteria for Liver disease includes what labs?
Answer: INR >1.5, Albumin <2.5
What weight-related decline often supports eligibility?
Answer: Unintentional weight loss >10% in 6 months. Or a 7.5% weight loss in 3 months. (CHF is the exception)
Name one supporting comorbidity that strengthens hospice eligibility for cardiac LCDs.
Answer: Renal failure, diabetes, COPD, etc.
How can response poor response to bronchodilators be documented?
Answer: Maintenence medications have not kept patient comfortable in last 3 months.
Name one major functional decline required at FAST stage 7.
Answer: Incontinence, inability to ambulate, inability to speak more than 6 words, etc.
End stage liver disease must include at least one of the following?
Answer: Ascites, bacterial peritonitis, hepatorenal syndrome, low sodium, variceal bleeding, hepatic encephalopathy...etc
Which type of documentation is essential to support LCD eligibility?
Answer: Narrative summary showing decline tied to LCD criteria.
Name one intercurrent illness that strengthens hospice eligibility in cardiac patients.
Answer: Treatment resistant arrhythmias, syncope, cardiac arrest, emobolic strokes, oxygen dependent, HIV, etc
Name one intercurrent illness that strengthens hospice eligibility in pulmonary patients patients.
Answer: weight loss, tachycardia, dyspnea.
Name one intercurrent illness that strengthens hospice eligibility in dementia patients.
Answer: Aspiration pneumonia, recurrent UTIs, sepsis, etc.
What are required labs for for end stage renal disease?
Answer: Serum creatinine >8mg/dl (>6mg/dl for diabetics), Creatinine clearance <10cc/min (<15cc/min for diabetics), GFR <10 ml/min
Hospice eligibility for cancer usually requires what clinical status?
Answer: Disease with distant metastases or progression despite therapy.
What EF prompts an admission to hospice if available?
Answer: <20%
Name one supporting comorbidity that strengthens hospice eligibility for pulmonary LCDs.
Answer: Right heart failure
Name 2nd criteria needed for a dementia patient needed with no other comorbidities?
Answer: Weight loss of 10% or more in last 6 months.
What are some supportive criteria for Renal disease?
Answer: uremic syndrome, chronic lung disease, advanced cardiac disease or liver disease, sepsis, AIDS
Which lab value may support decline in the LCDs?
Answer: Albumin <2.5 g/dL.
True or false? Cardiac patients must have weight loss for hospice admission.
False. (fluid shifts expected with CHF)
An example essential Criteria for Pulmonary patient to admit to hospice is?
Answers: oxygen less than 88% on RA, 4 or more ED visits in 12 months, poor response to bronchodilators.
Does a patient with FTD or Parkinson's disease have to meet fast scores of 7a or worse?
Answer: No, FAST is only accurate for Alzhiemer's disease as the scale is progressive
Can a patient on dialysis be admitted to hospice?
Answer: yes if discontinuing dialysis.