Role of Attending Physician in Hospice

Today we continue “DRops of Wisdom,” our physician blog, with Dr. Andrea Miller, the medical director for Good Shepherd Hospice, an affiliate of Chapters Health System. She describes the role of the community attending physician for patients who can benefit from hospice.

In Hospice, What’s the Role of the Community Attending Physician?

When I am out in the community talking to physicians, there are many who have patients who would benefit from the care, comfort and understanding that go hand in hand with hospice care. There seems to be a common misconception among these doctors. They are under the impression that if their patients are admitted to hospice they will not be kept in the loop and provided with care updates. This is simply not true.

At all affiliates of Chapters Health—Good Shepherd Hospice, HPH Hospice and LifePath Hospice, the hospice team works closely with community attending physicians to develop, review and update the patient’s plan of care. All attending physicians are kept informed of their patients’ condition and are alerted if there are any changes. On a regular basis, we also provide attending physicians with summaries after interdisciplinary team meetings.

What Should Community Physicians Do?

If a community physician has a patient who could benefit from end-of-life care, the first step would be to have a conversation with the patient and his/her family. We recognize that these conversations might not be easy and we can help facilitate the discussion with patients and their loved ones.

Although many hospice patients do have cancer, we serve terminally ill patients of all ages, with all types of progressive and chronic diseases. If hospice care is accessed early, there are many benefits. Some of these benefits are:

• Pain and symptom management reduces unnecessary hospitalizations and ER visits;
• Medications, durable medical equipment and supplies are provided, which decreases the financial burden on patients and families;
• Education and support reduces the stress on family and caregivers; and
• 24/7/365 access to care and the ability to benefit from psychosocial, volunteer and bereavement services.

In fact, many of our patients are able to enjoy life as much as they did before their diagnoses. Patients receive services for as long as they are appropriate and required, or in some cases when they choose to stop and thus revoke care.

Following Medicare Hospice Benefit regulations and rules, in order for any of the Chapters Health affiliates to provide care for patients, the community physician must certify that, based on his or her clinical expertise, the patient has a prognosis of six months or less given the diagnosis. It is important for patients to understand and know that their physician—if chosen as the attending physician—will continue to see and care for them if that is what they desire. However, the patient’s physician can refer him or her to hospice, but does not necessarily need to be the attending physician. And if the patient does not have a primary care physician, a referral can be made by the family with a hospice consultation still taking place.

When patients are admitting to hospice, they are asked to designate an attending physician. According to the Medicare Hospice Benefit, the attending physician is defined as “the individual having the most significant role in the determination of the patient’s medical care.” The patient has the right to keep his or her community physician or Advanced Registered Nurse Practitioner (ARNP) as the attending physician. Another option for the patient is choosing an individual with Chapters Health Medical Services.

As per these Medicare guidelines, the community attending physician decides how involved he or she would like to be with regard to the patient’s care. Additionally, the attending physician can choose to be notified for all orders or opt to place the responsibility for pain and symptom management with a Chapters Health hospice physician. It is important to know that if a patient designates a community attending physician that individual can continue to bill Medicare Part B for professional services such as office visits.

We are always available to speak with community physicians, patients and families about any questions they might have about hospice and palliative care.

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At Chapters Health System, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org. 

Andrea Miller, MD

As the medical director at Good Shepherd Hospice, Andrea Miller, MD, is a local resource for area hospitals seeking to educate staff on issues surrounding chronic conditions, palliative care and hospice programs.

Prior to joining Good Shepherd Hospice, Dr. Miller was a primary care physician with Brevard Health Alliance in Melbourne, Florida, and served as the medical director for Christian Care Ministry. Additionally, she has been a medical director since 2002; first with Barton Hospice in Lake Tahoe, California and then with Wuesthoff Health System Brevard Hospice and Palliative Care in Melbourne.

Dr. Miller earned her Bachelor of Arts in Chemistry from the State University of New York (SUNY) at Buffalo, New York; her medical degree from SUNY Upstate Medical University in Syracuse, New York; and completed her family practice residency at Saint Vincent Health System in Erie, Pennsylvania. She is certified in Hospice and Palliative Medicine.