From the Guidelines
A face-to-face visit is generally required to initiate hospice care, though some exceptions exist, as it allows healthcare providers to better assess physical symptoms, functional status, and environmental factors that might affect care planning. Medicare regulations require that a physician or nurse practitioner conduct an in-person evaluation to certify that a patient is terminally ill with a life expectancy of six months or less before hospice services can begin 1. This face-to-face encounter helps establish the patient's eligibility for hospice care and allows for proper assessment of their medical condition, symptoms, and care needs.
Some key aspects of hospice care include:
- Management of patient symptoms with a palliative care paradigm, as defined by the WHO 1
- Integration of medical, emotional, social, cultural, and spiritual care of end-of-life patients and their families by an interdisciplinary team 1
- Availability of various services, including routine home care, hospital care, medical social services, counseling services, and bereavement services 1
While remote communication has become more prevalent, especially during the COVID-19 pandemic, with experts reporting the need for daily remote communication with designated family members or loved ones 1, standard practice for initiating hospice care has returned to in-person assessments in most situations. After enrollment, the hospice team will conduct regular in-person visits to provide care, though the frequency varies based on the patient's condition and needs. These visits are essential for monitoring symptoms, adjusting medications, providing emotional support, and ensuring the patient's comfort.
From the Research
Face-to-Face Visits in Hospice Care
- The requirement for face-to-face visits in hospice care was implemented by the U.S. Centers for Medicare and Medicaid Services (CMS) in 2011 to ensure that patients continue to meet eligibility criteria 2.
- This requirement applies to patients who have been in hospice care for more than six months and requires a face-to-face visit by a physician or nurse practitioner to assess the patient's continued eligibility for hospice care 3.
- The face-to-face visit is an essential component of hospice care, as it allows healthcare providers to assess the patient's symptoms, medication, and overall condition, and make any necessary adjustments to their care plan 4.
- While face-to-face visits are necessary for hospice care, research suggests that a blended approach that combines virtual and face-to-face consultations may be beneficial for outpatient palliative care services, increasing flexibility and reducing travel burden for patients and caregivers 5.
Benefits and Limitations of Face-to-Face Visits
- Face-to-face visits are considered essential for physical examinations, first consultations, and situations where patients require hands-on care or emotional support 5.
- However, virtual consultations may be suitable for monitoring stable symptoms, follow-up appointments, and situations where patients are unable to travel to a healthcare facility 5.
- The use of face-to-face visits in hospice care has been associated with better symptom relief, better achievement of patient end-of-life wishes, and higher overall rating of quality of end-of-life care compared with standard care 4.
Documentation and Eligibility
- The face-to-face visit requirement includes specific documentation requirements, such as a clear title, date, clinical findings demonstrating continued hospice eligibility, and a signature of the individual completing the face-to-face visit 3.
- The FACE-2-FACE method can help clarify the clinical findings necessary to demonstrate a patient's continued hospice eligibility 3.
- Eligibility for hospice care requires a physician to determine that the patient has a prognosis of six months or less if the illness runs its expected course 4.