You may hear, “She can keep her doctor.” That sounds settled. It is not settled.
Before hospice begins, ask what keeping that clinician will mean in practice. Will the clinician serve as the attending clinician for hospice care? Has the office agreed? Will the clinician take calls from the hospice team, review proposed changes and see her if needed? Or will the name simply remain in the chart while the hospice physician handles the work?
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
This is worth clearing up before you sign. Later, when you are tired and someone tells you to call a different office, you should not have to discover the arrangement one unanswered call at a time.
Start with the exact role
Medicare says a person entering hospice may choose an attending physician or other eligible clinician who has a significant role in directing and providing that person’s medical care. The federal hospice rule also gives the patient a part in identifying that clinician.
This role is separate from the hospice medical director or hospice physician. The hospice still has its own clinical responsibilities. An outside attending clinician may remain involved, but that involvement needs coordination with the hospice plan of care.
Ask the hospice admissions person:
“Who will be listed as her attending clinician?”
Then ask:
“Has that clinician agreed to serve in this role, or are you recording the name because we supplied it?”
Those are different answers.
Call the clinician’s office yourself
Do not rely only on what one organization believes the other organization will do. Call the regular clinician’s office before enrollment if you can.
Use plain questions:
“Will you remain her attending clinician after she elects hospice?”
“Will you communicate directly with this hospice?”
“If the hospice nurse needs an order or a decision, will your office respond?”
“Do you expect the hospice physician to manage all hospice-related care instead?”
“If you are unavailable, who covers for you?”
Write down the name and role of the person who answers. If the office says it must review the request, ask who will give you the final answer and when you should call back.
You are not asking the office to promise constant availability. You are finding out whether the role being offered on paper exists in ordinary working life.
Ask who handles each kind of call
A family can hear “call hospice first” and “her doctor is still involved” without being told how those statements fit together.
Ask the hospice to walk through specific situations without asking anyone to predict what will happen medically:
“If we have a concern in the house, which number do we call first?”
“Who decides whether the hospice nurse should visit?”
“Who discusses changes to the hospice plan of care with us?”
“When would the hospice contact her attending clinician?”
“If her regular clinician recommends something, who confirms whether hospice will arrange and cover it?”
“If we call the regular clinician first, what should we tell that office about her hospice enrollment?”
Medicare tells families to contact the hospice before obtaining hospital, ambulance or outpatient services connected to the terminal illness and related conditions. That is one reason the first-call instruction matters. It should be clear enough to place beside the telephone.
Do not treat “still your doctor” as a coverage answer
Continued involvement by a familiar clinician does not mean every service that clinician suggests will automatically be furnished or paid for outside the hospice arrangement. Medicare states that care for the terminal illness and related conditions generally must be provided by or arranged through the chosen hospice.
Ask:
“If her attending clinician requests a visit, test, medicine or other service related to the hospice diagnosis, who must approve or arrange it?”
“Who will tell us whether hospice considers that service related or unrelated?”
“How will we receive that answer in writing?”
This is not a request for you to interpret coverage. It is a request for the hospice to identify the person responsible for explaining and documenting its determination.
Put the agreement where the family can find it
Before the admission visit ends, keep one page with:
The attending clinician’s name, office number and after-hours instructions.
The hospice’s main and after-hours numbers.
The name or role of the hospice person who coordinates with the attending clinician.
The instruction for which organization the family calls first.
Any question that remains unanswered.
Ask whether the attending clinician’s name appears correctly on the hospice election statement and plan records. If nobody outside the hospice has agreed to serve in that role, ask the hospice to say clearly who will carry the physician work.
You can change the designation
Choosing an attending clinician is not necessarily permanent. Medicare guidance describes a process for changing the designated attending clinician through a signed statement given to the hospice. Ask the hospice for its form and instructions if the arrangement is not working.
Before making a change, ask what date it will take effect, who will notify both offices and who covers the time between the request and the completed change. Keep a copy of what you sign.
The answer you need before you commit
You do not need a long explanation of teamwork. You need names, roles and a first-call instruction.
A usable answer sounds like this: the regular clinician has agreed to remain the attending clinician, the hospice nurse calls that office for the matters assigned to that role, the hospice physician covers the hospice responsibilities, and your family calls the hospice number first at any hour.
A different arrangement may also work. What matters is that everyone describes the same arrangement before care begins.
Medicare, the federal hospice conditions and Missouri hospice oversight materials distinguish the attending clinician from the hospice’s own clinical team. The supporting public references are collected on the site’s Sources page. If you are still sorting out what routine home hospice leaves with the household, begin with Start Here.