AMDA White Paper on Hospice in Long Term Care

Issued August 11, 2000

Over the last decade, the role of the medical director has become increasingly defined. Federal and state regulations as well as corporate entities have contributed to this process. AMDA has led the way in developing and refining this role.

All will agree that the administrative responsibilities as well as the liabilities of the long term care medical director have continued to increase. Yet the need for ancillary and consultative care continues, increasing these responsibilities and liabilities.

The medical director's role in quality end-of-life care is no exception. The Medicare Hospice Benefit has been identified within the long term care facilities as a six month entitlement to Medicare patients who meet specific criteria. However, the multitude of hospice providers has created a variability in the quality of care delivered. Despite the favorable final Office of Inspector General (OIG) report on Hospice in the Nursing Home released in April, 1998, there are still concerns of fraud, duplication of services, reimbursement and prognostication dilemmas. Some of these issues have been addressed, but the concerns of the nursing home medical director have not been covered extensively.

The responsibility of quality medical care throughout the facility rests on the medical director more than ever before. As a result, the Hospice Subsection has chosen to address the integration of hospice and long term care. The following concerns were discussed and approved by the Subsection at the 1999 Annual Symposium of the American Medical Directors. The goal of this document is to enhance the delivery of quality care to nursing home hospice patients by clearly delineating the role of the medical director.