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CAPC Palliative Care Discussion Forum
Hospital and Hospice Partnerships

Next Reply: Re:Hospitalists to act as hospice medical directors
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Post Hospitalists to act as hospice medical directors
Author: DonnaHyatt
Date: May 4, 2010 4:10 pm
Our hospital is in the process of negotiating a contract with a local hospice to provide IPU services to elligible patients who can not be safely transported to another facility. The hospice wants to contract with several hospitalists (hospital employees, not a contracted service) to act as medical directors for the hospice patients in the hospital. The medical staff office is concerned about the ethicality of this and wants the hospice to contract with the staff office directly rather than with the physicians separately.
They keep talking about double dipping but since the hospitalists would recieve a per diem payment from the hospice regardless of the patients seen and would only bill hospital patients through normal insurance channels, I can't see where double dipping could be an issue?
Can anyone give some guidance as to standard practice or where to find legal advice on this issue? Thanks
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Re:Hospitalists to act as hospice medical directors (by SharolHerr on 05/05/2010)
Many hospice programs contract with physicians to be part-time medical directors. The hospitalist's contract and the medical staff bylaws at the hospital would dictate how contracting would proceed for the hospitalists. Being a hospitalist for the hospital and medical director for the hospice would require the physician to have two contracts or to have the hospital contract reflect the hospice medical director work. It is important that whenever services are provided to different agencies that there is clarity which contract the provider is functioning under. There are many physicians who function under multiple contracts which is not unethical but how that is operationalized would be dependent on the actual contract. The double dipping point is that a physician could not be paid to provide hospitalist care at the same time they are paid to provide hospice care. Those time frames and roles would need to be kept discrete. For example: hospice medical director role 0700-1100, hospitalist role 1200-2000. The other issue is who is attending for the patient, is it the hospitalist service or the hospice medical director? The billing would flow accordingly. The request for the hospice to contract with the hospital for the physician services seems reasonable. The hospital and hospice would have legal counsel available to them and certainly would want to review with counsel the contracts as they are being developed and negotiated. Sharol Herr, RN, BSN, MSEd, CHPN; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.

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