As in any area of long term care, these rates are not in any way related to ability to refer patients, or tied to any performance clauses. There has been recent concern relating to dual medical directorships where a physician functions as both a nursing home medical director as well as a hospice medical director. If the purpose of the dual medical directorship is for referrals, then this remains unethical. If the purpose for dual responsibility is for education, integration, continuity of care, regulatory compliance, etc. The OIG has regularly published fraud alerts.
Areas pertaining to long term care include concerns over inducements by hospice providers.
Medicare skilled units were targeted because hospices provided free services to these residents in order for them to contract with the hospice when discharged. However, if a hospice patient has a hospitalization unrelated to the terminal diagnoses and qualifies for Medicare skilled care, they can remain on hospice related to their terminal diagnosis. The National Hospice Organization's development of prognostication guidelines, especially of the non-malignant diseases has helped defray many of the eligibility concerns. Physicians can utilize these and other similar documents to avoid non-eligible admissions. Terms of Use .