Our healthcare system is in just the initial stages of the Coronavirus19 crisis.  Hospices have a role to play.  Let’s keep it short.  Here is what we need to do:

• Telehealth. Many hospices report that nursing homes and assisted living facilities are on infection lockdown (perhaps rightly so) and will not admit hospice staff to see patients.  And hospice staff, like all other healthcare professionals, should not be spreading the virus by unnecessary in person visits.  Medicare has temporarily expanded telehealth in other contexts (office visits, mental health counseling, and preventive health); it should do the same in this virus-related context.  By temporarily allowing telehealth hospice visits (including certification and face to face visits) during this crisis, Medicare would mitigate risk of spread, ensure continuity of hospice care, and multiply force effectiveness of hospice.

• Certification/Narrative. Given the urgent need for doctors, Medicare should temporarily authorize NPs, RNs, and LPNs to execute any hospice certification; and Medicare should waive the narrative requirement on initial certification.  We need to reduce paperwork burdens to leverage our healthcare workforce effectively.

• Respiratory Distress. Allow any patient suffering generally from respiratory distress (do not require CV19 diagnosis (testing)) to elect hospice; in connection with any such election, waive the requirement that patients waive side-by-side curative treatments.  Hospices are a mobile work force, they know how to reach people in their homes, and deliver services.  Patients should not be forced to forego curative treatment to get help during this crisis.

As we await our role, hospices should be planning how to treat patients with the virus.