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To the Editor: Dr Fox and colleagues¹ make a significant contribution to the palliative care–hospice field by demonstrating the limitations of predicting the time of death in patients with terminal diseases. The findings lend further support to the call of the National Hospice Organization (NHO) for the elimination of local medical review policies (LMRPs) to justify hospice referrals for Medicare beneficiaries.

These policies not only expand the authority of the intermediary beyond the scope of the law that created hospice under Medicare, but they also diminish the role of physician judgment in the referral process. As this study demonstrates so well, the guidelines require further development for them to achieve prognostic confidence and accuracy. Indeed, they were intended only as a first step on the road to prognostic sophistication.

Unfortunately, Medicare intermediaries latched onto the guidelines in an effort to produce a standardized basis for referrals to hospice. In effect, . . . [Full Text of this Article]

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Evaluation of Prognostic Criteria for Determining Hospice Eligibility in Patients With Advanced Lung, Heart, or Liver Disease
Ellen Fox, Kristen Landrum-McNiff, Zhenshao Zhong, Neal V. Dawson, Albert W. Wu, Joanne Lynn, and for the SUPPORT Investigators
JAMA. 1999;282(17):1638-1645.
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