8 Epic EHR implementations with the biggest price tags in 2015


8 Epic EHR implementations with the biggest price tags in 2015

Investments in EHR systems are undoubtedly costly, but some implementations appear to carry more costs than others.

Implementation costs vary system to system and hospital to hospital. Prices fluctuate based on what types of additional features and modules a hospital selects. And, according to a Politico report, some EHR vendors charge for additional service fees while others don’t. The Politico report indicates for Epic’s 2014 edition software, the Verona, Wis.-based EHR vendor charges a software licensing fee, implementation costs and annual maintenance costs while OpenVistA, developed by Carlsbad, Calif.-based Medsphere, for example, does not.

Even within the subsector of Epic implementations, costs fall across the board. For example, Duke University Health System, based in Durham, N.C. paid approximately $700 million for its Epic EHR (systemwide go-live in 2014) while Dartmouth-Hitchcock Medical Center in Lebanon, N.H. paid $80 million (go-live in 2011), according to a Forbes report.

John Halamka, MD, CIO of Beth Israel Deaconess Medical Center. said in the Politico report that hospitals selecting Epic’s platform are not just buying a product — they are buying a process. BIDMC does not operate on Epic’s EHR; rather, the hospital earlier this year forged a partnership with athenahealth, which included using the Watertown, Mass.-based vendor’s product.

“Epic is selling a methodology; often a lot of manual processes or heterogeneity and standardizing the work,” Dr. Halamka told Politico. “It’s not that they’re buying expensive software, they’re buying a lot of software.”

No matter where the prices come from, the cost of Epic installations are significant. Here are eight of the most costly Epic implementations reported within the past six months. These are working numbers, with some systems having allotted the indicated amounts to implementation projects and others that have already completed installations.

Partners HealthCare: $1.2 billion
Boston-based Partners HealthCare is one of more recent implementations, going live the first week of June to the tune of $1.2 billion. This is the health system’s biggest investment to date. The implementation process took approximately three years, and in that time, the initial price tag of $600 million doubled.

LehighValleyHealth Network: $200 million
LVHN started its switch to Epic’s platform in February 2015, but the full transition will take between four and six years. Harry Lukens, CIO of the Allentown, Pa.-based system, told The Morning Call the total investment dedicated to the installation includes software, hardware, data conversion and additional personnel.

Mayo Clinic: “Hundreds of millions”
In January 2015, Rochester, Minn.-based Mayo Clinic announced it selected Epic’s EHR and revenue cycle management platforms and planned to drop its Cerner and GE Healthcare contracts to do so. The value of the contract was not disclosed by the health system or the vendor, but stock analysts told The Kansas City Star it is worth “hundreds of millions of dollars over several years.” Additionally, the headline of the Star report reads “Cerner loses Mayo Clinic contract worth hundreds of millions of dollars to Epic,” indicating a ballpark estimate of the new contract’s value.

LaheyHospital Medical Center: $160 million
On March 28, 2015, the Burlington, Mass.-based hospital completed its two-year implementation of Epic’s EHR system. Two months later, Lahey Health said it was laying off 130 people at three hospitals to close the budget gap. In the six months ended March 31, the health system had lost $21 million, partly due to preparatory EHR implementation costs.

Lifespan: $100 million
Providence, R.I.-based Lifespan announced plans to implement Epic’s EHR in March 2013, and the health system went live April 2015. Lifespan initially projected the implementation to cost $90 million, but in a Rhode Island Public Radio report, John Murphy, MD, executive vice president of physician services, alluded to a total closer to $100 million.

Erlanger Health System: $97 million
Chattanooga, Tenn.-based Erlanger Health System signed a contract with Epic in May 2015 nearing $100 million. The health system will invest $91 million in capital expenses, but operating expenses will bring the total to $97 million over the next 10 years. Erlanger was deciding between Epic and Cerner’s platform and ultimately chose Epic because the bid was less expensive, CFO Britt Tabor told Times Free Press .

WheatonFranciscan Healthcare: $54 million
In January 2015, Glendale, Wis.-based Wheaton Franciscan Healthcare announced plans to implement Epic across its hospitals. The system’s affiliated medical group and physician offices have been using Epic’s EHR since September 2012, but providers across the system can only view patient records and not input information. The implementation will create one central EHR platform across the system. Go-lives will begin January 2016. The system expects a return on investment after four years of using the platform.

Saint Francis Medical Center: $43 million
The hospital in Cape Girardeau, Mo. contracted with Epic in February 2015 and expects to go live in July 2016. Saint Francis plans to connect and exchange records with other hospitals in the St. Louis area also using Epic’s system, including SSM Health and Mercy Health.

Worth noting
A handful of other hospitals and health systems reported signing contracts with Epic this year but did not disclose the costs of the IT projects. Some of these organizations include Arlington Heights, Ill.-based Northwest Community Healthcare, SSM Health St. Mary’s Hospital-Audrain in Mexico, Mo. Oklahoma State University Center for Health Sciences in Tulsa, San Diego-based Scripps Health and St. Louis-based BJC HealthCare.

Editor’s note: An earlier version of this article identified Saint Francis Medical Center as being located in Dexter, Mo. We have updated the article to include the correct location, and we apologize for the error.

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Arizona Department of Administration, Benefit Services Office #cobra #and #medicare #part


Enrolling in COBRA Coverage

Your right to COBRA Coverage
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), entitles you to elect co ntinued coverage under the group health plan, if you will no longer have benefits with Benefit Options because of one of the following qualifying events:

  • End of employment;
  • Reduction in the hours of employment;
  • Death of the employee under whom coverage was received;
  • Divorce or legal separation; and/or
  • Losing dependent child status

COBRA coverage is also available to yo ur spouse and dependent children, if they were covered on your plan the day of the qualifying event.

COBRA Enrollment Options
You can choose:

  • To continue family or two-party coverage, if you had family or two-party coverage on the date of the qualifying event
  • For one of more qualifying persons to individually elect single coverage
  • For all qualifying persons to decline COBRA coverage entirely.

Duration of COBRA Coverage
You are eligible for COBRA coverage for 18, 29, or 36 months, depending on the nature of the qualifying event.

Your COBRA coverage may terminate early if:

  • Any required premium is not paid in full and on time;
  • If, after electing COBRA continuation coverage, a qualified beneficiary becomes entitled to Medicare benefits (under Part A, Part B, or both); or
  • The employer ceases to provide group health coverage for any of its employees.

Enrolling in COBRA Coverage

If you are Electing COBRA Coverage
You have 60 days from the date you received the notice to elect COBRA coverage. You should complete enrollment form A and return it to the Benefit Services Office postmarked no later than 60 days from the date you received the notice. Your COBRA coverage will begin at the full premium amount. Payment must be received within 45 days after the enrollment form has been received. COBRA will begin the day after active coverage ends.


Declining COBRA Coverage
To decline COBRA coverage, return COBRA enrollment Form A with the I decline COBRA coverage option marked. COBRA coverage will not be available to you onc e it is declined. If you fail to return an enrollment form, your right to COBRA coverage will expire after 60 days from the date on the COBRA notification.


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Medicare Donut Hole, Medicare Gap, and Medicare Part D #medicare #donut


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Part 3: Moving In and Out of the Doughnut Hole

En español | In any one year, the Part D drug benefit gives you initial coverage up to a certain level. But then in most cases there’s a gap in benefits before coverage kicks in again.

This gap, known universally as the “doughnut hole,” is the most criticized and unpopular part of the Medicare prescription drug program.

However, the health care reform law of 2010 is gradually narrowing the coverage gap. From 2006, when Part D began, through 2010, falling into the gap meant having to pay 100 percent of your costs while in it. But now and in the future you will pay much less. It works like this:

  • Once your total drug costs (what your plan has paid plus your deductible and copays) exceed a certain amount ($3,310 in 2016; $3,700 in 2017) from the beginning of the calendar year, you are then in the gap.
  • While in the gap, in 2016 you pay 45 percent of the cost of brand-name drugs and 58 percent of generic drugs. In 2017, you pay 40 percent and 51 percent respectively. (Fifty percent of the discount on brand-name drugs is paid by the companies that manufacture them, and the rest by the federal government. The discount on generic drugs is wholly paid by the federal government.) In subsequent years, these costs will reduce until, by 2020, you pay no more than 25 percent of the cost of any drug in the gap.
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    Medicare Part D Guide

    • You get out of the gap when your out-of-pocket costs during the earlier part of the year (deductible and copays) plus anything you paid for drugs in the gap reach a certain dollar limit ($4,700 in 2015). The manufacturers’ contribution for brand-name drugs also counts toward this limit, even though you didn’t pay for it. But the amount the government contributes for brand drugs and for generics does not count toward the limit.
    • If you reach this limit, catastrophic drug coverage kicks in automatically and your plan will pay 95 percent of your remaining costs until the end of the year.
    • This cycle — deductible, initial coverage period, coverage gap and catastrophic coverage — is repeated each calendar year.

    Will everyone fall into the drug coverage gap?

    No. You’ll avoid it if:

    • Your drugs over the year cost no more than a certain dollar amount ($3,310 in 2016; $3,700 in 2017).
  • You qualify for Extra Help, which has no gap.
  • You have extra coverage from employer or union benefits that covers all or part of the gap.
  • You have extra coverage from a state pharmacy assistance program that provides coverage in the gap.
  • You are enrolled in a Medicare drug plan that covers your drugs (usually generics only) during the gap, often for a higher premium.
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    How do I get drugs during the drug coverage gap?

    You can continue to get them through your plan at the price your plan has negotiated with the manufacturers, which is usually less than you’d pay retail. Your plan will track your expenses so they count toward the out-of-pocket limit. In the gap, you may find drugs elsewhere that are less expensive than your plan charges. You can buy these if you wish — but, under Medicare rules, only drugs purchased at pharmacies within your plan’s network count toward the limit that gets you out of the gap.

    What counts toward my out-of-pocket spending limit?

    • Your deductible (if your plan has one);
  • Your copays during the initial coverage period;
  • Any out-of-pocket payments you make for your drugs while you’re in the gap;
  • Fifty percent of the cost of brand-name drugs you buy in the gap (which represents the discount provided by the manufacturer), even though you have not paid full price for them;
  • Any payments for your drugs made by a family member or friend, a charitable group or a state pharmacy assistance program.
  • In all cases, only payments for drugs your plan covers on its formulary (including any “exceptions” you receive) and are purchased from a pharmacy in your plan’s network count toward the limit.

    What does not count toward my limit?

    • Your plan’s premiums;
  • Payments for drugs not covered by your plan;
  • Payments for drugs bought at a pharmacy outside your plan’s network;
  • Payments made by your plan, by an employer, union, federal agency or other group insurer;
  • Discounts on brand and generic drugs in the gap that are provided by the federal government;
  • The value of free or low-cost drugs provided by a drug manufacturer’s assistance program;
  • The value of drug samples provided by a doctor free of charge;
  • Any drugs bought from Canada or other foreign countries.
  • Will it take me longer to reach catastrophic coverage than before?

    No. The discounts you get in the gap will not slow you down in reaching low-cost catastrophic coverage. That’s because most of the full cost of brand-name drugs bought in the gap count toward the dollar limit that triggers catastrophic coverage

    How do I get these discounts?

    You don’t have to apply for them. They will be automatically deducted from the full price of your drugs at the pharmacy where you fill your prescriptions.

    Can I delay reaching the gap?

    Yes. Using lower-cost drugs will make your initial coverage last longer. Ask your doctor if generics or less-expensive brand-name drugs would work just as well as the ones you now take. Choosing these drugs could also reduce your copays. (For information on how similar drugs compare in effectiveness, go to the Consumer Union’s website.)

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    What if I can’t afford the cost of my drugs in the gap?

    First ask your doctor whether any other drugs on your plan’s formulary would be just as effective for your medical condition. Using lower-cost medications, such as generics or similar but older brand-name drugs, will substantially reduce your costs at any time, not just in the gap.

    If you don’t have additional insurance (for example, from an employer plan, a state pharmacy assistance program or Extra Help) that pays some or all of your costs in the gap, you may consider other (non-insurance) sources of help. These include:

    • Free or low cost drugs from assistance programs run by pharmaceutical manufacturers.
    • Free or low-cost drugs supplied by local medical clinics, charities or patients’ organizations.
    • Lower-cost drugs from Canada or other countries.

    Must I continue to pay my monthly premiums during the gap?

    If you stop paying premiums, your plan will likely terminate your contract, leaving you without drug coverage. In that case, if you join a Part D plan again in the future, you’d have to pay a late penalty according to the number of months you were without coverage.

    How will I know where I am in relation to the gap?

    The monthly statement you receive from your plan must explain how near you are to entering the coverage gap or, if you’re already in it, how much more you need to spend on your drugs this year before qualifying for catastrophic coverage.

    If you use the Prescription Drug Plan Finder tool to choose a drug plan — by entering the names of the meds you take, plus their dosages and how often you take them — you can see a bar chart that indicates your total out-of-pocket expenses month by month over the whole year for each plan. The chart shows if and when you’ll fall into the doughnut hole and, if so, how long you’ll stay in it.

    Patricia Barry writes the AARP Ask Ms. Medicare column and is the author of Medicare for Dummies, 2 nd edition (Wiley/AARP, September 2015).

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    Medicare card – Australian Government Department of Human Services #how #to


    Medicare card

    You must live in Australia or Norfolk Island to get a Medicare card. And, you must be either:

    • an Australian citizen
    • a New Zealand citizen
    • an Australian permanent resident
    • applying for permanent residency – conditions apply
    • covered by a Ministerial Order, or
    • a Resident Return visa holder

    You may also get a Medicare card if you re visiting from a Reciprocal Health Care Agreement country.

    If you live on an Australian dependency island

    You re eligible for Medicare services you get in Australia if you can give us evidence you re a citizen or permanent resident of:

    • Cocos (Keeling) Islands
    • Christmas Island
    • Lord Howe Island

    What may be different

    If you live in Australia and have applied for permanent residency, you may get a Medicare card. This doesn t include applying for a parent visa. You must:

    • be on a visa allowing you to work, or
    • prove your parent, spouse or child is an Australian citizen, permanent resident, or a New Zealand citizen living in Australia

    You adopt a child from overseas

    If you adopt a child from overseas, you can add them to your card if:

    • they hold a permanent resident visa, and
    • you have a letter proving the adoption is finalised

    You adopt a child from Australia

    If you adopt a child from Australia, you can add them to your card if:

    • you have their birth certificate, and
    • a letter proving the adoption is finalised, and
    • your Medicare card

    You may get a Medicare card if you visit Australia.

    We have agreements with some countries to cover your essential health care during your stay.

    You may be eligible if you live in a country that Australia has an agreement with.

    You can have your own Medicare card if you re aged 15 years or older.

    What you need to do

    Submit this at a service centre and bring either your:

    • birth certificate
    • current driver s licence
    • current passport
    • non commemorative marriage certificate
    • current Australian school or educational photo ID, or
    • proof of age card

    Once you get your Medicare card, create a Medicare online account through myGov and download the Express Plus Medicare mobile app to access a range of services using a secure digital channel.

    To add your baby under 12 months old to your Medicare card, you’ll need to submit a form.

    You can use your Medicare card:

    • to make a claim for Medicare benefits:
      • when visiting a doctor who submits the claim on your behalf
      • when you have a paid or unpaid doctor s account and you need to submit it yourself:
        • use online services such as myGov and Medicare Express App
        • visit a service centre
        • send by mail
    • when you re treated as a public patient in a public hospital
    • to get cheaper Pharmaceutical Benefits Scheme medicines at a pharmacy

    Your Medicare card must be current to claim benefits. We ll replace your card before it expires. Make sure we have your current details so we can send your new Medicare card to you.

    Destroy your old card when you get your new one. We ll cancel your old card when we issue your new card.

    You can update your address, contact details and bank account online. To change your name, date of birth or gender, you need to visit a Medicare Service Centre.

    If your Medicare card gets lost, stolen or damaged you can:

    Sign your letter and include:

    If you re overseas, we can t replace your card until you return.

    We can t replace your card until you came back to Australia to live if you re:

    • an Australian citizen who s overseas for more than 5 years
    • an Australian permanent resident or New Zealand citizen who s overseas for more than 12 months

    A duplicate card is a copy of your current Medicare card with the same details.

    We provide duplicate cards when more than 1 family member needs their own card. We can only issue 1 duplicate card.

    We can t issue a duplicate card when you re the only person on the Medicare card.

    You can ask for a duplicate card by:

    We ll send you a new Medicare card about 4 weeks before your current card expires.

    Keep your address details up to date

    Update your details if you ve changed your address. If you don t and your card expires, your card will go to your previous address and you ll need to request a replacement card.

    • update your address details and request a replacement card online using your Medicare online account or Express Plus Medicare mobile app
    • call the Medicare line we ll confirm your identity over the phone
    • visit a service centre with identity documents such as your driver s licence
    • write to us and send a signed request for a replacement card and certified copy of identification, such as your driver s licence

    If your card has expired

    If your card expired 6 months ago or more, visit a service centre to request a replacement. You ll need an identity document, such as your driver s licence. You may also need to show evidence you re living in Australia. You should also bring 2 documents to prove you live in Australia like a utility bill, rental agreement or employment contract.

    If you re overseas

    If you re overseas, we can t replace your card until you return.

    We can t replace your card until you came back to Australia to live if you re:

    • an Australian citizen who s overseas for more than 5 years
    • an Australian permanent resident or New Zealand citizen who s overseas for more than 12 months


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    Tom Price – s radically conservative vision for American health care



    Tom Price s radically conservative vision for American health care

    Gutting Obamacare might be the least controversial part of Tom Price ’s health care agenda.

    By tapping the tea party Republican as his top health care official, President-elect Donald Trump sends a strong signal he may look beyond repealing and replacing Obamacare to try to scale back Medicare and Medicaid, popular entitlements that cover roughly 130 million people, many of whom are sick, poor and vulnerable. And that’s a turnabout from Trump’s campaign pledge — still on his campaign website — that he would leave Medicare untouched.

    Story Continued Below

    Price, a former orthopedic surgeon and six-term House member from suburban Atlanta, has proposed policies that are more conservative than those of many House Republican colleagues. His vision for health reform hinges on eliminating much of the federal government’s role in favor of a free-market framework built on privatization, state flexibility and changes to the tax code. The vast majority of the 20 million people now covered under Obamacare would have far less robust coverage — if they got anything at all.

    “Young, healthy and wealthy people may do quite well under this vision of health care reform,” said Larry Levitt, a senior vice president at the nonpartisan Kaiser Family Foundation. “But the people who are older and poorer and sicker could do a lot worse.”

    A close ally of Speaker Paul Ryan and his successor as House Budget Committee chairman, Price also supports privatizing Medicare so that seniors would receive fixed dollar amounts to buy coverage — an approach that Democrats lambaste as a voucher system that would gut a 50-year-old social contract and shift a growing share of health care costs onto seniors. Republicans argue the changes are needed to keep Medicare from going bankrupt. Trump’s transition spokesman did not return calls Tuesday about whether the president-elect now shares his nominee’s views on Medicare.

    Price also wants to limit federal Medicaid spending to give states a lump sum, or block grant, and more control over how they could use it — a dream of conservative Republicans for years and a nightmare for advocates for the poor who fear many would lose coverage. Trump has endorsed block grants.

    “When it comes to issues like Medicare, the Affordable Care Act and Planned Parenthood, Congressman Price and the average American couldn’t be further apart,” said New York Sen. Chuck Schumer. who will be minority leader in the Senate next year. “Between this nomination of an avowed Medicare opponent to serve as HHS secretary and Republicans here in Washington threatening to privatize Medicare, it’s clear that Republicans are plotting a war on seniors next year.”

    Price’s partner at Health and Human Services will be Seema Verma, whom Trump picked to run the Center for Medicare Medicaid Services, the agency in HHS that would actually dismantle Obamacare and set up whatever slimmed down system succeeds it. She’s a health care consultant who worked with several states that put a conservative stamp on their Medicaid program — including one under Indiana Gov. Mike Pence that booted participants who failed to pay small monthly premiums.

    Price is close to Ryan, who will lead congressional Republicans’ efforts to repeal and replace Obamacare starting in January. The GOP is expected to roll back much of the sweeping health care law early on in Trump’s presidency through a complicated budget process called reconciliation — one of only two opportunities in 2017 to pass legislation without Democrats’ cooperation.

    Republicans could then set their sights on Medicaid and Medicare, assuming they have the appetite for an even bigger health care fight with Democrats who will fiercely defend the programs.

    “They will … not just roll back five or 10 years of progress — but 50.” said Anthony Wright, executive director of Health Access California, a consumer advocacy group that supports Obamacare.

    The administration also has multiple other priorities — tax reform, infrastructure investment, filling the Supreme Court vacancy — and it’s not yet clear how Trump’s White House will order them.

    Senate Majority Leader Mitch McConnell dodged a question Tuesday about whether he expects to take up a Medicare overhaul next year. “I am not going to speculate on what the agenda may be on a variety of issues,” he said.

    Democrats pounced on Price’s nomination as a bad sign for the future of Obamacare and Medicare, but they don’t have the numbers to block his confirmation.

    Given Chairman Price’s past health proposals, I have grave concerns with what his policies would do to Americans,” said Sen. Ron Wyden. the top Democrat on the Senate Finance Committee, which would have to approve Price’s nomination.

    11/29/16 11:27 AM EST

    Price’s selection also raised concerns among women’s rights groups, who pointed to his past support for defunding Planned Parenthood and scaling back access to birth control. He’s also a strong opponent of abortion.

    Price could take women back decades, Planned Parenthood President Cecile Richards said.

    Still others questioned whether he possessed the experience to run an organization as large and complicated as HHS. Price ran an orthopedic clinic prior to running for Congress, and would be the first physician to head the agency since 1993.

    To put in charge of the nation’s health care system and a trillion-dollar budget someone who has never overseen anything larger than a congressional committee ought to raise eyebrows when this position has historically been reserved for an individual with significant administrative experience, said Rep. Steny Hoyer .

    But many Republicans praised Price’s choice — and if they remain united, they may not need any Democratic support to get him confirmed.

    As HHS secretary, several said they expect Price to serve as the conduit between the administration and congressional Republicans on the overhaul effort. Price’s 2015 Obamacare replacement plan largely dovetails with Ryan’s own ideas and could serve as a rough blueprint.

    The legislation promotes the use of health savings accounts and selling insurance across state lines, but does away with requirements that insurers offer comprehensive benefits as well as constraints on what they can charge older enrollees.

    Tax credits meant to help individuals afford insurance would be determined based on age rather than income, with those older than 55 receiving the maximum $3,000. That’s not enough to buy a comprehensive policy in most places today — but the GOP says they’ll make the market more competitive and let consumers buy policies that may be skimpier but cheaper.

    Price’s plan would offer less protection for people with pre-existing conditions — individuals would need to maintain continuous insurance coverage, or risk running into problems getting covered.

    “In general they’re trying to shift risk from the government to individuals, and particularly to low-income individuals, said Topher Spiro, who heads health policy at the left-leaning Center for American Progress. It’s hard to see how that’s giving them a leg up, and how that’s improving the quality of their lives.”

    How much of that vision makes it into legislation likely depends on whether Republicans can first successfully — and quickly — come together on a broad Obamacare replacement package. Price’s nomination positions him to play a key role in that process, and in shaping the GOP’s ambitious vision for health care.

    Dr. Tom Price will bring practical knowledge as a doctor and a legislator to an agency that needs it now more than ever, McConnell said. Obamacare has failed the American people who have been let down by years of broken promises. Americans deserve better and Dr. Price is the right person to lead the charge.

    Victoria Colliver contributed to this report.

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    Insurance companies in las vegas #home #hospice, #las #vegas #hospice, #hospite,


    Hospice offers medical care toward a different goal: Maintaining or improving the quality of life for someone whose illness, disease or condition is unlikely to be cured. Each patient’s individualized care plan is updated as needed to address the physical, emotional and spiritual pain that often accompanies terminal illness. Hospice care also offers practical support for the caregiver(s) during the illness and grief support after the death. Hospice is something more that is available to the patient and the entire family when curative measures have been exhausted and life prognosis is 6 months or less.

    ​History of Hospice

    In Western society, the concept of hospice has been evolving in Europe since the 11th century. Hospice were places of hospitality for the sick, wounded or dying, as well as those for travelers and pilgrims. The modern concept of hospice, includes palliative care for the incurably ill given in such institutions as hospitals or nursing homes. but also care provided to those who would rather spend their last months and days of life in their own homes.

    It began to emerge in the 17th century, but many of the foundational principles by which modern hospice services operate were pioneered in the 1950s by Dame Cicely Saunders. when she opened St. Christopher’s Hospice in 1967. St. Christopher’s Hospice in London emphasized the multi-disciplinary approach to caring for the dying, the regular use of opioids to control physical pain and careful attention to social, spiritual and psychological suffering in patients and families.

    Within the United States. the term is largely defined by the practices of the Medicare system and other health insurance providers, which make hospice care available, either in an inpatient facility or at the patient’s home, to patients with a terminal prognosis who are medically certified at hospice onset to have less than six months to live.

    Hospice care also involves assistance for patients’ families to help them cope with what is happening and provide care and support to keep the patient at home.

    In 1969, Elisabeth wrote On Death and Dying. coining the 5 stages of death: Shock/Denial, Anger, Bargaining, Depression and Acceptance.


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