Patients will be considered to be in the terminal stage of pulmonary disease (life expectancy of  6 mo) if they meet the following criteria. The criteria refer to patients with various forms of advanced pulmonary disease who eventually follow a final common pathway for end-stage pulmonary disease. (1, 2, and 3 must be present. Documentation of 4 or 5 will lend supporting documentation.) |
| 1 Severe chronic lung disease as documented by both A and B |
| A Disabling dyspnea at rest, poorly or unresponsive to bronchodilators, resulting in decreased functional capacity, eg, bed to chair existence, fatigue, and cough; documentation of FEV1, after bronchodilator < 30% of predicted is objective evidence for disabling dyspnea, but is not necessary to obtain. |
| B Progression of end-stage pulmonary disease, as evidenced by increasing visits to the emergency department or hospitalizations for pulmonary infections and/or respiratory failure or increasing physician home visits prior to initial certification. Documentation of serial decrease of FEV1 > 40 mL/yr is objective evidence for disease progression, but is not necessary to obtain. |
2 Hypoxemia at rest on room air, as evidenced by PO2 55 mm Hg or oxygen saturation 88% on supplemental oxygen determined either by arterial blood gas levels or oxygen saturation monitors (these values may be obtained from recent hospital records) or hypercapnia, as evidenced by PCO2  50 mm Hg. This value may be obtained from recent (within 3 mo) hospital records. |
| 3 Right heart failure secondary to pulmonary disease (cor pulmonale), eg, not secondary to left heart disease or valvulopathy. |
| 4 Unintentional progressive weight loss of > 10% of body weight over the preceding 6 mo. |
| 5 Resting tachycardia > 100 beats/min. |
| Documentation certifying terminal status must contain enough information to confirm terminal status upon review. Documen-tation meeting the above criteria would meet this requirement. If the patient does not meet the above criteria, yet is deemed appropriate for hospice care, sufficient documentation of the patient’s condition that justifies terminal status, in the absence of meeting the above criteria, would be necessary. Documen-tation might include comorbidities, rapid decline in physical or functional status in spite of appropriate treatment, or symptom severity that with reasonable reliability is consistent with a life span prognosis of 6 mo. |
