For Physicians: Hospice Referrals
Fast referrals. Clear handoffs.No extra burden on your practice.
Most hospice referrals don’t fail because of clinical uncertainty. They fail because the conversation keeps getting pushed to the next appointment.
"Written for that moment."
Clarity when the clinical picture is already clear.
If you're reading this, the clinical picture is probably clear enough. You know the disease has crossed a line. You know aggressive intervention is doing more harm than good. What's still unresolved is the conversation — with the patient, with the family, maybe with yourself. This page is written for that moment.
St. Marie's Hospice is a Medicare-certified, CHAP-accredited hospice serving Wayne, Oakland, and Macomb counties. We've been operating since 2015. We work with referring physicians across the Detroit tri-county area regularly, and we understand what makes a referral work cleanly and what causes friction. Below is everything you need — eligibility benchmarks, documentation requirements, what happens after you call, and how to handle the conversation with your patient.
When to Refer
Patients are referred to hospice too late.
The data on this is consistent and worth naming directly: patients are referred to hospice too late. The national median hospice stay is approximately 18 days. That figure doesn't reflect short disease courses — it reflects late referrals. Most patients who die with a median stay of 18 days had a clinical picture that warranted hospice weeks or months earlier.
The Surprise Question remains the most practical internal screen for non-cancer diagnoses where trajectory is harder to predict: Would I be surprised if this patient died in the next twelve months? If the honest answer is no, the referral conversation is overdue — not premature.
Specific patterns that typically support eligibility:
Cancer
distant metastases, treatment exhausted or declined, ECOG performance status 3–4, >10% weight loss over six months
CHF
NYHA Class III–IV despite optimal therapy, EF ≤20%, repeated hospitalizations for decompensation, refractory symptoms
COPD
FEV1 <30% predicted, oxygen-dependent, repeated exacerbations requiring hospitalization, MRC dyspnea scale 4–5
Dementia
FAST scale Stage 7 or greater, loss of ambulation, minimal verbal communication, recurrent aspiration, UTIs, or pneumonia, >10% weight loss over six months
Renal failure
dialysis discontinued or declined, creatinine clearance <10 mL/min, uremic symptoms
Liver disease
end-stage cirrhosis, refractory ascites, hepatic encephalopathy, Child-Pugh Class C
Adult failure to thrive / multi-system decline
progressive functional decline, unintentional weight loss, dependent in most ADLs — no single terminal diagnosis required
Medicare eligibility isn't tied to a specific diagnosis. It requires clinical certification that life expectancy is approximately six months or less if the illness follows its expected course. If the clinical picture is borderline or complex, call before you commit. Our hospice physician is available to review cases where there's genuine uncertainty.
The documentation requirements are straightforward.
We handle everything after that. Our intake team contacts the patient or family, schedules the in-home evaluation, walks through the election statement, and coordinates first-day service delivery. You receive a copy of the care plan and stay in the communication loop throughout.
A common concern worth addressing directly: referring to hospice doesn't mean handing the patient off. You remain the attending physician. You continue to see the patient if you choose, collaborate on the care plan, and make clinical decisions alongside our hospice physician and team. What changes is that the symptom management load — medication titration, round-the-clock monitoring, family education — shifts largely to the hospice team. In practice, most referring physicians find that the relationship with the patient and family actually improves after hospice starts, because the day-to-day crisis management is no longer falling entirely on their practice.
Once enrolled, your patient receives care from a full interdisciplinary team:
Most patients are admitted within 24 hours of the referral call. For urgent situations — uncontrolled pain, refractory dyspnea, terminal agitation — contact us directly and tell us. We can move same-day when the clinical situation calls for it.
The Conversation With Your Patient
For many physicians, the referral conversation is the barrier.
For many physicians, the referral conversation is the barrier — not the paperwork, not the eligibility question. It’s the conversation in the exam room that keeps getting deferred.
A few things that are consistently true and worth keeping in mind:
Most patients who are appropriate for hospice have already recognized where things are heading. The conversation rarely lands as news. More often, it lands as permission — permission to stop pursuing treatments that are causing suffering without changing the outcome. What families say afterward, almost universally, is that they wish someone had raised it sooner.
You don’t have to frame it as “giving up.” What you’re actually describing is a shift in strategy: from treatments aimed at the disease to care aimed at the person. That distinction matters to patients and families, and it changes how the conversation lands.
You also don’t have to carry the whole conversation yourself. A practical approach that works well in real scenarios: introduce the referral, remove the finality, and let the hospice intake team carry the clinical detail. One framing that consistently works:
"I'd like to connect you with a team that specializes in managing exactly this kind of situation at home. They'll come and talk with you, explain what they can offer, and answer all your questions. If after that conversation it doesn't feel like the right fit, there's no obligation to move forward."
That framing removes the sense of finality that makes the conversation feel impossible. It gives the patient and family agency — which is what most families actually want.
If the patient pushes back strongly, that's a goals-of-care conversation that may need more than one visit. Our social work team can support that conversation in the home if it would help.
Service Area
We serve Wayne, Oakland, and Macomb counties — and the surrounding communities.
Including Detroit, Southfield, Troy, Warren, Sterling Heights, Lathrup Village, Farmington Hills, Royal Oak, Rochester Hills, Bloomfield Hills, and surrounding communities.
Make a Referral
The fastest route is a direct call
If you have a clinical question about a specific patient before committing to a referral, call anyway. Our hospice physician is available for case reviews, and we’d rather you call with an uncertain case than have a patient who qualifies go without the support they need.