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The Hospice Medical Director Role: Responsibilities, Compensation, Certifications, and More

We often see questions submitted by members of our physician communities about being a hospice medical director, usually because a doctor has been approached about this role by a hospice company or agency but isn’t sure what it entails. In the past, the role was usually more of an administrative role that was simply pitched as needing a physician signature on orders and prescriptions. These days, as Medicare regulations evolve and the physician is intended to take on a more significant role in the interdisciplinary team, the role is becoming more substantial. While responsibilities vary depending on the role, it offers physicians an opportunity to be involved with hospice care in a very meaningful and fulfilling way. There are now certifications available in the space, as well as dedicated fellowships in hospice and palliative medicine. Below, we’ll cover what to know about being a hospital medical director based on the experiences of members of our physician communities, including duties, responsibilities, compensation and pay, qualifications, and more.


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Hospice medical director overview




What is a hospice medical director?


The overarching job of a hospice medical director is to oversee hospice operations, including ensuring patient safety, the quality of care hospice patients receive, and compliance with (the many) regulations in this space. Hospice medical director roles can vary quite a bit depending on the size of the company or employer, the role that the company carves out for the physician on the interdisciplinary team, and the personal preferences of the physician. However, there are certain regulatory requirements by Medicare that must be met.


These roles involve a fair amount of administrative work, as well as varying amounts of direct patient care or face to face interactions with the family that can range from a few hours a month to a few hours a week depending on the job description and the medical director’s preferences. Unlike so many fields where you are not compensated for your administrative time, a hospice medical director is primarily paid for the time spent doing the administrative work. 


The physician serving as the medical director will work alongside the interdisciplinary hospice team, which may consist of nurses, nurse practitioners, social workers, bereavement coordinators, religious providers, aides, psychologists, and others. Many times the hospice medical director is responsible for overseeing the clinical work of a team of nurses that is seeing a significant number of patients at their homes or as inpatients, or during consultations for appropriateness and enrollment into hospice. In some cases, they may be rounding or seeing patients themselves.


Physicians in our communities warn about large for-profit companies that may make it seem like it is an easy role or who minimize the role of the physician, as it feels as though some of them are just hiring physicians to fulfill Medicare regulations and sign off on prescriptions. There have been many reports of fraud in this space, and physicians should do their due diligence before taking on these roles. Our members remind their colleagues that this is a highly regulated space, and the physicians are the name that is associated with the claims, orders, and compliance, so it is a true medical director role that should be taken seriously. More on this below.



What are some examples of things a hospice medical director may do?


Some examples of potential responsibilities include:


  • Ensuring compliance with the many ethical standards, regulations, and laws in this space 

  • Certifying and re-certifying that patients meet criteria to be on hospice at a regular cadence 

  • Being available to sign off on medication orders (new, renewals, or changes)

  • Reviewing the patient care plan for each patient on the service, which may involve not just medical needs, but also emotional and spiritual needs, as well as support for the family

  • Overseeing the hospice care team and meeting with them at a regular cadence to ensure the objectives for each patient’s care plan are being met

  • Being available for questions from the hospice team and the families

  • Taking call for the hospice service (size of the service seems to vary quite a bit)

  • Seeing patients occasionally (may have to drive to their homes)

  • Attending family meetings and ensuring that the goals and wishes of the patient and family are being respected, and that they understand the care plan and available options

  • Rounding on inpatients



What does a typical hospice medical director role look like in terms of hours and responsibilities?


Again, while this will vary from job to job, we’ve compiled some descriptions from physicians within our communities. 


For the vast majority of our physicians serving in this role, this is a side gig rather than a main gig. For some people it is an add on to their primary job through their hospital system. Many physicians report that it takes about 20-40 hours a month, although some report as few as 10.


Many physicians report that they need to be available for interdisciplinary meetings every other week to certify the appropriateness of patients on the hospice service. Most physicians in this role are not doing the majority of the face to face interactions with the patients, as these are being done by nurses and/or nurse practitioners, but the physicians are available for backup or management discussions. 


Note, however, that you may be on call around the clock depending on how many medical directors there are, so just because you're not actively working the other hours doesn't mean your responsibility is contained to those hours above. Many medical directors have rounding responsibilities as well.


There are also some physicians that do this as a main gig, particularly for nonprofit organizations, large agencies, or hospital systems.


Many hospice medical directors working for larger entities report having approximately 100-150 on their service at any given time.



What physician specialties can be hospice medical directors?


While there is now a hospice and palliative medicine fellowship, many of those that do this fellowship pursue full time roles in palliative medicine. Anecdotally, many fellows say that they spend more time learning about palliative care during their training than hospice.


As such, there are still many roles for hospice medical directors for physicians without this level of training. Oftentimes, physicians asked to become medical directors for hospice come from family medicine, general internal medicine, oncology, or emergency medicine backgrounds. 



What training is helpful or necessary to be a hospice medical director?


Many hospice medical directors and hospice and palliative medicine doctors feel that having hospice specific training is invaluable to keep you out of trouble with Medicare regulations, as well as for teaching you all the aspects of the job.


If you haven't done a full hospice and palliative medicine fellowship, there is a hospice medical director certifications that may be helpful. Some examples include courses from CAPC (Center to Advance Palliative Care) and the AAHPM. There is a hospice medical director certification board (HMDCB) which will allow you to become a certified hospice medical director (HMDC) after taking an exam and fulfilling the requirements. Members state that this is a relatively simple process but very helpful. Per the HMDCB website, goals of this certification process include (quoted):


  • Defining and upholding standards of practice for this specific role

  • Addressing the core roles and administrative, regulatory, legal, and ethical responsibilities of the hospice physician

  • Serving as a verification of the mastery of a minimum level of competence in the skills and knowledge required by the hospice physician

  • Improving the quality and consistency of the practice within hospice and palliative medicine and the care provided by local hospices.



How much do these positions generally pay?


Payment varies, as does the structure of the payment. Some physicians are paid hourly and some are paid a monthly stipend. 


Hourly rates appear to average between $150-250 / hour. 


Monthly stipends appear to range between $2000-4000 dollars per month.


Many companies will offer some compensation for driving/mileage per face to face encounter, usually about $100-200.



What are some other tips from physicians in our communities about being a hospice medical director?


  • Do your research on the company before accepting a position. Talk to other physicians working there as well as those that have left and make sure that everything is being done in compliance with guidelines. 

  • Our doctors report that some for-profit hospice agencies really just want you to supervise other non-physician clinicians and sign off on what they want you to, and may push the boundaries of Medicare regulations (which can get you in trouble). Your license will be on every claim, so you are going to want to scrutinize all orders, care plans, and appropriateness criteria carefully.

  • Be familiar with all the Medicare guidelines yourself so that you can judge whether a company or organization is functioning ethically and according to the regulations. Experienced hospice and palliative care physicians point out that some companies love new and inexperienced physicians because they can be more easily persuaded to sign things easily. 

  • Make sure you’re able to accommodate the interruptions from the call frequency, as due to the nature of the field, calls are time sensitive and can come at all times. This will include during your office hours as a physician. 

  • You must care about the work to do it, as it can be demanding both from a time and emotional perspective. 

  • Review the medical records yourself prior to approving a patient for hospice instead of listening to an administrator or company who tells you that they meet criteria. 

  • If you think someone no longer qualifies, take them off the service.

  • The quality of your nurses and nurse practitioners will make all the difference.  Make sure you review the standing orders and are comfortable with the flexibility that the nurses have to increase doses.

  • Always ask to be called about any opioid or benzodiazepine changes.



Conclusion


Being a hospital medical director can be very rewarding, but is not an easy side gig and your compensation isn't high compared to the responsibility that you take on. Depending on the size of the company or organization you are working for, there can be a lot of call responsibilities and orders to sign, as well as other administrative responsibilities. Our members warn about for-profit companies, as they state there is a lot of fraud in the space if you go with an agency that wants to maximize profit at the risk of bending Medicare guidelines and regulations. Ultimately, your name will be on every order and prescription and claim, so you need to feel comfortable with both the employer as well as the interdisciplinary team that you are working with, and set clear parameters for how you’d like things to be done. In order to do the job ethically and serve your patients in the best way possible, our members recommend that if you’re not board certified in hospital and palliative medicine (HPM), that you pursue one of a number of available hospice medical director certifications.



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