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When the Patient is Clearly Terminal, but the Diagnosis Isn’t?

Title: When the Patient is Clearly Terminal, but the Diagnosis Isn’t? with Joan Harrold, MD MPH, FACP, FAAHPM               

CE/CME Offered:

CE/CME Credit Available: Nurse, Physician, and Non-Physician Healthcare Professional CE credit

Member Price: $105.00
Non-Member Price: $210.00

Payment Options:

Add to Cart without CE/CME
Add to Cart with Nurse CE
Add to Cart with Physician CME credit
Add to Cart with Non-Physician Healthcare Professional Certificate

Length: 1.5 hours

Are you flummoxed when trying to admit a patient who appears terminal, but doesn’t have an end-stage diagnosis? Are you using the disease-specific guidelines correctly as you assess and document eligibility?  What do information do you gather to support certification of a patient with an uncommon diagnosis or one who is medically complex without a clear terminal diagnosis?  How do you determine which diagnoses are designated “related” for reporting and coverage purposes? 

What about your interdisciplinary team processes for these types of patients? The importance of the initial and comprehensive assessments and the process of re-assessment  is becoming more important every day and, particularly in these challenging situations, is a vital component of ensuring that care is coordinated, integrated and everyone is “on the same page.”

Perhaps most importantly, what organizational and team processes do you have in place for determining consistent and medically rational answers to any of these questions when the answers are not obvious?  Do you and other interdisciplinary team members (particularly medical directors and physicians) understand your changing role with respect to these issues? What about the challenges they pose to the function and practice of the interdisciplinary team?

Drawing on her experiences as a hospice medical director, medical reviewer, and member of the MAC/NHPCO Collaborative Workgroup, Dr. Harrold will address these and similar questions that often create dilemmas where clinical mission and regulatory compliance intersect. 


  • Utilize and apply disease-specific guidelines and related information to support certification
  • Determine “related” diagnoses for reporting and coverage purposes
  • Describe organizational processes needed to confidently support certification

Joan Harrold, MD, MPH, FACP, FAAHPM

Dr. Joan Harrold is the Medical Director and Vice President, Medical Services of Hospice and Community Care in Lancaster, PA and has more than 16 years of experience in hospice and palliative care. Board certified in Internal Medicine with added qualifications in Hospice and Palliative Medicine, she received her medical degree from the Medical College of Virginia. She also completed a Master of Public Health degree with special emphasis in epidemiology and biostatistics.  Dr. Harrold serves on the Boards of Directors of the Hospice and Palliative Nurses Foundation and the Pennsylvania Hospice Network.  She previously served as a director on the Boards of the American Academy of Hospice and Palliative Medicine (AAHPM) and the American Board of Hospice and Palliative Medicine (ABHPM). Dr. Harrold actively participates in NHPCO as well in a number of capacities including: former Physician Section Leader of the National Council of Hospice and Palliative Professionals, NHPCO/MAC Workgroup, Governance Committee, Physician Education Subcommittee, Chief Medical Officer Council and Palliative Care Task Force. Additionally, Dr. Harrold serves on the inaugural Examination Committee of the Hospice Medical Director Certification Board; she formerly served on the American Board of Internal Medicine Examination Committee for Hospice and Palliative Medicine and the Examination Committee for the American Board of Hospice and Palliative Medicine. Dr. Harrold is co-author of the Handbook for Mortals: Guidance for People Facing Serious Illness (2011), has participated in peer-reviewed research in hospice care and has is a frequent presenter on national and regional levels.  


Planners: Barbara L. Bouton, MA, FT, and Jennifer Kennedy, MA, BSN,  RN, have no relevant financial relationships to disclose. 

Faculty:  Joan Harrold, MD, MPH, FACP, FAAHPM has no relevant financial relationships to disclose. 

CE/CME Credit Hours: Nurse: 1.5 Contact Hours
Social Work: 1.5 Contact Hours
Physicians:  1.5 AMA PRA Category 1 Credits ™
Completion: In order to complete this online activity and obtain CE/CME credit, participants must view the course in its entirety, correctly answer all case studies and quiz/test questions (as appropriate) and complete the evaluation.  You will have 90 days to access this course from the date of purchase.
CE/CME Info:


Nurse: NHPCO is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

NHPCO designates this enduring material for a maximum of 1.5 contact hours. Nurses should claim only the contact hours commensurate with the extent of their participation in the activity. Accredited status by ANCC refers only to continuing nursing education and does not imply   endorsement of any commercial product discussed in conjunction with this activity.


Physician: The National Hospice and Palliative Care Organization is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

NHPCO designates this enduring material for a maximum of 1.0 AMA PRA Category 1 credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Certificate of Participation for Non-physician Healthcare Professionals: 
For participants* whose disciplines are other than counselor, nurse, physician, and social worker, you may request a Certificate of Participation for Non-physician Healthcare Professionals to submit to your accrediting bodies/licensing boards for continuing education credit. This certificate will indicate the Webinar was certified for AMA PRA Category 1 Credit(s) TM. It is the responsibility of participants to submit the certificates to their accrediting bodies/licensing boards for approval. Unfortunately, NHPCO cannot guarantee its acceptance. To receive this certificate, you must complete all CE/CME requirements and indicate your desire to receive this certificate on the evaluation form. *including bereavement professionals, finance professionals, physician assistants, spiritual care givers, etc.

Release Date:


Review date: 05/22/2017

Expiration Date:  


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