The NHPCO guidelines for non-cancer diagnoses were published in 1996 as a well intentioned attempt to help hospices and clinicians decide when it was appropriate to refer patients for hospice care based on a prediction of less than six months survival. The committee developing the guidelines used the best medical evidence at the time to establish clinical prognostic indicators. Hospice programs across the country have adopted these guidelines into admission checklists, to be used at the time of hospice referral to help the core team decide if patients meet admission criteria under the Medicare Hospice Benefit; hospice fiscal intermediaries have similarly adopted most aspects of the guidelines as criteria to use for determining payment eligibility. Unfortunately, since 1996 good quality research projects looking at the validity of these prognostic criteria have shown that the disease-specific NHPCO guidelines are little better than a flip of the coin in determining whether a patient with end-stage heart or lung disease or dementia will survive more or less than six months. Two recent Fast Facts and Concepts (#141-COPD; #143-CHF) discuss current research on prognostic factors in end-stage heart and lung disease (go to www.eperc.mcw.edu).