Monday, December 17, 2007

Outliving Medicare's Hospice Benefits

According to recent news reports, Medicare is assessing charges against some hospice institutions that cared for substantial numbers of terminally-diagnosed patients who outlived the six-month hospice benefit period.

On December 17, 2007, the Providence Business News posted an article entitled "When life doesn’t end as expected", by Marion Davis, who reported:

Lengths of stay for hospice patients are increasingly under scrutiny nationwide because some hospices – particularly, for-profit institutions in the South and West – have had so many patients exceed the six-month time frame that Medicare has charged them back millions of dollars: $166 million from 220 hospices in 2005, according to the Medicare Payment Advisory Commission. * * *
The article focused on the "hospice benefit" provided by Medicare:
Medicare pays for hospice – specialized end-of-life care focused on physical and emotional comfort, spirituality and support for the family – when a patient has been given less than six months to live and agrees to forgo life-extending treatments. * * *
The publication "Medicare Hospice Benefits" (Rev. 09/2007; PDF, 16 pages) issued by the Centers for Medicare & Medicaid Services, explains the program.
Hospice is a program of care and support that you may want to consider if you or someone you care for is terminally ill.

Here are some important facts about hospice:
  • Hospice provides comfort and support services to people who are terminally ill. It helps them live out the time they have remaining to the fullest extent possible.
  • Hospice care is provided by a specially trained team that cares for the “whole person,” including his or her physical, emotional, social, and spiritual needs.
  • Hospice provides support to family members caring for a terminally ill person.
  • Hospice is generally given in the home.
  • Hospice services may include drugs, physical care, counseling, equipment, and supplies for the terminal and related condition(s).
  • Hospice isn’t only for people with cancer.
  • Hospice doesn’t shorten or prolong life.
  • Hospice focuses on comfort, not on curing an illness.
Medicare Hospice Benefits -- You can get Medicare hospice benefits when you meet all of the following conditions:
  • You are eligible for Medicare Part A (Hospital Insurance)
  • Your doctor and the hospice medical director certify that you are terminally ill and have six months or less to live if your illness runs its normal course
  • You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness*
  • You get care from a Medicare-approved hospice program
*Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.
The problem occurs when substantial numbers of patients certified for hospice benefits actually live longer than the expected six months.

The article describes one individual's case where benefits continued, and also addresses the problem on an institutional level when charges are levied upon the provider.

U.S. Senator Pete V. Domenici is aware of the problem. On October 26, 2007, he issued a press release entitled "Domenici Seeks 3-Year Moratorium on Medicare Hospice Repayments, Says Penalties Could Sink N.M. Programs":
U.S. Senator Pete Domenici today warned that some New Mexico hospice programs that serve eligible non-cancer patients face financial ruin if they are forced to repay millions of dollars in Medicare payments.

Domenici has formally asked the leadership of the Senate Finance Committee to impose a three-year moratorium on Aggregate Hospice Cap (Cap) repayment notices being issued by the Centers for Medicare and Medicaid Services (CMS), the agency that administers Medicare programs.

Domenici asked that a moratorium—covering fiscal years 2005, 2006 and 2007—be written into Medicare legislation now being developed by the Finance Committee. * * *
The New York Times reported about the effects on hospice providers in an article entitled "In Hospice Care, Longer Lives Mean Money Lost", by Kevin Sack, published November 27, 2007:
Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.

Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

The charges are assessed retrospectively, so in most cases the money has long since been spent on salaries, medicine and supplies. After absorbing huge assessments for several years, often by borrowing at high rates, a number of hospice providers are bracing for a new round that they fear may shut their doors. * * *
On December 3, 2007, The NY Times published letters to the editor sent in reaction to that article. See: "Hospice Care: When the Dying Live On".

In his letter, J. Donald Schumacher, the President and Chief Executive Officer of the National Hospice and Palliative Care Organization, identified the first priority:
There is one very simple point that must be emphasized: No person in need of hospice care should encounter unnecessary barriers to quality care at the end of life. * * *