HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, July 1, 2008

New Medicare Rules for Hospice

The Washington Post reports on the new Medicare rules for hospice care. Alicia Ault writes,

Twenty-five years after Medicare began paying for hospice care, the federal health program has issued a new rule calling hospice providers to closer account on the quality of care they offer. The rule, which will take effect in December, guarantees hospice patients a say in their treatment plans and requires hospice providers to show they are improving in areas where they have been found deficient. 

The move comes at a time when hospice care is growing exponentially but is still vastly underused and under-appreciated, hospice providers and advocates say. About 1.3 million people received hospice services in 2006, more than twice as many as did a decade earlier.
What was once a grass-roots, community-based movement in the late 1960s has become a booming health-care business. . . .

Many in the field say they find it surprising that hospice care isn't more widely used, given the generosity of the Medicare benefit: There are no co-pays, deductibles or out-of-pocket costs for beneficiaries who use hospice. Malene Davis, president and chief executive of Capital Hospice, based in Falls Church, blames widespread misperceptions (the idea, for instance, that hospice is only for cancer patients, or that once someone is in, he can't leave) for holding down the rate of use.

Not all of the 1.3 million people who received hospice services in 2006 died within the next six months, although a life expectancy of six months or less is often a condition for treatment. Some lived into the following year, and about 220,000 were discharged. Predicting the time of death, though, is a notoriously inexact science.

Linda Neighborgall of Falls Church is an enthusiastic supporter, after using hospice for her mother and mother-in-law, both of whom died from cancer. . . .  "If there really are angels on Earth, I know where they work: They work at hospice," Neighborgall said.

Some devils may work there, too. In 1995 government investigators issued a "fraud alert" on hospice after they found false claims from providers who improperly diagnosed patients as terminally ill or billed for undelivered care. There's still no central repository of complaints data. "We hear terrible stories about even the most reputable hospices," says Naomi Naierman, president and chief executive of the American Hospice Foundation, a nonprofit consumer advocacy group based in Washington. . . .

The new Medicare rule may not suddenly increase acceptance of hospice, but it will start reducing variations in how care is delivered, and eventually it will help consumers choose high-quality hospice providers, Davis said. . . .   

Beginning Dec. 2, hospice organizations will also have to implement a quality assessment and improvement system. Hospices will have to show the Centers for Medicare and Medicaid Services, the agency that administers Medicare, that they are trying to improve in problem areas.  Initially, quality data will be available only to each hospice organization and Medicare. Eventually, providers and advocates expect, data will be shared with the public, as the federal government has done with information on nursing homes, hospitals and home health agencies.

Hospice providers are happy with the new rule, Lund Person said. NHPCO members have already been tracking performance voluntarily through its Quality Partners program, she said. Most hospices also use family surveys to measure how well they have handled a case. . . .

Until there are more public data, "there is no way of choosing at this point or differentiating among hospices," Naierman said. That's problematic, she added, because often, "once you make a decision to go into hospice, there's really no recourse; it's a fairly final decision."

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