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Medicare And Hospice
By Janice
Sanford
October 16, 2005
The Medicare hospice benefit is designed to provide palliative care to beneficiaries with terminal illnesses who are approaching the end stages of their lives. Medicare offers a benefit-the hospice benefit-that is specifically targeted to Medicare beneficiaries with a terminal illness. To elect the hospice benefit, beneficiaries must forgo curative treatment for their terminal condition.
Medicare spending on hospice has grown from $1.9 billion in 1995 to an estimated $5.9 billion in 2003. What is the Medicare hospice benefit and how has its use changed over time? Medicare's hospice benefit offers a broad array of palliative care services, including counseling and other psychological services, to beneficiaries with a terminal illness. Medicare spending on the hospice benefit more than doubled from 2000 to 2003.
The Medicare hospice benefit covers the following services for palliative care:
· skilled nursing care
· medical social services
· physician services
· patient counseling (dietary, spiritual, and other)
· short-term inpatient care· medical appliances and supplies
· drugs and biologicals for pain control and symptom management
· home health aide services
· homemaker services
· therapy (physical, occupational, and speech)
· inpatient respite care (providing a limited period of relief for informal caregivers by placing the patient in an inpatient setting like a nursing home)
· family bereavement counseling
· any other item or service listed in a patient's care plan as necessary for the palliation and management of the terminal illness
The Medicare hospice benefit has always covered prescription drugs for palliative purposes. Who certifies the patient as being eligible for hospice services? Hospice services can continue as long as patients are certified as eligible.
Both the hospice medical director and the patient's attending physician (if he or she has one) must complete the initial certification of terminal illness. The initial benefit period is 90 days, which may be followed by another 90-day benefit period. Subsequently, a beneficiary may qualify for an unlimited number of 60-day benefit periods.
The medical director of the hospice must recertify that the patient is terminally ill at the beginning of each benefit period. At any time, beneficiaries may discontinue their hospice care, in which case they revert back to their full Medicare coverage.
Half of all hospice agencies are freestanding. The remaining half are owned by other types of providers, namely, home health agencies, hospitals, and skilled nursing facilities. Most hospice agencies are not-for-profit organizations, but for-profits have grown to over a third of the industry.
In most cases, a beneficiary's length of enrollment is determined by the number of days a beneficiary lives after electing the hospice benefit. Between 2001 and 2002 the average length of enrollment for a beneficiary in hospice care increased from 50 days to 55 days
but the median remained 16 days. From 1998 to 2002, more than 25 percent of beneficiaries dying in hospice stayed less than a week. Between 1998 and 2002, the share of beneficiaries age 95 or older who died while in hospice care rose from 12% to 23%. From 1992 to 2000, use of hospice by beneficiaries in nursing facilities grew from 11% to 36%. (Hogan 2002).
The number of Medicare-certified hospice agencies increased by 8% between 2001 and 2002. For-profit facilities have seen the most rapid growth. Increased by 25% between 2001 and 2003. The number of freestanding agencies grew 29%-considerably more than their provider-based counterparts, which all experienced single-digit change between 2001 and 2003.
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