ChatGPT understands the benefits of hospice care. Why don't we?

Why isn’t the Medicare hospice benefit more accessible given it improves patient care and saves billions annually for tax payers?

We inhibit hospice access with two unnecessary regulations:

1. The six month death certification by a physician. This rule has no clinical foundation. It should be replaced by one that says any patient with a terminal diagnosis is eligible for hospice.

2. The requirement that patients must give up regular Medicare in order to receive hospice. Again this rule has no foundation. In fact Medicare’s own research documents the benefits of allowing patients to have both regular Medicare and hospice simultaneously.

I recently asked ChatGBT to provide me with documentation for the benefits to society for enhancing access to hospice. This what it said:

Medicare achieves significant cost savings when beneficiaries choose hospice care, primarily by reducing hospitalizations, intensive treatments and emergency room visits. Studies estimate that Medicare saves between $2,000 to $7,000 per patient who elects hospice, depending on factors such as timing and diagnosis.

Overall, Medicare’s hospice benefit saves billions of dollars annually. A report from the Medicare Payment Advisory Commission (MedPAC) indicated that hospice care could reduce Medicare spending by approximately $3 billion to $5 billion per year, though savings vary depending on utilization patterns and patient demographics.

Recent studies have provided more detailed insights into the cost savings Medicare achieves through hospice care:

• Annual Savings: In 2019, hospice care resulted in approximately $3.5 billion in Medicare savings, equating to a 3.1% reduction in costs during patients’ last year of life. 

• Per-Patient Savings: For patients with Alzheimer’s disease and related dementias, enrolling in for-profit hospice care led to about $29,000 in Medicare savings over the first five years post-diagnosis. 

• Impact of Hospice Duration: Longer hospice stays correlate with greater savings. Patients receiving hospice care for six months or more experienced an average cost reduction of 11% compared to non-hospice patients. 

These findings underscore the financial benefits of hospice care for Medicare, alongside the quality-of-life improvements for patients and their families.

Hopefully someone from DOGE reads this common sense savings opportunity.

Primary care catastrophe

Yet another powerful article demonstrates that Primary Care (PC) in the US is underpaid and facing a massive shortage - creating a crisis in access to care. One fact in the article that was particularly compelling was that 50% of PC physicians are over age 55. So we currently have a shortage of PCs and very few new physicians are pursuing a practice in PC. Our shortage crisis will become a catastrophe without a new healthcare policy. 

Unfortunately, the article is light on solutions.

One fact not well known is that increased access to PC materially lowers healthcare costs AND improves the quality of care.

Opportunities to improve PC access exist (see www.thejourneys-end.org). Hopefully, our new Secretary of HHS will aggressively address this serious health issue.

What could really improve primary care

A recent New England Journal of Medicine article discusses Medicare’s new regulatory efforts to improve primary care physician compensation through updated coding and payment policies. The authors begin by emphasizing the importance of primary care:

“A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) concluded that primary care is a common good and is foundational to the U.S. health system.”

The report further highlights that increased investment in primary care would enhance quality and reduce costs within the U.S. healthcare system.

However, as the article notes, investment in primary care has steadily declined for decades, mirroring the dwindling supply of primary care physicians. This declining investment has directly contributed to the severe shortage of primary care providers. The authors conclude:

“The need to bolster primary care…is clear. Improved compensation for primary care.”

While these insights are critical for shaping future U.S. healthcare policy, the solutions proposed by the authors are unlikely to succeed.

The Challenges of Coding and Administrative Burdens

One key factor that makes primary care undesirable—beyond inadequate compensation—is the overwhelming administrative burden tied to payment obligations. Primary care physicians often spend more time navigating the complex billing and coding system than they do seeing patients. Unfortunately, Medicare’s approach of introducing more complex codes to enhance payment exacerbates this issue rather than resolving it.

The authors of the article appear to overlook the realities of these administrative burdens.

For a typical primary care physician managing 2,500 patients, building trusting relationships—fundamental to effective primary care—requires time and meaningful conversations. However, the coding system actively discourages such patient-centered care. It focuses instead on documentation for reimbursement purposes, which undermines the very essence of primary care. Trust cannot be measured by codes, and compensating primary care physicians based on these codes is both ineffective and counterproductive.

A Flawed Funding Strategy

Medicare’s funding strategy is fundamentally flawed: it fuels systemic issues like fraud, prioritizes volume over quality, increases paperwork obligations and discourages the meaningful conversations essential for primary care.

A Better Path Forward

Rather than adding complexity through additional coding, Medicare should explore simple, non-coding solutions to improve primary care compensation and enhance physicians’ quality of life. These changes would allow primary care practitioners to focus on what matters most—building trusting relationships with their patients, as I discuss on my website.

More coding will not solve the challenges facing primary care. Instead, it will continue to harm the field, perpetuating the very issues it seeks to address.