Why shouldn't everyone benefit from Hospice care improvement opportunity?

“CMS to Allow Hospice Care During VBID Extension.” That is the title of a recent article in Hospice News. In essence, it is declaring is that patients will now be eligible to receive both traditional Medicare and Hospice Care in Medicare Advantage Plans. My question is - why give this care improvement and cost savings opportunity to only private insurers?

Medicare is failing financially and it decides to give away the $2.3 billion dollar savings that Medicare gets from Hospice annually!

The policy logic of this strategy is flawed at best. The Hospice Benefit needs a major overhaul because evidence demonstrates it could improve end-of-life care and save Medicare billions of dollars. Major changes like:

1. Eliminating the six-month death certification and replace it with a terminal diagnosis

2. Allowing patients to receive curative care and comfort care simultaneously

3. Expand the home care benefit in hospice to make it a more viable option for families.

Going into Hospice compared to receiving ineffective and expensive hospital care, drugs, and treatments would save money and improve care.

Medicare funding challenges will not be solved with incremental change. End-of-life care in our nation will not improve without dramatic and simple payment and insurance change by Medicare. My book, The Journey’s End offers a thoughtful analysis and concrete recommendations based on sound economics to address these concerns.

Hospice saves money. Why the time limit?

Hospice saves Medicare billions annually. This is the conclusion of research reported by author Jim Parker in Hospice News. One might argue these research conclusions are merely common sense observations. Think about it - if a patient selects hospice care they avoid much more expensive hospital care. The longer the patient is in hospice the greater the savings to Medicare. Yet the Office of Inspector General for the United States Department of Health and Human Services (OIG) considers stays of longer than 6 months in hospice to be grounds for fraud. Medicare and the OIG need to support hospice, not investigate it, if they wish to save billions for Medicare. Furthermore, Medicare should pay for hospice based on an hourly cost - and not pay hospice based on a complex coding system that encourages fraud and needless OIG oversight. To learn more details on these observations read The Journey’s End.

Solutions for avoiding aggressive EOL care

Many older patients today are not getting what they wanted. Instead, they are receiving invasive--and unproductive--care in the last month of their lives. As Paula Span eloquently explains in her The New York Times article, Aggressive Medical Care Remains Common at Life's End, elder care is fraught with these trials and tribulations. While the systemic reasons for these failures and frustrations would take an entire book to explain (trust me--my book is available April 4th), Span points to two potentially powerful solutions:

• Making more of an effort to offer patients Palliative Care Consults before offering aggressive end-of-life treatments like chemotherapy, dialysis, surgery, or a visit to the ICU.

• Allowing patients the option to continue curative treatment while in hospice. Reforming Medicare to allow this would benefit everyone. In fact, VA Insurance has found it beneficial to offer curative care in hospice. Even Medicare itself piloted a project showing that hospice with curative care improves experience and lowers costs.

If you found Span's article of interest, you might benefit from my book, The Journey’s End, which was written to help you avoid a similar fate at your life's end.