Growing Pains for the Medicare Hospice Benefit (New Eng Jour Med)

[pinto]

A good read on the Hospice Benefit in the big picture of Medicare and health care overall. ~ pinto

Growing Pains for the Medicare Hospice Benefit

David G. Stevenson, Ph.D.
N Engl J Med 2012; 367:1683-1685, November 1, 2012

For 30 years, the Medicare hospice benefit has played a key role in shaping end-of-life care in the United States. Authorized by the Tax Equity and Fiscal Responsibility Act of 1982, the benefit was meant to improve the dying experience for terminally ill beneficiaries and to reduce the intensity and cost of health care services at the end of life. After a slow start, hospice became an integral part of Medicare, and nearly half of all people who die while covered by Medicare now use the benefit before death.

Medicare beneficiaries are eligible for hospice when physicians certify that their prognosis suggests they have 6 months or less to live and when they agree to forgo curative therapies. The benefit covers a broad array of palliative and supportive services, and hospice agencies receive per diem payments ($151, on average) to manage all care related to patients' terminal conditions. There is no cap on the benefit's duration, provided that physicians certify that enrollees continue to meet the eligibility requirements. Medicare does, however, enforce an aggregate cap for agencies, effectively limiting the total amount they can receive (about $24,500 per beneficiary in 2011).

By many accounts, Medicare's hospice benefit has been an enormous success. From its initial focus on community-dwelling seniors with cancer, hospice has expanded to offer access for a much wider range of Americans at the end of life. Although data on its cost-effectiveness are mixed, hospice appears to deliver valuable benefits to recipients, including a reduced number of hospitalizations, greater attention to emotional and spiritual needs, improved pain management, and greater patient and family satisfaction.1

http://www.nejm.org/doi/full/10.1056/NEJMp1208465?query=health-policy-and-reform

[enough]

1. Very interesting, thanks. (nt)

[dhol82]

2. still waiting

still waiting for this country to accept the concept of death. seems like everybody wants to live forever.

death is the natural end to life. don't understand why so few get it.

[SharonAnn]

3. They were wonderful and we could keep my husband at home. I volunteer with

them now and do things like visit for social interaction. Read out loud, play music, play cards or other games, or just talk. Even provide respite care (like babysitting) so the family can get out for a while. Patients especially talk about "the old days". They like to talk about their early years, things they did as kids, their parents, siblings, and other family members. I have tremendous affection for them and am richer for knowing them.

Also, I am impressed with the number of people who make every effort to keep their family members at home as long as they can be comfortable there. It gives the patients such peace and they really need little care when they have this terrific family support. The nurse comes by periodically, frequency depends on the patient's needs. Other support people come in and help.

All in all, it's a real blessing for most people during their last days.