Medicare Compliance & Reimbursement

Many terminally ill patients refuse to elect Medicare's hospice benefit because they would have to give up curative treatment, but the new health care reform law could change their perspective.

Children will benefit immediately from the new health law, as it instructs Medicaid to cover simultaneous hospice and curative care for children with terminal illnesses. At the same time, another provision -- the Medicare Hospice Concurrent Care Demonstration Program - directs the Health and Human Services Secretary to establish a three-year demonstration program that would allow patients who are eligible for hospice care to also receive all other Medicare covered services while receiving hospice care.

"The demonstration would be conducted in up to 15 hospice programs in both rural and urban areas and would undergo an independent evaluation of its impact on patient care, quality of life, and spending in the Medicare program," according to the National Hospice & Palliative Care Organization.

CMS currently is designing that demonstration, CMS's Randy Throndset said in the May 26 Open Door Forum for home care providers. "We're in the very early stages for that." Watch for more details on that demo later, he added.

Diane Meier, director of the Center to Advance Palliative Care at the Mount Sinai School of Medicine in New York, says in The Philadelphia Inquirer that the provision makes it easier for the dying to accept hospice care -- without forcing them to give up anything. Patients will be able to come to terms with their terminal state and make decisions about their treatment on their own. This change in perspective could demonstrate the very essence of what hospice is all about: quality of life, experts say.

About one million Medicare beneficiaries entered hospice care in 2008, and cost the federal government about $11.2 billion, according to the Medicare Payment Advisory Commission. In 2008, a patient's length of stay in the hospice care program averaged about 83 days.