Nov. 27, 2007 - The increase in hospice patients
who live longer than expected has led
CMS (Centers for Medicare & Medicaid Services) to demand
hundreds of millions of dollars in repayments from facilities that
exceed Medicare reimbursement limits, the
New York Times
reports.
The Medicare hospice program originally was
designed for people with terminal illnesses who had less than six months
to live, as certified by a physician. Nearly all of the patients had
cancer and "tended to die relatively quickly and predictably once
curative efforts were abandoned," according to the Times.
However, in the last five years, the use of hospice
by patients with less predictable life expectancies, such as those with
Alzheimer's disease and dementia, has "skyrocketed," the Times reports.
According to the
Medicare Payment
Advisory Commission, the average stay for an Alzheimer's
patient is 86 days, compared with 44 days for lung cancer patients.
Congress in 1998 removed limits on how long a
person could receive Medicare hospice services but did not remove a cap
on the aggregate amount that hospice could be reimbursed each year.
A recent MedPAC analysis projected that 220
hospices, or about one in every 13 providers, received 2005 repayment
demands totaling $166 million. The
National Alliance for
Hospice Access, which is lobbying for a three-year moratorium
on repayments, says 250 hospices received 2005 repayment demands
totaling $200 million.
Many could be forced to close
According to the Times, "Hundreds of hospice
providers across the country are facing catastrophic financial
consequences" because of the repayments and could be forced to close.
The Times reports that the charges are assessed
retrospectively, and in many cases the funds already have been spent on
salaries, medicine and supplies. Lois Armstrong, president of the
hospice access alliance, said if the limits are not changed or removed,
patients' access to care will decline at a time when hospice care is in
high demand and saves Medicare money.
Medicare Drug Program News
Open enrollment period allows seniors to change
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Website also includes tool that addresses the
"doughnut hole" coverage gap
Nov. 15, 2007
According to the Times, hospice has become "one of
the fastest growing components" of Medicare, with its services being
used by nearly 40% of Medicare beneficiaries and spending nearly
tripling from 2000 to 2005 to $8.2 billion.
Medicare officials say that because less than
one-tenth of all providers have faced repayment, mismanagement might be
a greater issue than the reimbursement cap.
CMS deputy director Herb Kuhn said, "Well over nine
out of 10 hospices seem to be managing well, including the ones in
higher-wage areas, so it does raise an issue of management." Another
issue that should be reviewed is whether physicians are prematurely
certifying their patients as terminal, Kuhn said (Sack, New York Times,
11/27).
Website also includes tool that addresses the
"doughnut hole" coverage gap