AMERICAN STYLE HEALTHCARE:

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AMERICAN STYLE HEALTHCARE: HOSPICES FORCED TO REPAY MEDICARE FOR
PATIENTS WHO LIVE TOO LONG

NY TIMES - Hundreds of hospice providers across the country are facing
the catastrophic financial consequence of what would otherwise seem a
positive development: their patients are living longer than expected.

Over the last eight years, the refusal of patients to die according to
actuarial schedules has led the federal government to demand that
hospices exceeding reimbursement limits repay hundreds of millions of
dollars to Medicare.

The charges are assessed retrospectively, so in most cases the money has
long since been spent on salaries, medicine and supplies. After
absorbing huge assessments for several years, often by borrowing at high
rates, a number of hospice providers are bracing for a new round that
they fear may shut their doors. . .

In the early days of the Medicare hospice benefit, which was designed
for those with less than six months to live, nearly all patients were
cancer victims, who tended to die relatively quickly and predictably
once curative efforts were abandoned.

But in the last five years, hospice use has skyrocketed among patients
with less predictable trajectories, like those with Alzheimer's disease
and dementia. Those patients now form a majority of hospice consumers,
and their average stays are far longer  -  86 days for Alzheimer's
patients, for instance, compared with 44 for those with lung cancer,
according to the Medicare Payment Advisory Commission. . .

Medicare, which pays the vast majority of hospice bills, reimburses
providers $135 a day for a patient's routine home care. The hospice is
then responsible for providing nurses, social workers, chaplains,
doctors, drugs, supplies and equipment, as well as bereavement support
to the family.

Studies have reached various conclusions about whether hospice care
actually saves money, especially for long-term patients. But a new study
by Duke University researchers concluded that it saved Medicare an
average of $2,300 per beneficiary, calling hospice "a rare situation
whereby something that improves quality of life also appears to reduce
costs."

In 1998, Congress removed limits on the number of days that an
individual could receive Medicare hospice coverage, a move that
encouraged physicians to refer terminal patients.

http://www.nytimes.com/2007/11/27/us/27hospice.html?ex=1353906000&en=
2c18975f444b77a7&ei=5088&partner=rssnyt&emc=rss


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