CMS takes closer look at hospice care benefit

The Medicare program will revisit how it pays for the hospice care benefit in an attempt to avoid duplicate payments, Kaiser Health News has reported. However, some advocates worry that any changes could make it more difficult for terminally ill patients to decide to switch to hospice care.

The primary issue centers on patients in hospice care who receive treatment for care outside of their actual hospice facility. If the patient seeks care outside of hospice, Medicare will pay that non-hospice provider, even if the hospice provider already receives reimbursement for providing the same services, according to Kaiser Health News.

The Medicare Payment Advisory Commission (MedPAC) said the Medicare program spent $1 billion on non-hospice services for hospice patients in 2012, according to Kaiser Health News.

Medicare is already being challenged on another front regarding hospice care: More than half of such care is now being provided by national or for-profit entities, according to a recent study published in Health Affairs, with the possibility such firms could drive up utilization and costs. And while hospice care is less expensive than continuing hospital care, federal investigators have also raised concerns regarding hospice billing fraud.

"There will always be exceptions for people who have terminal conditions and have other conditions that need to be attended to," Sean Cavanaugh, deputy administrator at the Centers for Medicare & Medicaid Services, told Kaiser Health News. "But the majority of their services would be provided through hospice."

However, hospice advocates expressed concern. "The easiest thing for CMS to do is to say everything would be related to the terminal illness and then there would be no billing problems," Terry Berthelot, senior attorney at the Center for Medicare Advocacy, told Kaiser Health News. "If your blood sugar gets out of control, that could hasten your death. But people shouldn't be rushed off to die because they've elected the hospice benefit."

Along with such issues, there is next to no communications between hospice and other providers to determine if a patient seeks care outside of the hospice setting.

To learn more:
- read the Kaiser Health News article 
- check out the Health Affairs study abstract