Medicare demands money back as hospice patients live longer

Historically, patients who ended up in a hospice have tended to live less than six months once curative efforts were withdrawn. Medicare reimbursement for hospice services was structured around this assumption.  More recently, however, hospices have begun taking in patients, such as those with Alzheimer's disease, who live longer than the cancer patients that once filled most hospices. While there's no time limit on how long these patients can stay in the hospice, there is a limit on how much Medicare will pay a hospice during a single year--and that's turning out to be a big problem. With payments fueled by these longer-stay patients, hospices have begun to exceed those limits. And now, Medicare is now asking some hospices to pay back funds they received.

In demanding refunds from hospices, Medicare is trying to trim expenses in a critical area. Hospice is one of the fastest growing components of Medicare, with its services being used by nearly 40 percent of Medicare beneficiaries and spending tripling from 2000 to 2005. According to some estimates, more than 200 hospices got CMS repayment demands for reimbursements that exceeded yearly limits. The demands totaled between $166 million and $200 million, depending on who you ask. What's missing from this discussion, however, is whether Medicare actually did the math and determined whether a crackdown actually saves money when the lower patient management costs for hospice care are figured in. After all, these patients are going to be in care somewhere, right?

To learn more about this issue:
- read this article from The New York Times

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