Studies have shown that underutilization of hospice care increases end-of-life costs; more aggressive use of hospice could lead to significant savings and better care. Medicare seems understand that promoting hospice care is not a "Death Panel."
Fanned by fiery political rhetoric, seniors were led to believe that secreted into the new healthcare legislation was an ominous provision—“The death panel.” In other words, it’s costing too much to keep granny alive so we’re going to pull the plug; a massive bureaucratic Dr. Kevorkian.
Of course, nothing could be further from the truth, but the outcry led legislators to can a provision of the House bill that would have paid for voluntary consultations between physicians and Medicare beneficiaries about end-of-life care: living wills, hospice benefits and the like.
Fortunately Medicare took another look at hospice care.
Under current Medicare rules, beneficiaries whose doctors determine that they have less than 6 months to live can choose hospice care -- but only if they forgo any further life-prolonging treatment related to their disease.
The new law establishes a three-year "concurrent care" demonstration program at 15 sites nationwide, in which Medicare would cover both kinds of treatment simultaneously.
Although the vast majority of patients seeking hospice benefits are over 65, starting in 2013, the new law also allows children who are enrolled in Medicaid or the Children's Health Insurance Program (CHIP) to receive both hospice and curative care.
One problem is that many terminally ill patients wait until death is imminent to choose hospice care. The median length of time in hospice was just over 20 days in 2008; more than a third of people died or were discharged from hospice in seven days or less.
Underutilization of hospice adds unnecessary costs and hampers the delivery of high-quality care. It’s time to chuck histrionics and follow science and reason. Medicare appears ready to do that in the very difficult area of end-of-life care.
