|
|
Development Rationale Elements |
Lexicon Resources FAQ Miscellaneous |
|
| How to Establish a Palliative Care Program | ||||
 |
||||
Financing Hospice CareIn the US, hospice care has chiefly been delivered at home. This has been driven by the fact that more than 80% of Americans say that, if they have a terminal illness, they would like to be cared for and die at home. In 1993, 256,900 patients were cared for by hospice programs and an estimated 540,000 were managed in 1998 . In 1999, the National Hospice and Palliative Care Organization estimated that over 600,000 Americans died while receiving hospice care (29% of all Americans who died that year) Medicare has been the main source of funding for hospice home care in the US. Sixty-five percent of hospice patients are covered by the Medicare Hospice Benefit. Other funding sources include: Many hospices also provide care to uninsured individuals. To do so, they rely on donations to cover their costs. Medicare Hospice Benefit Based in part on the experience of the National Hospice Study, the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA) established the Medicare Hospice Benefit (MHB). It became effective the following year. It was the first use of a prospective payment system by Medicare. Today, it continues to be the most comprehensive benefit for end-of-life care available. For eligible patients who elect to enroll in the Benefit, a Medicare-certified hospice program assumes responsibility for the complete plan of interdisciplinary care for the patient and family related to the patient's terminal illness. This includes a wide range of covered services. In return, the hospice program receives one of 4 fixed reimbursement rates per day (the Perdiem) according to level of care: routine home care, continuous care, general inpatient care and inpatient respite care. These rates cover all of the services that are covered under the Benefit. For conditions unrelated to the terminal illness, the patient use their regular Medicare coverage. The Medicare Hospice Benefit provides two benefit periods of 90 days each, followed by an unlimited number of 60 day periods. Resource: Medicaid Commercial Insurers Case managers are an important component of obtaining commercial insurance coverage for hospice. Coverage outside of their policy can often be negotiated by a savvy administrator in the hospice.
Managed Care Under current regulations, a Medicare managed care plan (such as Medicare+Choice) will continue to receive 25% of its Medicare capitation for a patient who elects the Medicare Hospice Benefit because it remains responsible for the care of problems not related to the terminal illness. Some managed care plans try to "unbundle" or otherwise negotiate the services provided to its members by an individual hospice. For example, if the managed care plan already covers prescriptions and home care services, they will try to have the hospice provide only the nurse or social work or chaplain visits on a fee-for-service basis rather than under a single per diem rate.
Government (Veterans Affairs, Active Duty Military) The Department of Veterans Affairs covers hospice and palliative care by statute. Services can be provided directly and through contracts with medicare-certified hospice programs in their communities. However, implementation is variable thorught the system. Next, consider the financing of physicians. CAPC Resources:
|
|
Elements |
|||||||||||||||||||||||
