Unintended Consequences of the Medicare Hospice Benefit
There have been 2 unintended consequences of the Medicare Hospice Benefit:
- The Benefit set up an alternative health system. Patients are discharged from their regular Medicare reimbursement and provider system in order to elect hospice coverage under Medicare. The hospice program, rather than the hospital or clinic or other unit becomes legally and financially responsible for the care of the patient's terminal illness. Although the patient keeps his or her attending physician, many patients never see their physician again because most physicians don't make house calls. This is problematic. Patients and families want a sense of continuity and don't want to feel abandoned. Doctors, particularly in the US, have a sense of ownership of their patients. They don't want the care of "their" patients to be taken over by someone else, no matter how skilled or well-intended.
- Added services are available to a patient who has a particular prognosis, rather than
a particular set of needs. Prognosis is an elusive concept for an individual patient.
Physicians are particularly inaccurate in determining prognosis for an individual with
certainty . Additionally, in an effort to stem the growth of non-hospital services
within Medicare, the US Office of the Inspector General has scrutinized the care of
patients who live longer than 6 months with an eye to uncovering fraud.
This has had a chilling effect on hospice referrals.
Consider alternate revenue sources for financing hospice.
CAPC Resources:
Additional resources on "Financing US Healthcare"
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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Elements
Select section:
Basis, Context, Components,
Case Examples
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Basis of Palliative Care Practice
Palliative Care Definitions
Historical Definitions
WHO
Oxford Textbook
ABHPM
NHPCO
Palliative Care
Applicability
Application to Patients at Risk
Differences–Hospice & Palliative Care
Values, Ethical Principles
Values
Ethical Principles
Conceptual Framework
Square of Care
Square of Organization
Square of Care & Organization
Norms / Standards of Practice
Guidelines
Policies, Procedures
What are They?
Developing, Implementing, Evaluating
Measures
Definitions of Common Terms
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Context
Tensions
In Therapeutic Relationships
Within Host Organizations
Within Healthcare System, Community
Who's the Customer
US Healthcare
Acute Care Hospitals
Long-term Care Facilities
Home
Hospice Care
Financing US Healthcare
Expenditures for EOL Care
Overview by Settings, Revenue Sources
Medicare
Medicaid
Commercial Insurers
Managed Care
Government (VA, Military)
Financing
Community Hospitals
Academic Hospitals
Subacute, Skilled Care
Custodial Care
Ambulatory Care
Home Care
Hospice Care
Eligibility
Covered Services
Reimbursement Rates
Unintended Consequences
Financing Physicians
Coding
Procedure / Service Codes
Coding Based on Time
Frequently Used E/M Codes
Example
Addition of Procedure Codes
Diagnosis Codes
ICD-9 Codes for Palliative Care
Avoiding Concurrent Billing Problems
Example
Documentation
Example
Physician Reimbursement
Medicare
Medicare Hospice Benefit
Non-hospice Physicians
Associated with a Hospice
Medicaid
Commercial Insurers
Managed Care
Government (VA, Military)
Financing Non-physician Providers
Hospital–Hospice Relationships
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Program Components
1º, 2º, 3º Model of Palliative Care Delivery
Interdisciplinary Care
Members of Interdisciplinary Team
Core Competencies
Physician
Nurse
Social Worker
Chaplain
Volunteer
Specialized Environments
Types of Services
Consultation Services
Consultation Etiquette
Consultation Documentation
Sample Note
Inpatient Units
Developing an Inpatient Unit
Staffing
Acuity
Nursing Model
Unit Size
General Ward vs. Palliative Care Unit
Roles
Decisions
Case Example
Nursing Staff
Physician Staff
Other Staff
Advice
Home Care
Eligibility, Medicare Home Health Benefit
Covered Services
Usually Not Covered
Hospice Care at Home
Ambulatory Outpatient Care
Respite Care
Financing Palliative Care Programs
Acute Hospital
Skilled Care Nursing Home
Hospice
Home Health
Ambulatory Outpatient
Managed Care
Financing Physicians in Palliative Care
Financing Non-physicians in Palliative Care
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Case Examples
CAPCManual Case Examples
Pioneer Program Case Examples
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