(Snippets from the frontline)
How is hospice care paid?
Hospice under Medicare costs about $20 billion per year.
The criteria to admit a patient is blurred, leading to financial abuse. As this care is end-of-life, elders seniors who might benefit can suffer.
Over the past 5 years, the number of licensed hospice agencies has increased exponentially. Why? Easy money.
Payment from Medicare to hospice agencies is based on “level of care.” There are four levels. At the lowest level, they receive about $196 daily, whether they see the patient or not. This can go as high as $998 per day for highly skilled and intensive hospice care.
The agency is expected to use this money for all services including physician, nurses, aides, social worker, end-of-life medication, and supplies.
Do the math: For the lowest level, 7 days is $1,372, versus $35,280 for 180 days. You can calculate the highest level. Some patients have been on hospice over 5 years! There is therefore monetary incentive for patients to remain on hospice as long as possible.
Clarifying admission criteria, while assuring the patient is “actively dying”, would substantially lower the yearly cost of hospice for Medicare and reduce financial abuse.
Gene Uzawa Dorio, M.D.
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