40th Anniversary of Medicare Hospice Benefit

2020 marks the 40th anniversary of the Medicare Hospice benefit. Since nearly 40 years have passed since the inception of the benefit, some industry experts believe it may be time to re-examine aspects of the program in light of the ways patient characteristics and the larger health care system have since evolved. 

According to a recent article in Hospice News, “The hospice benefit was established as a demonstration project in 1970 and became a formal part of Medicare in 1983. At the time, nearly all of the patients who enrolled in hospice were suffering from cancer, and the U.S. Centers for Medicare & Medicare Services (CMS) and its collaborators designed the program around the needs and illness trajectory of those patients."

2017 data highlighted by the National Hospice and Palliative Care Organization indicates the profile of the typical Medicare hospice patient has changed. Of the 1.49 million Medicare beneficiaries who enrolled in hospice during that year, cancer patients represented only 30%. Patients with cardiac conditions, such as congestive heart failure, accounted for nearly 18%.

New Flavor of Fraud? Hospice hastening death for financial gain.

According to Kuruvilla (2018, May 18), "A former health care executive in Texas has admitted to playing a role in an alleged $60 million Medicare fraud scheme that included disturbing practices such as overdosing hospice patients to “hasten their deaths” and maximize company profits."

Medicare reimburses hospice services on a per diem basis, meaning, the longer a patient is on hospice, the more overall reimbursement an agency will receive. Even on days where hospice staff do not visit a patient, the agency can bill Routine Home Care (RHC). More intense, skilled services, must meet criteria and are subsequently reimbursed at the higher Continuous Home Care (CHC) level. The allegations of hastening hospice patients' death via overdose is counter-intuitive on its face for those of us that follow hospice-related Medicare fraud cases. Ordinarily, Hospice providers encounter challenges in justifying the length of time a patient is on-service, the documentation supporting terminal illness, and correctly calculating the hours associated with the CHC level of care. If the Medicare Hospice Payment System is unfamiliar, a primer can be found here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/hospice_pay_sys_fs.pdf