The Medicare hospice benefit has played a large role in moving our nation forward providing quality care for our dying. Hospice care was incorporated to improve the dying experience by providing comfort care to alleviate pain, decrease the use of intense care, and decrease the costs associated with intensive treatments. Hospice care has been a success for health care in America and for Medicare more specifically. It has proven to provide benefits to the patient and their families, including a reduced number of hospitalizations, fulfillment of spiritual and emotional needs, pain management, and greater patient and family satisfaction.
While hospice care is extremely beneficial, the Medicare hospice benefit has remained largely unchanged, but its role in health care has vastly expanded. At its creation in the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA), hospice was geared mostly towards patients with terminal cancer. Today patients terminally ill from a wide variety of diseases seek hospice care at the end of their life. We must update the hospice benefit to adapt to the increased uses and fundamental changes seen in the program over the past 30 years.
The Medicare hospice benefit covers a wide range of palliative and supportive services is set up so that when a doctor deems a patient to have six months or less to live, they can elect hospice care. In its current form, when the patient agrees to receive hospice care, they must forgo any and all curative therapies. This makes a difficult decision for a patient and their family even harder. There is a firm line they have to cross, which is interpreted by many as the beginning of the end.
This also makes the physician’s decision to request hospice more difficult. In its current form, a physician requesting that their patient seek hospice care means that she believes that curative treatments are no longer beneficial. While this is likely true, the firm line that has to be crossed by patient and physician can likely be misunderstood as the doctor giving up on their patient. The current system creates an artificial distinction between curative treatments and care geared towards the patient’s emotional needs while providing care to ensure their comfort. Even in Medicare Advantage, a program that promotes coordinated, streamlined care through its capitated payment system, the Medicare hospice benefit is excluded. A patient enrolled in Medicare Advantage who elects hospice care reverts back to regular fee-for-service Medicare.
Hospice is a necessary and valuable alternative to traditional medical care at the end of life. It is also an important mechanism for reducing intensive and costly treatments that only make a loved one’s death harder. While the benefits of hospice are clear, the Medicare hospice benefit must be updated to adapt to the increased use and wide variety of patients who seek its care. By breaking the divide between curative treatments and hospice care, and developing a smoother transition into such care, Medicare and its beneficiaries will receive more value from an integral piece of its health care delivery system.