- Thread starter
- #11
- 1,908
OK.
For the record, my Aunt was in hospice for Cancer. Though it only lasted a week before she passed, they were angels brought down from heaven.
Wall Street Article In Yesterday's Paper
- Thread starter Bob_The_Insurance_Guy
- Start date
OK.
For the record, my Aunt was in hospice for Cancer. Though it only lasted a week before she passed, they were angels brought down from heaven.
- 4,689
If you really think about it, we're all terminally ill.
- 29,480
- 16,877
Oh yes they are great people. And they put up with some dysfunctional crap in a lot of houses. They will be treating mom for pain in her final days and have some deadbeat son or daughter trying to steal mom's morphine or other pain Meds.
Most of us could never do that job in a million years.
I am so thankful there are people who are able to do that job.. I know I could not handle it emotionally no matter how great the salary and benefits. I also do not understand how people can handle it that work in juvenile cancer hospitals.
- 4,689
**************That's very deep thinking.
Six feet deep in fact.
If I'm not mistaken, there is one other part to the "terminally ill" thing. I think you have to have 6 months or less life expectancy.
My mother also had emphysema and wasn't supposed to last 6 months. She lasted about 10 years and was on hospice the whole time.
- 305
Todd,
You're absolutely correct about the 6 month or less life expectancy to qualify for Medicare to pay for Hospice. You also sign away your Medicare A/B benefits to treat the condition for which you're receiving Hospice benefits, so it's certainly a difficult decision.
Thanks for the thread Bob!
Arthur Rudnick
Guru
- 1,652
In order to qualify for Hospice Care one requires a diagnosis of being terminally ill and having 6 months or less to live.
Hospice can be provided in-home or in a hospital. If in-home and paid by Medicare, a hospice caregiver will provide care for 4 hours a day, 5 days a week.
Alzheimer's & dementia are considered "chronic illnesses" and can last for years. People die from the complications, not necessarily from the diagnosis itself. Being diagnosed with either would not by itself qualify one for Hospice.
People who sign up for hospice must have a recommendation from the doctor and an agreement by the health care poxy, POA or immediate family members.
Hospice is not to improve one's condition, it's usually to manage pain & discomfort. In fact, while on Hospice, all regular medications are discontinued. The only prescribed meds are to lessen pain & discomfort.
A LTC policy will cover hospice care, up to one's daily benefit in any setting.
Hospice can be provided in-home or in a hospital. If in-home and paid by Medicare, a hospice caregiver will provide care for 4 hours a day, 5 days a week.
Alzheimer's & dementia are considered "chronic illnesses" and can last for years. People die from the complications, not necessarily from the diagnosis itself. Being diagnosed with either would not by itself qualify one for Hospice.
People who sign up for hospice must have a recommendation from the doctor and an agreement by the health care poxy, POA or immediate family members.
Hospice is not to improve one's condition, it's usually to manage pain & discomfort. In fact, while on Hospice, all regular medications are discontinued. The only prescribed meds are to lessen pain & discomfort.
A LTC policy will cover hospice care, up to one's daily benefit in any setting.
Last edited:
- 4,716
Lengthy Hospice Care Boosts Medicare Bills
More dementia patients and others who die slowly are receiving care, causing costs to rise
By Christopher Weaver,
Anna Wilde Mathews and
Tom McGinty
Feb. 18, 2016 8:59 p.m. ET
Medicare pays hospice agencies to care for patients who are close to death. For some beneficiaries of the taxpayer-funded program, hospice has become a way of life.
Between 2005 and 2013, about 107,000 patients received hospice care for an average of nearly 1,000 days spread out over four or more calendar years, according to a Wall Street Journal analysis of Medicare billing records. They cost Medicare 14% of its overall hospice spending, even though they accounted for just 1.3% of its hospice patients.
Medicare’s hospice program, which has been around for 33 years, is supposed to be only for patients who doctors certify are likely to die within six months, or about 180 days. Today, care is routinely being extended not only to those with terminal cancer—the program’s original focus—but to patients with an array of ailments, including dementia, whose declines can take years.
Hospice-care providers are partly responsible for the expansion, sometimes canvassing nursing homes and other facilities for Medicare patients to persuade to enroll in hospice programs, according to hospice workers and regulators. Patients, their families and sometimes their doctors have ample reason to agree. For many, it entitles them to care that wouldn’t otherwise be covered by the federal government.
The shift has fueled a steady increase in Medicare hospice spending, which roughly doubled over the nine years examined by the Journal, to about $15 billion in 2013. That growth shows how payment rules in the government’s program for seniors and disabled people can influence patient care in ways that weren’t intended.
“It was never thought of as something people would be on for years at a time,” says Joan Teno, a doctor at the University of Washington who researches hospices.
In an effort to explain the growth of hospice spending, the Journal searched about 35 million billing records for patients who used the service in four different years—a group that includes many who spent multiple long periods in hospice care. The findings show the extent to which such patients are adding to the system’s costs.
Medicare said in a written statement it is “committed to appropriate hospice payments,” and that it recently changed how it pays for hospice care to better align payments with treatment received during stays of various lengths. “We will continue to monitor hospice payments closely to determine if future changes are needed,” it said.
Cost implications
The extension of hospice care to a broader range of patients raises questions about the assumption that it saves Medicare money by limiting expensive treatments for patients who are dying. A report last year commissioned by the Medicare Payment Advisory Commission, an independent congressional agency, found that patients without cancer who used hospice ended up costing Medicare about 19% more than those who didn’t use hospice in the last year of their lives. Major medical journals have reporting similar findings.
Hospice advocates say studies have demonstrated that hospice care can produce cost-savings and that, economics aside, it provides an important benefit for patients.
Tom Hoyer, a former Medicare official who in the 1980s helped design the agency’s method of paying hospices, notes that the government “decided to pay for something that was difficult to quantify and price. But since [dying] is the most important thing any of us do after being born, it is hard to say, ‘Let’s just not pay for it.’ ”
When a Medicare patient enrolls in hospice care, the hospice provider takes over all care related to the patient’s incurable condition, including pain management. It provides services in residential facilities or at home.
Helen Blincoe, a 100-year-old from Loma Linda, Calif., bounced in and out of hospice care from 2009 until last year. Currently, her main health problem is dementia, and she is in relatively stable condition. On a recent day, she sat upright in an easy chair, her walker nearby.
During the nearly 850 days she spent in hospice care, her services consisted mostly of visits by home-health aides. Nurses and social workers also saw her, but less frequently.
Such patients can be more lucrative to providers than those who die rapidly. Medicare pays hospice agencies for each day a beneficiary is enrolled, regardless of whether services are rendered on a given day. For typical days—when patients aren’t hospitalized—the average rate was about $140 a day during the period the Journal studied.
The Journal’s analysis found patients who had spent at least a year in hospice received visits on about 13.6 days a month in 2013, compared with an average of 17.6 for those who spent just one month in hospice.
Medicare has so far paid the three hospice agencies that have cared for Mrs. Blincoe at least $140,000, according to billing documents viewed by the Journal and records from the geriatric-care company hired by her family.
Mrs. Blincoe’s daughter, Kay Prins, 70, says her mother enrolled in hospice during periods when her health seemed to be declining, and that the family appreciated the extra help the agencies provided. “It was a wonderful service,” she says.
A generation ago, long-term patients rarely received hospice care. When Medicare designed the program in the early 1980s, it based the requirements on research on cancer patients. Some early studies suggested hospice care could save Medicare money in part because patients might forgo expensive but potentially ineffective treatment near the end of life.
The program wasn’t officially limited to cancer patients. Over time, the desire of patient advocates to make hospice services available to more people, coupled with efforts by hospice businesses to expand their markets, opened such care to more patients.
The most recent Medicare data show that patients dying from Alzheimer’s disease, heart disease and other chronic conditions now are among the most common in the hospice program.
Medicare’s system for paying hospices “has remained the same, but the patients have changed,” says Donald Schumacher, chief executive of the National Hospice and Palliative Care Organization, a trade group. However, patients spending long periods in hospice remain a small portion of Medicare’s total, he says, and in some cases patients would benefit from longer periods of care.
The course of conditions other than cancer can be harder to predict, resulting in more patients living past 180 days and getting recertified for hospice. Industry experts and some policy makers say hospice care can improve the health of some such patients, leading them to cycle in and out of hospice.
Such patients often need less intense services than cancer patients, making them more lucrative for providers, doctors and health-services researchers say.
Andrew Duxbury, a University of Alabama at Birmingham geriatrician who has worked as a medical director for several large hospice operators, says: “Some of these very-long-stay people are relatively inexpensive for the business to care for because they are pretty stable, but the way the reimbursement rates are built, the profit margins become good.”
The Justice Department has brought several cases, which arose from whistleblower complaints, alleging hospices enrolled Medicare patients who weren’t close to death. Department officials are investigating additional allegations that hospices may have enrolled patients who didn’t qualify, or recertified patients to maximize payments, according to people familiar with the cases.
A Justice Department spokeswoman said that “too often” it had “uncovered evidence of health-care facilities abusing this critical service in order to get higher reimbursements from the Medicare program.”
Medicare patients’ average time in hospice rose to 88 days in 2013, from 54 days in 2000, according to the Medicare Payment Advisory Commission. By 2013, around 32% of Medicare hospice payments were attributable to patients with at least 365 total days in hospice care as of the end of that year, according to the Journal’s analysis.
The largest hospice company, Vitas Healthcare, a subsidiary of the publicly traded Chemed Corp. , got 36% of its 2013 Medicare hospice payments from patients who spent a year or more in hospice.
Chemed Chief Financial Officer David Williams says the company loses money on half its patients—those staying less than about two weeks. Patients with long stays, he says, subsidize losses on shorter-stay patients.
He says recent changes by Medicare partially address the problem, but don’t go far enough.
Beginning this year, the Medicare agency tweaked the payment formula, lowering daily rates after 60 days and increasing payments during the first part of patients’ stays.
Mr. Williams says more substantial changes to payments would help “level the playing field,” deter abuse and better tie pay to the costs of care.
Some other chains have higher rates, the analysis shows. Gentiva Health Services Inc., a large U.S. hospice operator that was acquired by Kindred Healthcare Inc. last year, received 43% of its 2013 Medicare hospice payments for patients with at least 365 days of hospice enrollment. Kindred didn’t respond to requests for comment.
Rival Curo Health Services Inc, which is owned by private-equity firm Thomas H. Lee Partners and runs hospices under various brands around the country, received 44% of its 2013 Medicare hospice payments for the care of such long-term patients. Curo declined to comment through a spokesman for its owner.
Home-health and hospice company Amedisys Inc. received 38% of its 2013 Medicare hospice payments for patients with at least 365 days of enrollment, up from about 31% in 2008, the data show.
During that period, the company saw a big shift from cancer patients to those with dementia and other conditions, says Amedisys Chief Executive Paul Kusserow. In 2015, he says, 32% of the company’s patients had dementia as their terminal disease, compared with 19% in 2009.
Red flag
Mr. Kusserow, who became CEO in late 2014, says he recognizes that patients with stays stretching over a year “are a red flag” for regulators. He says Amedisys has taken steps beginning last summer to ensure such patients really qualify for hospice. For example, he says, the company does extra reviews of the charts of more of the long-stay patients to determine if they still meet requirements. The share of hospice patients with stays longer than a year has dropped in recent months, he says.
The case of Mrs. Blincoe, the California centenarian, shows how hospice care can stretch on for many months. The widow of a Seventh-day Adventist pastor, Mrs. Blincoe lived alone until her daughter, Mrs. Prins, grew concerned over signs of memory lapses in 2009.
The family hired a geriatric-care company, Parent Care Management Services Inc., to help manage her care, and moved her to a boarding facility for the elderly with 24-hour-a-day help.
That December, after Mrs. Blincoe shed weight quickly over four months and had problems swallowing, among other issues, she enrolled in hospice care for the first time. Her condition improved quickly, however, and the hospice care ended the following May, according to notes provided by the care managers.
In 2013, Mrs. Blincoe appeared to be declining again. Mrs. Prins, visiting from Florida, bought her mother’s favorite canned soup and couldn’t get her to eat more than a few bites. Depressed and weakened, according to her daughter, she was again enrolled in hospice that April.
A year later, Mrs. Blincoe broke a hip and needed surgery. She again left hospice care, and after a brief stint in a nursing home, returned to her boarding home and started hospice care once more. Her condition steadied again. The care-management company’s notes indicate that she was “awake, alert and cooperative” during a visit in November 2014.
Mrs. Blincoe remained under hospice care for months more. Last March, she exited the program once more when the hospice-care provider shut down.
“She had gained weight, there was a spring in her step,” says Mrs. Prins, who didn’t attempt to enroll her in another hospice. “If she keeps going the way she is, she may live to 105.”
Ten days after her most recent hospice stint ended, Mrs. Blincoe celebrated her 100th birthday with dozens of family members and friends. In a festive gathering at a church, she was able to sing along to her favorite hymn.
More dementia patients and others who die slowly are receiving care, causing costs to rise
By Christopher Weaver,
Anna Wilde Mathews and
Tom McGinty
Feb. 18, 2016 8:59 p.m. ET
Medicare pays hospice agencies to care for patients who are close to death. For some beneficiaries of the taxpayer-funded program, hospice has become a way of life.
Between 2005 and 2013, about 107,000 patients received hospice care for an average of nearly 1,000 days spread out over four or more calendar years, according to a Wall Street Journal analysis of Medicare billing records. They cost Medicare 14% of its overall hospice spending, even though they accounted for just 1.3% of its hospice patients.
Medicare’s hospice program, which has been around for 33 years, is supposed to be only for patients who doctors certify are likely to die within six months, or about 180 days. Today, care is routinely being extended not only to those with terminal cancer—the program’s original focus—but to patients with an array of ailments, including dementia, whose declines can take years.
Hospice-care providers are partly responsible for the expansion, sometimes canvassing nursing homes and other facilities for Medicare patients to persuade to enroll in hospice programs, according to hospice workers and regulators. Patients, their families and sometimes their doctors have ample reason to agree. For many, it entitles them to care that wouldn’t otherwise be covered by the federal government.
The shift has fueled a steady increase in Medicare hospice spending, which roughly doubled over the nine years examined by the Journal, to about $15 billion in 2013. That growth shows how payment rules in the government’s program for seniors and disabled people can influence patient care in ways that weren’t intended.
“It was never thought of as something people would be on for years at a time,” says Joan Teno, a doctor at the University of Washington who researches hospices.
In an effort to explain the growth of hospice spending, the Journal searched about 35 million billing records for patients who used the service in four different years—a group that includes many who spent multiple long periods in hospice care. The findings show the extent to which such patients are adding to the system’s costs.
Medicare said in a written statement it is “committed to appropriate hospice payments,” and that it recently changed how it pays for hospice care to better align payments with treatment received during stays of various lengths. “We will continue to monitor hospice payments closely to determine if future changes are needed,” it said.
Cost implications
The extension of hospice care to a broader range of patients raises questions about the assumption that it saves Medicare money by limiting expensive treatments for patients who are dying. A report last year commissioned by the Medicare Payment Advisory Commission, an independent congressional agency, found that patients without cancer who used hospice ended up costing Medicare about 19% more than those who didn’t use hospice in the last year of their lives. Major medical journals have reporting similar findings.
Hospice advocates say studies have demonstrated that hospice care can produce cost-savings and that, economics aside, it provides an important benefit for patients.
Tom Hoyer, a former Medicare official who in the 1980s helped design the agency’s method of paying hospices, notes that the government “decided to pay for something that was difficult to quantify and price. But since [dying] is the most important thing any of us do after being born, it is hard to say, ‘Let’s just not pay for it.’ ”
When a Medicare patient enrolls in hospice care, the hospice provider takes over all care related to the patient’s incurable condition, including pain management. It provides services in residential facilities or at home.
Helen Blincoe, a 100-year-old from Loma Linda, Calif., bounced in and out of hospice care from 2009 until last year. Currently, her main health problem is dementia, and she is in relatively stable condition. On a recent day, she sat upright in an easy chair, her walker nearby.
During the nearly 850 days she spent in hospice care, her services consisted mostly of visits by home-health aides. Nurses and social workers also saw her, but less frequently.
Such patients can be more lucrative to providers than those who die rapidly. Medicare pays hospice agencies for each day a beneficiary is enrolled, regardless of whether services are rendered on a given day. For typical days—when patients aren’t hospitalized—the average rate was about $140 a day during the period the Journal studied.
The Journal’s analysis found patients who had spent at least a year in hospice received visits on about 13.6 days a month in 2013, compared with an average of 17.6 for those who spent just one month in hospice.
Medicare has so far paid the three hospice agencies that have cared for Mrs. Blincoe at least $140,000, according to billing documents viewed by the Journal and records from the geriatric-care company hired by her family.
Mrs. Blincoe’s daughter, Kay Prins, 70, says her mother enrolled in hospice during periods when her health seemed to be declining, and that the family appreciated the extra help the agencies provided. “It was a wonderful service,” she says.
A generation ago, long-term patients rarely received hospice care. When Medicare designed the program in the early 1980s, it based the requirements on research on cancer patients. Some early studies suggested hospice care could save Medicare money in part because patients might forgo expensive but potentially ineffective treatment near the end of life.
The program wasn’t officially limited to cancer patients. Over time, the desire of patient advocates to make hospice services available to more people, coupled with efforts by hospice businesses to expand their markets, opened such care to more patients.
The most recent Medicare data show that patients dying from Alzheimer’s disease, heart disease and other chronic conditions now are among the most common in the hospice program.
Medicare’s system for paying hospices “has remained the same, but the patients have changed,” says Donald Schumacher, chief executive of the National Hospice and Palliative Care Organization, a trade group. However, patients spending long periods in hospice remain a small portion of Medicare’s total, he says, and in some cases patients would benefit from longer periods of care.
The course of conditions other than cancer can be harder to predict, resulting in more patients living past 180 days and getting recertified for hospice. Industry experts and some policy makers say hospice care can improve the health of some such patients, leading them to cycle in and out of hospice.
Such patients often need less intense services than cancer patients, making them more lucrative for providers, doctors and health-services researchers say.
Andrew Duxbury, a University of Alabama at Birmingham geriatrician who has worked as a medical director for several large hospice operators, says: “Some of these very-long-stay people are relatively inexpensive for the business to care for because they are pretty stable, but the way the reimbursement rates are built, the profit margins become good.”
The Justice Department has brought several cases, which arose from whistleblower complaints, alleging hospices enrolled Medicare patients who weren’t close to death. Department officials are investigating additional allegations that hospices may have enrolled patients who didn’t qualify, or recertified patients to maximize payments, according to people familiar with the cases.
A Justice Department spokeswoman said that “too often” it had “uncovered evidence of health-care facilities abusing this critical service in order to get higher reimbursements from the Medicare program.”
Medicare patients’ average time in hospice rose to 88 days in 2013, from 54 days in 2000, according to the Medicare Payment Advisory Commission. By 2013, around 32% of Medicare hospice payments were attributable to patients with at least 365 total days in hospice care as of the end of that year, according to the Journal’s analysis.
The largest hospice company, Vitas Healthcare, a subsidiary of the publicly traded Chemed Corp. , got 36% of its 2013 Medicare hospice payments from patients who spent a year or more in hospice.
Chemed Chief Financial Officer David Williams says the company loses money on half its patients—those staying less than about two weeks. Patients with long stays, he says, subsidize losses on shorter-stay patients.
He says recent changes by Medicare partially address the problem, but don’t go far enough.
Beginning this year, the Medicare agency tweaked the payment formula, lowering daily rates after 60 days and increasing payments during the first part of patients’ stays.
Mr. Williams says more substantial changes to payments would help “level the playing field,” deter abuse and better tie pay to the costs of care.
Some other chains have higher rates, the analysis shows. Gentiva Health Services Inc., a large U.S. hospice operator that was acquired by Kindred Healthcare Inc. last year, received 43% of its 2013 Medicare hospice payments for patients with at least 365 days of hospice enrollment. Kindred didn’t respond to requests for comment.
Rival Curo Health Services Inc, which is owned by private-equity firm Thomas H. Lee Partners and runs hospices under various brands around the country, received 44% of its 2013 Medicare hospice payments for the care of such long-term patients. Curo declined to comment through a spokesman for its owner.
Home-health and hospice company Amedisys Inc. received 38% of its 2013 Medicare hospice payments for patients with at least 365 days of enrollment, up from about 31% in 2008, the data show.
During that period, the company saw a big shift from cancer patients to those with dementia and other conditions, says Amedisys Chief Executive Paul Kusserow. In 2015, he says, 32% of the company’s patients had dementia as their terminal disease, compared with 19% in 2009.
Red flag
Mr. Kusserow, who became CEO in late 2014, says he recognizes that patients with stays stretching over a year “are a red flag” for regulators. He says Amedisys has taken steps beginning last summer to ensure such patients really qualify for hospice. For example, he says, the company does extra reviews of the charts of more of the long-stay patients to determine if they still meet requirements. The share of hospice patients with stays longer than a year has dropped in recent months, he says.
The case of Mrs. Blincoe, the California centenarian, shows how hospice care can stretch on for many months. The widow of a Seventh-day Adventist pastor, Mrs. Blincoe lived alone until her daughter, Mrs. Prins, grew concerned over signs of memory lapses in 2009.
The family hired a geriatric-care company, Parent Care Management Services Inc., to help manage her care, and moved her to a boarding facility for the elderly with 24-hour-a-day help.
That December, after Mrs. Blincoe shed weight quickly over four months and had problems swallowing, among other issues, she enrolled in hospice care for the first time. Her condition improved quickly, however, and the hospice care ended the following May, according to notes provided by the care managers.
In 2013, Mrs. Blincoe appeared to be declining again. Mrs. Prins, visiting from Florida, bought her mother’s favorite canned soup and couldn’t get her to eat more than a few bites. Depressed and weakened, according to her daughter, she was again enrolled in hospice that April.
A year later, Mrs. Blincoe broke a hip and needed surgery. She again left hospice care, and after a brief stint in a nursing home, returned to her boarding home and started hospice care once more. Her condition steadied again. The care-management company’s notes indicate that she was “awake, alert and cooperative” during a visit in November 2014.
Mrs. Blincoe remained under hospice care for months more. Last March, she exited the program once more when the hospice-care provider shut down.
“She had gained weight, there was a spring in her step,” says Mrs. Prins, who didn’t attempt to enroll her in another hospice. “If she keeps going the way she is, she may live to 105.”
Ten days after her most recent hospice stint ended, Mrs. Blincoe celebrated her 100th birthday with dozens of family members and friends. In a festive gathering at a church, she was able to sing along to her favorite hymn.
