Recently Mark Lewandowski shared a podcast with us in which he addressed the issues relating to palliative care as expressed in the hospice care and comprehensive chronic care management models.In the first part of this podcast (0:00 - 1:59) he specifically addresses the issues surrounding hospice care funding. The problem is that hospice is based on the practice of providing frequent, direct care to patients who are experiencing end-of-life circumstances. This often means that the patient is unable to care for their bodily needs and require clinicians to provide those services in a compassionate manner. This can be rather expensive depending on the condition of the patient and the length of time for which they need those services.
He notes that problems with hospice reimbursement include the following:
Low reimbursement built around physician visits once a month for which Medicare pays less than $100.00.
Hospice patients - with their upfront setup costs - may not live long enough for the hospice provider to recoup those expenses.
Hospice providers must constantly educate and support their staff about enrolling patients appropriately into Hospice to stay within Medicare compliance. Enrolling patients prematurely will put them at risk to higher scrutiny when the patients have declined further and need hospice care even more.
While the hospice care model was designed, basically, to care for cancer patients who were at the end-stage of their life expectancy, such is no longer the case. Other diagnoses have come under the hospice care umbrella that represents a longer time span. A 2015 NHPCO study noted that, while approximately one-third of hospice patients expired within 7 days and roughly 50% died within two weeks, over 10% exceeded 180 days of survival - the CMS coverage limit.
The hospice model of compassionate palliative care for persons in the terminal stage of life is praise-worthy but is fraught with serious funding issues.