Hospice payment plans jammed by longer lasting patients
Unexpectedly longer life spans of some hospice patients have forced hundreds of hospice providers to refund millions of dollars in excessive Medicare payments, forcing many to face "catastrophic financial consequences," according to a report in the New York Times. One federal panel estimated 1 in 13 providers were subject to refund demands for 2005.The increased use of hospice by patients with Alzheimer's disease and other forms of unpredictable dementia has caused many to exceed Medicare reimbursement limits, the Times reported.
Originally, the Medicare hospice program was created for people with a terminal illness and who were certified by doctors as having less than six months to live. Many of the patients had cancer, which runs a somewhat predictable course once curative treatments are stopped, experts said.
An Alzheimer's patient's average length of stay is 86 days, while the average is 44 days for lung-cancer patients, according to the Medicare Payment Advisory Commission. Complicating providers' plight is a 1998 action by Congress that removed length-of-stay limits but kept an aggregate reimbursement cap in place. One federal health official, however, intimated that poor management might be more responsible for hospice financial troubles than insufficient government reimbursements.