Majority of hospices exclude some patients due to Medicare daily fee, researchers discover

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Despite the fact that hospice is one of the fastest growing parts of Medicare, 78% of surveyed hospice operators turned away patients with the potential for high-costing care, according to a new study published Monday in the journal Health Affairs.

The findings illustrate the hospice community finds Medicare's reimbursement rates too low to pay for expensive medical services, said lead study author Melissa Aldridge Carlson. Payments are $153-per-day rate for routine hospice care and an $896 rate for around-the-clock care, according to the Centers for Medicare & Medicaid Services. The report recommends an increase in Medicare reimbursements so more high-cost patients can be enrolled.

Hospice is one of the fastest growing segments of Medicare. Numerous experts applaud it as a humane and cost-effective way to care for those in the last half-year of their life. But surveyed hospices contend that Medicare's daily fixed fee has discouraged them from accepting people with expensive needs.

For-profit hospices are more likely to limit special needs patients, researchers found. Hospices that average care for 20 or fewer per day also had a higher incidence of turning away those with high-cost treatment needs. Larger hospices spread the financial risk of high cost-patients the report noted.

Some services, such as radiation and chemotherapy to alleviate pain, can cost more than $10,000 per month, according to the survey. Patients also were turned away due to intravenous feeding, blood transfusions or getting pain medication with an automatic pump.