Our compassionate conservative gummint at work

This article really ticks me off.

In Hospice Care, Longer Lives Mean Money Lost

CAMDEN, Ala. — Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.

Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

The charges are assessed retrospectively, so in most cases the money has long since been spent on salaries, medicine and supplies. After absorbing huge assessments for several years, often by borrowing at high rates, a number of hospice providers are bracing for a new round that they fear may shut their doors.

[…]

In the early days of the Medicare hospice benefit, which was designed for those with less than six months to live, nearly all patients were cancer victims, who tended to die relatively quickly and predictably once curative efforts were abandoned.

But in the last five years, hospice use has skyrocketed among patients with less predictable trajectories, like those with Alzheimer’s disease and dementia. Those patients now form a majority of hospice consumers, and their average stays are far longer — 86 days for Alzheimer’s patients, for instance, compared with 44 for those with lung cancer, according to the Medicare Payment Advisory Commission.

[…]

The medical director at Hometown Hospice, Dr. Sumpter D. Blackmon, said he relied heavily on the judgment of the hospice’s nurses to determine whether prospective patients were rather likely to live longer than six months. But of the 56 patients on the books on Oct. 31, 17 had been there for at least that period, including two for more than 500 days.

“Doing this for 40-something years,” said Dr. Blackmon, a longtime physician here, “every time I think somebody is going to die tomorrow, damned if they don’t live for a year and a half.”

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Hospice and the palliative care it gives is one of the best end-of-life care measures to come along. Problem is, coverage is only for six months. So now that people are living longer, it means that their six months can stretch into a year or two. And, heaven forbid, that is way too long for someone to be in hospice and receive medicare coverage.

So once again, people will wait until the last minute to be admitted to hospice. I've walked with families whose loved one was served by hospice for literally three hours before the individual died. It's such a fragile moment — to decide to enter hospice means that one is admitting that one is 'terminal.' But aren't we all? It just depends when we'll get off the train. Some will disembark sooner than later. But we're all on the same ride. So why make it more difficult?

Now that hospice care centers are being forced to repay the government, I can't help but imagine that they will be more cautious in admitting people to their care. And that is tragic.