Elizabeth Luth and her colleagues’ recent study of 3,387 hospice patients with dementia found that about 5 percent of them are pulled from hospice when their condition seems to have stabilized.
Five things to know:
1. When Congress created Medicare’s hospice benefit in 1982, it capped the definition of terminal illness at six months to live, according to the article. The benchmark worked for a few decades because most early hospice patients had cancer. Doctors can predict with relative accuracy when a patient with advanced cancer has less than six months to live.
2. Now, about half of Medicare hospice patients have dementia, according to a study published in 2021. Predicting when a patient with dementia only has six months to live is difficult, according to the Washington Post article.
3. Physicians can recertify patients who are alive after six months as terminally ill, but the reality is more complicated, University of California at San Francisco health researcher Krista Harrison told the Post. Hospice programs with too many patients receiving care for more than six months can lead to an audit. If an audit uncovers seemingly inappropriate use of the benefit, the hospice might have to repay the money that Medicare reimburses. That can be millions of dollars.
4. Medicare’s penalties leave clinicians and hospice organizations in an “impossible moral quandary,” Harrison told the Post. The needs of the patient are on one side and the six-month regulations are on the other.
5. CMS has introduced some changes in recent years to address hospice admission criteria, but none have modified the six-month benchmark. That would require a change in law, a CMS spokesperson told the Post.
