The New York Times ran a story yesterday titled "In Hospice Care, Longer Lives Mean Money Lost", by Kevin Sack, which details the struggle between Hospice providers and the federal government, neither of whom want to cover the costs of hospice patients who are living longer than expected.
Though the achievements of modern medicine have helped people to live longer lives- the years they spend incapacitated due to Alzheimer's and dementia - diseases that we haven't cured - is costing the government more and more money.
Currently, Medicare, who pays the majority of hospice bills, reimburses hospice providers $135/day for a patient's at home care. Guidelines say that hospices should accept patients who have only 6 months, or less, to live.
But over the last several years, patients' longer life spans have led the federal government to start charging hospices extra for the extra days, months, and even years of care that the patients are receiving.
These extra costs for the hospices threaten to run them into the ground. One hospice - Hometwown Hospice in Wilcox County, Alabama, which cares for 60 patients- incurred excess costs of $900,000, payable to the federal government. That's 27% of its revenues over the two years it has been open.
While many hospices seem to manage well despite these excess costs, others - mostly in Southern and Western states like Mississippi, Alabama, and Oklahoma - are on the verge of bankrupcy. Some suspect that mismanagement may be to be blame in these cases.
Still, the extra costs to hospices whose patients live longer than expected is not an easy problem to solve. If a patient is expected to live 6 months, but winds up living for over a year, can you blame them? Better yet, can you make them leave? Hardly.
Says Dr. Sumpter Blackmon, medical director at Hometown Hospice, "everytime I think someone is going to die tomorrow, damned if they don't live for a year and a half".
Who should be responsible for those costs?
Published On: November 28, 2007