June 6

Hospice fraud becoming a costly problem for Medicare

No one knows how big the problem of hospice fraud is — all types of improper Medicare payments are estimated at $65 billion for 2010 — but federal investigators prosecuted more than 60 cases in the last year alone, involving hundred of millions of dollars nationwide. The system that was built to help dying patients live out their remaining days with dignity and comfort has few quality metrics to meet, no minimum requirements for how often care is provided, and low barriers to getting into the business. Critics say that can make end-of-life care seem ripe for abuse. “There’s a built-in incentive to get patients in the door,” said Claire Sylvia, a lawyer representing whistleblowers in health care fraud cases at the San Francisco offices of Phillips & Cohen LLP. For example, former Horizons Hospice chief operating officer Mary Ann Stewart, is under indictment in federal court in Pittsburgh on charges of inflating enrollment at her company’s Monroeville facility by recruiting patients who often weren’t really dying. A long-awaited reform in how Medicare pays hospice providers that went into effect in January will do little to curb such abuse, experts say. Medicare began staggering payments to better reflect the cost of care — the first reimbursement change since the benefit began in 1983.

For the article from the Pittsburgh Post-Gazette, click here.

July 22

Centers for Medicare and Medicaid Services to Test Concurrent Coverage of Hospice and Curative Care

Terminally ill patients no longer will have to give up curative treatment to receive Medicare-paid hospice care, under a limited new program the CMS will start testing with 140 hospice providers as early as January. The Medicare Care Choices Model, established by the Affordable Care Act, waives the requirement that terminally ill patients must end curative treatment such as chemotherapy to qualify for Medicare hospice coverage. The model, which will run through 2020, will test whether the expanded benefits will convince more patients to enter hospice and whether it improves care, enhances patient satisfaction, and reduces costs. Under the Medicare Care Choices Model, patients can continue to receive curative services such as physical therapy, prescriptions, medical equipment, physician services, and short-term hospital visits for pain or symptom management. Instead of getting a per diem payment, hospices will receive a Medicare monthly payment of $200 to $400 per patient for any hospice care that patients need. Meanwhile, other providers will continue to be able to bill Medicare for curative services. The program will launch in two phases with the first hospices entering in January and a second wave to begin in January 2018.

For the article from Modern Healthcare, click here.

May 21

Shift Toward Hospice Care Has Increased Medicare Costs

The popularity of hospice care grew between 2004 and 2009, but that didn’t bring down Medicare costs for people dying in nursing homes, according to a new study of three quarters of a million U.S. nursing home residents. “We found that although hospice use was associated with a reduction in aggressive end-of-life care, it was also associated with a net increase of $6,761 in Medicare expenditures per decedent in the last year of life,” writes the research team, led by Dr. Pedro Gozalo of Brown University. Gozalo told Reuters Health in a telephone interview that the higher costs may be due, in part, to the fact that more patients are being enrolled in hospice earlier and those patients are more likely to be suffering from dementia or other problems that make it difficult to predict how long they will live. In 2004, the mean hospice length of stay was 72 days; by 2009 it was just under 93 days. The study did not look at Medicare costs for people who receive hospice care in their homes, and who account for the majority of hospice cases. Of all the money Medicare spends on health care, one quarter is spent in the final year of a person’s life.

For the article from Reuters, click here.