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Part I — Hospice Programs

Hospice — An Overview

Hospice is a type of care provided to patients of any age who have been diagnosed with a terminal disease. The goal of hospice is to allow the patient to die with dignity - at home if possible — without pain or distress. Many people think that hospice is a place; while there are some facilities that care for hospice patients, the goal is to make a patient comfortable in his home.

Hospice agencies provide medical oversight, caregiver training, nursing, social work, bereavement, equipment, medications and supplies in order to meet the physical and emotional needs of the patient and the family at the end of the patient’s life. They help the patient maneuver the system so that he doesn’t have to contact providers on his own to figure out how to obtain equipment, medication and supplies.

In order to qualify for hospice care, two doctors - usually the patient’s primary physician and the hospice medical director - must certify that the patient will probably die within the next six months and the patient has to agree not to pursue aggressive treatment. That doesn’t mean that if the patient doesn’t die he can’t continue to receive hospice; as long as he continues to decline the patient will continue to qualify for hospice care no matter how long it takes.

Payment for Hospice Care

Medicare is the common payment for hospice, although Medicaid and most private insurance companies also have a hospice benefit. There are four levels of care under the Medicare benefit:

• Routine Care - $140.15 per day: provides normal daily care provided to patients including the services mentioned above.
• Continuous Home Care - $817.26 per day: provides care in the home for patients who are experiencing pain or symptoms that require constant attention. This type of care helps patients whose needs can be met on an extremely short term basis without the trauma of moving them to another location.
• Respite Care - $142.41 per day: provides a bed in a skilled nursing facility or hospice inpatient unit for the patient, so that the caregiver can have some time off. This type of care can also be used for a scheduled event such as weddings, graduations, etc.
• General Inpatient Care - $622.66 per day: provides a bed in a skilled nursing facility or hospice inpatient unit for the patient to help stabilize patients who are in crisis. This is a short term service.

The daily rate that a hospice receives covers all of its operational costs; hospices are able to contain their costs by contracting with pharmacies, medical equipment providers, and medical suppliers. Because of these contracts, hospices pay much less than the patient or Medicare would pay for the same items. This allows the hospice the opportunity to make a lot of money if the business is well managed.

Medicare reimbursement for hospice programs is complicated; essentially, the more patients signed onto their program, the more money the hospice makes. The incentive is for the hospice to sign on as many patients as possible, whether or not the patient will benefit from the program.

How Does Hospice Care Differ from Home Health Care?

Home health care is a payment-based short-term service designed bridge the gap between hospitalization or rehabilitation and home. Home Health Care helps patients recover from an illness or surgery by providing nursing services and physical & occupational therapies in the home. These visits are limited in nature, and are based on the amounts Medicare or the insurance company will pay rather than what the patient needs. In order to qualify, home health patients must be homebound and unable to leave the home except for medical care. The patient is responsible for ordering his own medical equipment, with co-payments, pre-approvals, and limitations. For instance, patients can either receive a wheelchair or a walker, but not both. Supplies such as IV tubing, solutions, and briefs aren’t provided under the home health care benefit. In order to receive medications, patients must follow up with their doctor and obtain them through the pharmacy on their own.

Hospice Care is patient-based; the hospice is required to provide for the patient’s & family’s needs . The amount of nursing visits is based on the patient’s needs and aides are sent out to bathe and provide personal care up to seven days a week. All medications related to the patient’s terminal prognosis are paid by the hospice, and delivered directly to the patient’s home. The hospice provides all of the equipment, supplies, and training that the patient needs without having to justify to Medicare why they are needed. The hospice is allowed to charge a copayment for medications, but most don’t do so in order to remain competitive with other hospices.

It’s important to note that the services the hospice provides is supplemental to the care already provided in the home, and that hospice doesn’t replace the need for a caregiver. Patients must have a caregiving plan sufficient to meet their needs — hospice social workers can help set up services in the home, but payment for the care is the responsibility of the patient or family.

Calling 911

When a patient signs onto a hospice program, he is agreeing to allow the hospice to manage his medical care. If going to the doctor presents a hardship for the patient, he can communicate with the doctor via the Hospice R.N. Case Manager; it’s also possible for the hospice Medical Director to visit the patient in his home. Other than regular doctor’s visits, any treatments the patient receives must be preauthorized by the hospice. This include emergency services; instead of calling 911, the patient/family agrees to call the hospice, which is available 24 hours per day to answer questions and come to the patient’s home if necessary. If the patient receives treatments that aren’t approved by the hospice, Medicare probably won’t pay for them and the patient will be responsible for the full cost of the bill.