Are Medicare Patients Unknowingly Forfeiting Their Hospice Benefit?
At a recent hospice fundraiser someone asked me why a hospice would need to fundraise. “Doesn’t insurance pay for hospice?” he asked. What followed was a ‘Hospice 101’ conversation that caused my new friend to say, “I don’t think most people know this. What are hospices doing to get the word out?” Sigh. Hospice providers are doing everything they can to educate the public, even climbing mountains to attract attention. The reality is people don’t pay attention until they need help, and then they almost always wait too long to get it.
In answering my friend’s question I explained factors such as cost of care and the reality that not everyone has hospice insurance. Hospice services include skilled nursing services, pain and symptom management, physician services, pharmaceuticals, durable medical supplies, non-curative therapies to improve quality of life, social worker services, spiritual care and bereavement care. All of these services are offered to every patient along with supplemental life-enhancing services provided by trained volunteers. It is highly personalized and patient-directed care. Some hospices, especially for-profits, will charge an upfront enrollment fee. Others offer services regardless of ability to pay and that is why they may need to fundraise, especially if the provider is an independent nonprofit.
Hospice programs are for people of any age with any type of life-limiting illness or injury who are no longer responding well to treatments. If the illness is incurable and the life-expectancy is six months or less, the individual is eligible for hospice. Because terminal illness can strike at any age, not everyone who needs hospice care has Medicare.
The need to fundraise is easily explained. What is difficult to explain is the under-utilization of services by those who do have Medicare. The Medicare hospice benefit is something that all of us pay into throughout our working years. It is there to ensure a wholistic healthcare experience if we are ever faced with an incurable illness.
Last year in the U.S. Medicare paid for 91.2% of all hospice care. Despite that high percentage, most only used a fraction of the benefit.
The Medicare hospice benefit offers two ninety day periods of services followed by unlimited sixty day periods of services as long as the prognosis does not change. Despite this generous benefit period, of the 1.5 million plus individuals who received hospice care in 2013 over thirty-four percent died within the first seven days. They waited too long.
Hospice providers are continuously puzzled by the lack of utilization and the late enrollment of patients with the Medicare hospice benefit. Considering the fact that the Medicare benefit is something we’ve all paid to have, why do people wait so long to enroll? Why do Americans pay for a guaranteed minimum of 180 days of care and willingly forfeit 176 days? A death-denying culture and poor patient/physician communication may be factors, but so is not understanding what we’re paying for and not claiming what we deserve. Everyone deserves the right to live fully and to die well.