Tuesday, November 27, 2007

More Ways To Save Money At Medicare

Yesterday I posted on the latest efforts to "contain costs" at Medicare by hiring outside contractors to review and deny charges for what good medical practice would deem necessary treatment. Today's NY Times contains an article which details another "cost containment" measure at Medicare. Once again, the poor and elderly, especially the elderly poor, are the targets. The subject this time is hospice care.

Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare. ...

In the early days of the Medicare hospice benefit, which was designed for those with less than six months to live, nearly all patients were cancer victims, who tended to die relatively quickly and predictably once curative efforts were abandoned.

But in the last five years, hospice use has skyrocketed among patients with less predictable trajectories, like those with Alzheimer’s disease and dementia. Those patients now form a majority of hospice consumers, and their average stays are far longer — 86 days for Alzheimer’s patients, for instance, compared with 44 for those with lung cancer, according to the Medicare Payment Advisory Commission. ...

To be eligible, patients must be certified by two doctors as having six months or less to live, assuming their illness runs a normal course. They must agree not to bill Medicare for curative procedures related to their diagnosis.

Medicare, which pays the vast majority of hospice bills, reimburses providers $135 a day for a patient’s routine home care. The hospice is then responsible for providing nurses, social workers, chaplains, doctors, drugs, supplies and equipment, as well as bereavement support to the family.

Studies have reached various conclusions about whether hospice care actually saves money, especially for long-term patients. But a new study by Duke University researchers concluded that it saved Medicare an average of $2,300 per beneficiary, calling hospice “a rare situation whereby something that improves quality of life also appears to reduce costs.”
[Emphasis added]

Here's the harsh part for those providers: only after the care has been provided, the Medicare reimbursements received, and then paid out in salaries and supplies is the demand for repayment made by the government. As a result, the hospices don't get dunned until the next year, which meant for some of the hospices in the poorer regions in the southern and southeastern part of the country huge bank loans which aren't as forthcoming this year. Many of the for-profit organizations are closing their doors, leaving the patients with nothing to rely on during the last days or months of their lives.

Admittedly, the actuarial tables never took into account the vagaries of such conditions as Alzheimer's and dementia, but both conditions, with their complications, do lead to death and the end stages are dreadful. Instead of punishing the care-givers, perhaps the actuarial tables should be amended to include these conditions. Or, better yet, the regulations could be amended to remove the cap on the length of hospice benefits.

Oh, wait. That wouldn't work. It would mean an entitlement, and that entitlement is a sure first step on the road to socialized medicine. We can't have that. Better the dying elderly suffer the consequences.



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