CBS Evening News Offers Misleading Coverage of Medicare Hospice Benefit
The CBS Evening News aired a story this week on a hospice owner who owes the Centers for Medicare & Medicaid (CMS) $3 million (view video below) for services she provided to terminally ill patients. HFA does not know the details of this particular case, and cannot address the specific billing issues raised by the brief story. However, we would like to correct the inaccurate portrayal of how hospice payment by CMS works. The report stated:
In fact, hospice care is a covered benefit under Medicare for patients with a prognosis of six months or less. A patient can remain in hospice care beyond six months if a physician re-certifies that the patient is terminally ill every 60 days thereafter.
The payment issue is more complicated than the report implies. Hospices are paid a daily rate by CMS for each day the patient receives care, according to a fee schedule for four broad categories of care. In addition, there is the cap amount set by CMS (the cap for 2008 is $22,386.15). However, this cap is not applied to each individual hospice patient, but rather aggregated across the entire patient population. So a hospice that serves 100 patients a year, could have a total cap of $2,238,615.
Since the majority of patients served by hospice are referred less than six months before their death, a hospice can provide care to those patients who live longer than six months and still receive payment for their services from CMS. In recent years, some hospices have exceeded their caps and there are groups lobbying to change the way hospices are reimbursed. HFA is not an advocacy organization, and has not taken a position on the payment issue or those efforts, but we would like to provide our readers with accurate information on how CMS hospice payments work currently.
But there's a problem: 11 years ago, Congress mandated that terminally-ill patients are entitled to unlimited hospice care - but Medicare only pays the hospices for six months' worth, CBS News correspondent Thalia Assuras reports.
In fact, hospice care is a covered benefit under Medicare for patients with a prognosis of six months or less. A patient can remain in hospice care beyond six months if a physician re-certifies that the patient is terminally ill every 60 days thereafter.
The payment issue is more complicated than the report implies. Hospices are paid a daily rate by CMS for each day the patient receives care, according to a fee schedule for four broad categories of care. In addition, there is the cap amount set by CMS (the cap for 2008 is $22,386.15). However, this cap is not applied to each individual hospice patient, but rather aggregated across the entire patient population. So a hospice that serves 100 patients a year, could have a total cap of $2,238,615.
Since the majority of patients served by hospice are referred less than six months before their death, a hospice can provide care to those patients who live longer than six months and still receive payment for their services from CMS. In recent years, some hospices have exceeded their caps and there are groups lobbying to change the way hospices are reimbursed. HFA is not an advocacy organization, and has not taken a position on the payment issue or those efforts, but we would like to provide our readers with accurate information on how CMS hospice payments work currently.
Labels: hospice and palliative care, providers
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