It’s Past Time for An Upgrade To The Medicare Hospice Benefit

Health Affairs Forefront | By Cara Wallace

When most people think about hospice care, they imagine someone such as the late Rosalynn Carter, who enrolled onto hospice and died within a few days. Jimmy Carter’s long hospice stay, now more than a year, has shown a different model for hospice—one that supports its mission to help people live well, with dignity and quality of life, for whatever time remains.

However, current policy restrictions to enroll and remain on hospice make it difficult for many hospice recipients to receive hospice care for “whatever time remains,” as 17.2 percent of Medicare hospice patients are discharged alive.

To enroll on hospice, a person must meet eligibility criteria based on their specific disease, with a physician statement of a six-months or less prognosis. The person must also elect hospice care by being willing to forgo any curative treatment related to their terminal diagnosis.

To remain on hospice care, a person must show demonstrable decline toward death, as a physician must recertify the patient for ongoing care every 90 days during the first six months, then every 60 days thereafter.

These restrictions are closely tied to the two most common reasons for a live discharge from hospice: decertification—when a patient is removed from hospice care due to a stabilized condition; or revocation—when a patient chooses to leave hospice care to seek curative care. Both are challenging and disruptive and are the result of inflexibility in current policy.

Live Discharge Is Disruptive For Patients, Families, And Hospices

First, let’s consider decertification, or rather when a patient does not experience enough decline in their condition for a physician to recertify them for ongoing care. Medicare refers to these patients as “no longer terminally ill,” although in most cases the patients’ diagnoses that qualified them for hospice in the first place remain the same. Because of this, we refer to this type of live discharge as decertification, although others refer to it as disenrollment, or more flippantly as “not dying fast enough” or “failure to die on time.”…

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