"Hospice care is Medicare's hidden treasure," Grassley said. "It makes all the difference for those who know about it. It brings dying patients peace, and it eases their pain. The problem is, too few people use the hospice benefit for too little time. That has to change."
Grassley's comments came at a hearing, "Barriers to Hospice Care: Are We Shortchanging Dying Patients?", at which witnesses testified about the value of hospice care and the reasons behind patient access problems. Added to Medicare in 1982, hospice care includes palliative (rather than curative) care to patients who are certified by a physician as being likely to die within six months.
Ruby Tooks of Carol City, Fla., called hospice a "god send" for her late mother, Louise Tharpe. Because of hospice, Mrs. Tharpe had more time at home than expected and was surrounded by family and friends during her terminal illness.
Many patients may have similarly satisfying experiences, but for much shorter periods of time. The General Accounting Office presented a report showing that hospice stays are getting dramatically shorter. The number of patients who receive less than a week in hospice care rose sharply in the 1990s.
Hospice providers including Frances Hoffman, the executive director of Hospice of Northern Iowa in Mason City, expressed concern about the trend toward short patient stays in hospice. The longer terminally ill patients are in hospice, the more they can be treated for pain and emotional distress, the hospice managers said.
Grassley learned that several factors contribute to short hospice stays, including some that are not policy-related, such as a cultural unwillingness to face death and a reluctance by doctors to abandon curative efforts in favor of palliative treatment.
However, Grassley said, he will take action to fix the government-imposed barriers to hospice care. They include:
*Low payment rates. Many hospice providers assert that Medicare's hospice payment rates are inadequate, especially given the dramatic increases in drug costs in recent years. This year, the Medicare payment for a routine day of hospice care in the home is just under $100.
*Confusion over eligibility requirements. Hospice is available to Medicare patients who are certified by a physician as being likely to die within six months. As long as the patient remains eligible, there is no time limit on hospice care. However, hospice managers say they have been subject to fraud scrutiny if they let patients stay longer than a short period. Medical experts say it is difficult to predict how long someone will live with a terminal illness.
To address these issues, Grassley said he will:
*Urge the chairman of the Senate Finance Committee to include an increase in the base hospice rate as part of this year's Medicare package.
*Write the Health Care Financing Administration urging that it review the hospice benefit and make concrete, serious legislative recommendations to Congress by March 18, 2001. Key questions include whether a new eligibility criterion should replace the six-month rule; whether Medicare needs to undertake a professional and public education campaign on the hospice benefit; and whether current Medicare reimbursement is adequate.
"Nobody looks forward to dying, but we should all look forward to a peaceful passing," Grassley said. "Hospice care gives us all the hope of dying as we want to, in our own homes, without pain, with our family and friends nearby."