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October,
2000
U.S. General Accounting Office
Health Financing and
Public Health Issues
Health, Education, and Human Services Division
Washington, D.C.
 Many Beneficiaries Use
Hospice; Many Factors Contribute to Shorter Periods of Use
The Medicare hospice benefit, authorized in 1982 under part A
of the Medicare program, covers medical and palliative care
services for terminally ill beneficiaries. A Medicare-certified
hospice provides physician services, nursing care, physical and
occupational therapy, home health aide services, medical supplies
and equipment, and short-term care in the hospital (for procedures
necessary for pain control and symptom management). In addition,
the hospice benefit provides coverage for several services not
generally available under the regular fee-for-service Medicare
benefit. These include drugs for symptom control and pain relief,
inpatient respite care, and bereavement counseling for the patient's
family. For each day a beneficiary is enrolled, the hospice
provider is paid an all-inclusive, prospectively determined rate,
depending on the level of care that is provided.
Beneficiaries who elect hospice are required to waive Medicare
coverage of care related to their terminal illness that is
provided outside the hospice, although they retain coverage for
services unrelated to their terminal illness. A beneficiary can
cancel his or her election of hospice benefits at any time, return
to regular Medicare, and reselect hospice coverage later. To be
eligible for hospice services, a beneficiary's physician and the
hospice medical director (or other physician affiliated with the
hospice) must certify that his or her prognosis is for a life
expectancy of 6 months or less, if the terminal illness runs its
normal course. This eligibility requirement has been a concern
among patient advocates and providers, who assert that it deters
referrals to hospice. Research has shown that it can be difficult
for physicians to accurately predict whether or not a patient is
likely to die within 6 months. It is particularly difficult to
estimate life expectancy for persons with non-cancer diagnoses
because the course of their disease is often uneven. 
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