Is hospice a viable readmission alternative for Medicare patients?

Hospice marketers are pitching a new idea to improve hospitals’ bottom lines and cut readmissions. Send Medicare patients with chronic conditions to hospice, rather than admit them to the hospital. The Hospital Readmission Reduction Program will penalize hospitals that have a high readmission rate for patients with certain medical conditions (heart failure, chronic obstructive pulmonary disorder, and pneumonia). The penalties could cost some hospitals 3% of their total Medicare revenue by 2015. Some hospice marketers are suggesting hospitals send these patients to hospice, where they can receive services for an extended period. Hospice care is reserved for patients that are expected to die within six months. Hospices provide comfort and support to patients who have decided to forgo other treatment options and wish to pass on with dignity. According to Medicare guidelines, beneficiaries must “elect” the Medicare hospice benefit; in so doing, they agree to forgo Medicare coverage for intensive conventional treatment for the terminal illness. A March report from Medicare Payment Advisory Commission (MedPAC) showed that hospice is the fastest-growing area of Medicare. The number of hospices grew 53% between 2000 and 2010. The report also found that some hospices are discharging live patients at an unusually high rate, which raised a few eyebrows at MedPAC. A high rate of live discharges suggests that some hospices may be seeking out Medicare patients who do not meet hospice eligibility requirements and discharging them when they reach Medicare’s length of stay cap. The report warns that hospices admitting patients before they meet eligibility requirements could be subject to investigation by the Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS). With that said, hospices that market themselves as a readmission alternative could be open for investigation if they accept ineligible patients.