BackUnderstanding the Medicare Hospice Benefit
Article submitted by Barbara Gray, Vice President of Operations, VITAS Innovative Hospice Care(r). To learn more about VITAS service, please call 1-800-93-VITAS.
When patients and their families are dealing with a terminal illness, the physical and emotional challenges are burden enough. But the financial stresses sometimes are more than a family can bear. So it's helpful to understand the financial benefits available to Medicare enrollees who choose to take advantage of their hospice benefit.
Stated simply, the Medicare Hospice Benefit is all-inclusive-Medicare-certified hospices generally accept the per diem reimbursement rate as 100 percent coverage for the services provided to the hospice patient and family.
For patients, that means no co-pays, deductibles or coverage limits. It means that all prescription medications, over-the-counter drugs, durable medical equipment (like a hospital bed) and medical supplies related to the patient's terminal illness are provided at no cost to the patient.
It means that the hospice physician, nurses, certified home health aides, social worker, chaplain, physical/occupational/speech/music therapists, dietician and volunteers provide care related to the patient's terminal illness at no additional cost to the patient and the patient's family.
The Medicare Hospice Benefit also requires all Medicare-certified hospices to provide an organized program of services to meet the bereavement needs of the family for at least one year after the beneficiary's death.
Considering End-of-Life Choices
Of course, not all hospices are the same. When selecting a hospice provider, patients and families should consider which one is best able to meet their individual needs.
Local hospices can provide the information you need to make an informed decision about the choices available. Here are some questions that might be helpful when evaluating hospices:
Range of Services:
Q: How long has the organization been in business?
Q: What sources of payment does the hospice accept for its services (Medicare, Medicaid, private insurance)?
Q: Does the hospice provide services in a variety of settings? Private residence? Assisted living community? Nursing home?
Q: Does the hospice provide inpatient care for pain control, symptom management and "respite" purposes? How and where is inpatient care provided?
Q: Does the hospice provide "continuous care" to manage an acute medical crisis as necessary to maintain the patient at home?
Q: Does the hospice exclude certain treatments (for example, feeding tubes, artificial respiration, cardiopulmonary resuscitation)?
Q: Does the hospice accept patients who will not execute a "do not resuscitate" (DNR) order?
Professionalism:
Q: What do other hospice patients and their families say about the care they received from this hospice provider?
Q: How are the hospice's professionals trained?
Q: How does the hospice team schedule visits?
Q: How does the hospice team respond to after-hours emergencies?
Family Interaction:
Q: In what ways can the hospice team honor the patient's unique wishes and needs (for example, communication in languages other than English, religious and cultural preferences at the end of life, advance directives regarding medical treatments, remaining in the home without a caregiver)?
Q: Does the hospice team provide the family caregivers with the information and training they need to care for the patient at home?
Q: How does the hospice team handle visits and calls when death occurs?
Q: What services does the hospice provide to help the patient and loved ones deal with grief and loss?
Medical Expertise:
Q: What is the role of the patient's physician once hospice care begins?
Q: What experience does the hospice have evaluating pain control and symptom management?