hospice cap article

Wednesday, October 17, 2007

Hospice Cap Article

A friendly reader pointed out this article in the Daily Oklahoman newspaper about a hospice that is facing a huge cap issue.

Since it seems that most of the people interviewed for the article are from the hospice that has this large cap problem, it is a bit slanted to their point of view, but this does show the prominence that the cap issue is taking in the hospice world.

Here’s a question for the mathematically inclined readers:

If this hospice owes $2,000,000 dollars in over payments, and that amount is equal to 20% of the hospices total reimbursement for the year, then what is the approximate average length of stay for patients on the hospice?

Yes, I know the cap formula is much more complicated than this, but I think we could use the information from the article to figure out roughly what the ALOS for the hospice was. Generally, I think you can assume that the cap allows an ALOS of 180 days. I think that means that the hospice featured in the article could well have an ALOS of around 220 days. Check my math; Lord knows that is far from my strong suit! Once you check your math, let me know if you think that a hospice that follows the certification/recert guidelines would/should/could have an ALOS of 220.

Before I publish this, I know commentors are going to say that cap problems can come from ethical hospices admitting patients that have been discharged by unethical hospices at the end of their cap usefulness. . . I know that kind of junk could happen, but I do not believe any of it has led to the apparent epidemic of cap issues. This hospice does not claim that their cap problems come from anything except, “their patients not dying fast enough.”

While I’m at it, I’d also like to say that I find the accusation that Medicare is punishing a hospice because patients don’t die fast enough to be tasteless. Rhetoric like that doesn’t make me want to join the cap fight for sure!


Christian Sinclair, MD

Glad to see a new post. I hope it means there is more to come. I have no big comment on the cap issues. I like to just practice medicine when possible and not get into the administrative side of things when I don’t have to. But alas sometimes that is necessary.


I work for a hospice that had to pay some money back. Does this make us bad? I don’t think so. ALOS was around 120 days not real close to the 180 days CAP is supposed to =. But we also have a much higher cost per patient/day on what we spend toward the patient than any other hospice in our area. So there might be some kinks that need to be worked out.

However there are consequences…What if agencies with CAP issues starts discharging patients with longer LOS. My hope is no hospice appropriate patients will be discharged but we know that will happen. Some of these patients will die soon after discharging which is not what hospice is all about.

I always thought it was better to get the patients sooner so we could start helping the family too. And most people do wait to begin service and then say “we wished we called you sooner.”

Hospice is changing we should be thinking “how and what” we can do instead of the old way of thinking “we can’t”. In some ways the CAP is the old way of thinking.

I have read some of your previous articles about some hospices admitting anyone to make a dollar. There are those out there but they won’t last for long. Like you said we should be policing our industry but in most areas we are fighting one another not really working for the good of all hospice patients…


I don’t think you can do the math to find ALOS without knowing the percentage of patients under each type of care (routine home care/respite/cc/ip) as the dollar amounts paid – and paid back – are so different for each kind of care.


To the person who said the hospices who are admitting anyone to make a buck and doesn’t think they’ll last long… They’ve been around in my area for 10 years. When exactly will they start throwing in the towel? As it is, they realize there’s money to be made. The cap will hopefully end some of that. It’s hard to work together with some of the hospices out there who have such low ethical standards.