my problem with tv news story

Thursday, November 01, 2007

My Problem with the TV News Story

I posted here about a story on a local news channel about the Medicare Hospice Cap issue. In that post I said that something about having an actual hospice family interviewed made me a bit uneasy, but I “couldn’t put my finger” on why. I’ve put my finger on it now.

A comment left on that post said:

I think using a real hospice patient makes this important story easier to understand and relate to at a personal level.

That’s when my brain clicked on what was bothering me, the patient, or more specifically his wife, didn’t seem to actually understand the hospice cap. Here’s the offending part of the transcript as best I could transcribe it:

(narrator) – Al is just one example of a hospice patient that has lived longer than [the] time Medicare allows hospice funding.

(Al’s wife) – It makes me angry. What do they expect him to do, just go behind the barn and go die?

There is no limit on the amount of time that Medicare will fund hospice for any individual patient. If you qualify for hospice for twenty years Medicare will pay for your hospice care for twenty years. Medicare puts a cap (thus the Medicare Hospice Cap) on the amount it will pay any given hospice company based on the number of new patients that hospice has admitted in that given year. There is no limit for how long Al can be on hospice. There should never come a day when Al is told that he needs to go out behind the barn and die because he no longer has access to hospice.

It seems to me this the patient/family doesn’t really understand what is going on. I hope it is an editing problem that can be blamed on the television station, but, taken at face value, it seems that the hospice is using, guilting, and upsetting patients to further its own political agenda. If that is true, then we have seen a new low in an industry that used to stand for all that was good and noble in the health care.



I am not sure that your comment about Medicare is accurate. Our fiscal intermediary, Palmetto GBA, has demonstrated an exceedingly low tolerance for keeping patients on hospice for longer than six months-especially those with non-cancer diagnoses.
They indirectly control this cap by requesting ADR’s on any and all patients with non-cancer diagnoses and withold any further payement. The patient must show evidence of significant decline or the hospice will be unable to provide service for 6 mos-could never provide service for years.

Hospice Guy

Anonymous, this is why I said anyone that qualifies for hospice for 20 years. . .

Obviously it would be hard to qualify for 20 years.

On Palmetto, it seems that they may be responding to Length of Stay issues (which are at the core of cap issues) since most of the documented cap issues are in states covered by Palmetto GBA.


I just have to comment on this. If this interview with a patient’s family actually happened, and it happened in the way that it was portrayed in this article, then I too, am sickened by the new low (hole) that hospice is sinking into.
We, too, have Palmetto as a fiscal intermediary and, even though we have a length of stay that is longer than average, we have received only ONE ADR in the past three years–and it was in a patient that had been on another hospice for years and was “dumped”. We picked admitted her when she met the LMRP criteria for her diagnosis and she lived another happy,wonderful 15 months. I have to wonder, too not particularly about the care, but about the admission criteria for hospices that are being capped. Is there the chance that they are not admitting patients that are complex and require intense care for a short period of time? That is the problem in our area–critical, complex patients are sometimes not admitted onto some companies services r/t med costs, labor hours,specialy equipment or intensive daily treatments. Perhaps the problem is not good care to those who exceed the LOS but poor admission criteria for needy patients that would require intense care?


I also have a problem with the use of the real patient and his wife in the video, but feel they were not so much misinformed as misused. I am also concerned with the possibility that any hospice would be disenrolling patients who “aren’t dying fast enough” regardless of their terminal diagnosis, cancer, in this particular patient’s case.
I’m also glad to see your blog focusing on the cap issue. Keep up the good work.


Hospice guy (different anonymous poster, btw…) I agree, the family doesn’t understand the issue. But honestly, I don’t think the reporter does either. She’s strictly reporting exactly what the hospice probably told her and seems to have done no research on the actual problem.