October 10, 2018 | Health System Risk Management
In the United States, hospice began as a social movement, providing care to dying patients through community volunteers and nonprofit secular and religious organizations. Today, more than two-thirds of hospice providers are for-profit entities; less than a third have not-for-profit status; and slightly more than 5% are government owned. (NHPCO "Hospital Policy")
Hospice care became a Medicare benefit in 1983. Currently, most hospice patients rely on the Medicare benefit to pay for care from state-licensed, Medicare-certified hospice providers. The Medicare hospice benefit provides four levels of care:
Medicare reimburses hospices with a per diem payment that starts when the patient elects the hospice benefit, based on prospectively determined rate categories for each level of care. Medicare pays the per diem rate regardless of the amount of services the hospice furnishes to the patient on a given day (42 CFR § 418).
According to Title 18, Section 1861 (dd) of the Social Security Act (42 USC 1395x), the term "hospice care" means the following items and services provided to a terminally ill individual by a hospice program, or by others under an arrangement with a hospice program, under a written plan of care for the individual that is established and periodically reviewed by the individual's attending physician, the medical director, and an interdisciplinary hospice team:
As of January 1, 2019, three types of providers will be authorized to act as hospice "attending physicians": licensed physicians, nurse practitioners, and PAs (CMS "Medicare Program; FY 2019").
Hospice patients may receive professional nursing care and home health aide and homemaker services on a 24-hour, continuous basis but only during periods of crisis (meeting criteria established by CMS) and only as necessary to maintain the patient at home.
Patients typically receive hospice care in the place they call home, with family and friends serving as the primary caregivers. Hospice care is also provided in acute-care hospitals, residential facilities, nursing homes, long-term care facilities, and freestanding hospice facilities. In order to obtain Medicare certification, a hospice provider must satisfy Medicare CoPs and be separately certified and approved, regardless of whether the hospice is part of a hospital, nursing home, or home health agency. (CMS...