Rules Change Could Increase Hospice Use

MONDAY Dec. 22, 2008 -- More people with life-threatening illnesses would seek hospice care if Medicare and other health insurers dropped the requirement that they give up aggressive treatment of their ailments, a new study finds.

That was especially true of blacks, but the issue was one of money, not race, said Dr. David Casarett, an associate professor of medicine at the University of Pennsylvania and leader of a group reporting the finding in the Dec. 22 online issue of Cancer.

"We looked at household finances, how much money was left at the end of the month," Casarett said. "African-Americans generally had less money at the end of the month. Money affects people's perceived need for hospice services. People with greater financial resources have other ways of getting the services that hospices provide. They could get home health care by paying a friend or neighbor to provide the service."

Under current Medicare rules, someone must have a prognosis of six months or less of life to get hospice services covered. They cannot get hospice services, which include a visiting nurse, a home health aide and a counselor, if they insist on continuing treatment. Hospice care focuses on quality-of-life issues such as pain reduction rather than curing the disease.

Casarett and his colleagues interviewed 283 people receiving cancer treatment at six oncology centers in the University of Pennsylvania Cancer Network, asking them about their perceived need for five hospice services and their preferences for continued cancer treatment. They concentrated on blacks, since statistics show they are less likely to seek hospice care.

"We found people who believed they could benefit from all of the services that hospices provide, yet some of them wanted treatment, which would keep them out of hospice care," Casarett said.

The researchers reported that "African-Americans had stronger preferences for aggressive cancer treatment compared with white patients. That is, they were willing to continue their treatment in spite of a smaller chance for six-month survival."

The researchers concluded that "the hospice eligibility criteria of Medicare and other insurers requiring patients to give up cancer treatment contribute to racial disparities in hospice use," and that "these criteria do not select those patients with the greatest needs for hospice services."

Those statements reflect Casarett's belief that "eligibility for hospice care should not depend on treatment. It should be determined by people's needs for hospice services."

The arrival of a new administration "is a great time for rethinking our health-care system," he said. "Medicare needs to rethink the way hospices are paid, so hospices will be able to provide more people the treatment they want or need."

The rules could be changed so that specific kinds of care could be provided -- for pain relief or management of other symptoms, as is now done in the Medicare Home Management Program, Casarett said.

More information

Learn about hospice through the U.S. National Library of Medicine.

Posted: December 2008


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