One of the most essential Medicare benefits for end-of-life care has a gap or two. Hospice, the end-of-life care provided by Medicare, is not often used for very long, even when patients could benefit from the care a lot sooner.
Almost half of hospice patients were only admitted in the last two weeks of life—a far cry from the six months the benefit is generally meant for, according to a study from Yale University.
Barriers to hospice admission
There are several reasons hospice care isn’t used more often or sooner, including a lack of knowledge or misunderstanding about what hospice care is, what it can provide and how it is paid for. The lack of education also influences why so many patients only use the benefit in the last few weeks of life, even when they could benefit sooner.
“Unfortunately, so many patients and their loved ones miss out on the full benefits to which they are entitled,” Michael Mencias, MD, senior hospice medical director at MJHS Health System in New York, told Home Health Care News. “So many people, even some physicians, are surprised that the hospice benefit is free. There are no co-pay and no charges for medicines that are related to terminal illness.”
While the transition times seemingly need improvement, as palliative care and other supportive care gain traction, hospice could actually find itself with more competition, rather than working alongside other ancillary services, according to Edo Banach, CEO of the National Hospice and Palliative Care Organization (NHPCO).
“There hasn’t been a ton of improvement over time,” Banach told HHCN of hospice transition times. “As you’ve had a lot more activity in care management and care coordination and palliative care, all this noise competes for folks’ attention. That sometimes prevents or delays folks from making a decision.”
Unlike hospice care, palliative care does not require families and patients to forgo curative treatment—another harsh reality for patients and families—but still provides relief at any stage of a diagnosis.
“In order to get hospice care, you have to forgo curative care mostly, that’s something people don’t want to do often until the very end,” Banach told HHCN. “A lot of foks delay hospice care; they are holding out hope or the family is. I don’t fault folks for that; that’s the reality.”
Improving transition times
When it comes to improving access and timeliness of hospice care, there aren’t a ton of resources, according to Mencias, who says there are no published best-practice guidelines. The best method may be reaching out to primary care physicians and providing information about how identify patients and when to refer them to hospice services.
However, education and outreach may still not be enough, and it may come down entirely to the patient and his or her family.
“With all of the aforementioned, it’s important to remember how a patient’s background may influence their decision-making,” Mencias said.
One positive sign has been an increase in physicians having end-of-life conversations with patients, and being able to bill for the time.
“Adding codes for physicians to have conversations, that’s a step in the right direction, but it isn’t everything,” Banarch said. “We’re not talking about the interdisciplinary team—the nurse, the social worker, the spiritual counselor, aides. Everyone has their own expertise and that yields the best outcomes.”
As the health care system continues to shift, hospice providers need to get a seat at the table as well.
“One thing that is important is to make sure that hospices are engaged in and competing with the folks further upstream,” Banach said. “The hospitals, home health care agencies and nursing homes all need to work together around the concept that hospice isn’t radical, but that it is about what people want.”
Written by Amy Baxter