Hospice

Key facts

Medicare benefit created

Tax Equity and Fiscal Responsibility Act of 1982, effective 1983

Federal standards

Conditions of Participation, 42 CFR Part 418

Benefit periods

Two 90-day periods, then an unlimited number of 60-day periods

Levels of care

Routine home care, continuous home care, inpatient respite, general inpatient

Quality program

Hospice Quality Reporting Program (HQRP)

What is hospice?

Hospice care focuses on relieving pain and other symptoms and supporting patients and families at the end of life. An interdisciplinary team of physicians, nurses, aides, social workers, chaplains and volunteers provides care wherever the patient lives, most often at home or in a nursing facility.

Under Medicare, a patient elects hospice and waives coverage of curative treatment for the terminal illness and related conditions. Medicare still covers care for unrelated conditions, and the patient can revoke the election and return to standard coverage. Hospices also provide bereavement support to families after a death.

How the Medicare hospice benefit works

The benefit has defined rules for eligibility, recertification and payment:

• Certification: the hospice medical director or team physician, and the attending physician if there is one, certify terminal illness for the first period. Later periods require recertification.
• Face-to-face encounter: a hospice physician or nurse practitioner must see the patient before the third benefit period and each period after that.
• Payment: Medicare pays a daily rate for each of the four levels of care, covering the team, drugs, supplies and equipment related to the terminal illness.
• Caps: an aggregate cap limits average Medicare payment per beneficiary, and an inpatient cap limits the share of inpatient days.

Why hospice data matters

Hospice affects drug coverage, referral networks and program integrity analysis:

• Drugs related to the terminal illness are the hospice's responsibility under its daily rate rather than Part D's, which affects pharmacy claims analysis for symptom management drugs.
• Care Compare publishes hospice quality measures and family caregiver survey results, which health systems use when choosing referral partners.
• Ownership changes and CMS enhanced oversight of newly enrolled hospices in several states make ownership and certification dates important diligence data.
• Length of stay and live discharge rates are common signals in payer, regulator and investor analysis.

Hospice vs palliative care

Palliative care also focuses on symptom relief, but it can be provided at any stage of a serious illness and alongside curative treatment. Hospice is palliative care for patients who meet the terminal prognosis requirement and elect the benefit. Treating the two as the same inflates counts of end-of-life programs.