Thank you for visiting Quality Hospice Care’s “Did You Know” blog.  This month I have chosen to focus on one of the most frequently asked questions when we first begin talking to someone about hospice. Who pays for hospice care? In 1982 Congress created the Medicare Hospice Benefit and it was implemented in 1983. The hospice benefit is part of the Medicare Part A (hospital insurance) plan.

Most people receiving hospice care are covered by the Medicare hospice benefit. This benefit covers virtually all aspects of hospice care with little, or most often, no out-of-pocket expenses to the patient or family. As a result, the financial burdens often associated with caring for a terminally ill person are virtually nonexistent. Medicare pays hospice a flat, per-diem rate. Most private health plans, HMOs & Medicaid cover hospice services. Currently, a patient with a Medicare Advantage Plan reverts to the traditional Medicare plan. The hospice industry is expecting a change regarding Medicare Advantage Plans in 2025. CMS has launched the Medicare Advantage Value-Based Insurance Design (VBID) model to test the inclusion of Medicare Part A in Medicare Advantage plans. Quality Hospice Care has taken a proactive approach to the proposed changes. We are continuously monitoring the data being produced by the trial groups, updating our systems and processes as well as laying the groundwork to be able to continue to provide service to the patients enrolled in Medicare Advantage Plans. This change WILL NOT affect the clients of traditional Medicare.

A common question that our office hears when speaking with someone about hospice care is “will I have to sign my home over?” The answer is “no”. Hospice will NOT seize your properties, social security check, bank funds, or any other assets.

What I have written so far relates to people having some type of health insurance. I want to also say that Quality Hospice Care accepts patients, meeting hospice criteria, through our charity care program on a case-by-case basis. We involve our social worker in these cases and often find some type of assistance for these people. Our focus isn’t just on the patient’s ability to pay for our services. The social worker can often find community resources such as food bank, assistance with utility bills, home modifications, etc.

The National Opinion Research Center (NORC) at the University of Chicago estimates that in 2019 Medicare spending for those receiving hospice care was $3.5 billion less than it would have been had they not received hospice care. At any length of stay, hospice care benefits patients, family members, and caregivers. It also provides increased satisfaction and quality of life, improved pain control, reduced physical and emotional distress, and reduced prolonged grief and other emotional distress. Many studies have shown that hospice enrollment is associated with fewer hospital 30-day readmissions as well as fewer in-hospital deaths. It is also associated with fewer hospital ICU days.

There are 4 levels of hospice care: Routine Home Care (RHC), Continuous Home Care (CHC), Inpatient Respite Care (IRC) and General Inpatient Care (GIP). Below is a breakdown of hospice usage in 2020 as provided by the National Hospice & Palliative Care Organization (NHPCO). I have added a brief description of each level.

  • Routine Home Care – 92.7% – most common level of hospice care. Receives hospice care in the place they call home: own residence; private residence of a family member; assisted living facility, etc.
  • Continuous Home Care – 1.1% – care provided up to 24 hours per day to manage pain and/or other acute medical symptoms. Care must be provided predominantly by a nurse. CHC is provided to maintain the terminally ill patient at home during a pain or symptom crisis.
  • Inpatient Respite Care – 0.6% – used to provide temporary relief to the patient’s primary caregiver. Care is provided in a long-term facility, that the hospice agency has an agreement with and that has sufficient personnel to make sure the patient’s needs are met. The stay is a maximum of 5 consecutive days.
  • General Inpatient Care – 5.6% – provided for pain control or other acute symptom management that cannot be controlled in any other setting. It is used when other efforts to manage symptoms have been ineffective. It must be provided in a Medicare certified inpatient hospice facility, Medicare certified hospital, or a Medicare certified skilled nursing facility that has a registered nurse available 24 hours/day to provide direct patient care in which the hospice agency has an agreement with.

The hospice interdisciplinary team develops and revises the patient’s plan of care based on assessment and progress toward patient-centered goals. All hospice patients are reassessed for hospice eligibility at regular intervals. There is no time limit that a patient can spend under hospice care as long as they continue to meet hospice criteria.

If you have further questions, please call Quality Hospice Care at 877-588-9292 or 931-879-9330. We look forward to speaking with you!