Hospice care is holistic care for the dying. Medicare coverage of hospice
care is available for beneficiaries who have been certified as terminally ill,
for services that are “reasonable and necessary for the palliation or management
of the terminal illness as well as related conditions.” Prior to receiving
Medicare coverage for hospice care, beneficiaries must sign a hospice election
form which indicates that they have a “full understanding of the palliative
rather than the curative nature of hospice care as it relates to the
individual’s terminal illness.”
Medical dictionaries define palliative care as care that affords relief, but not
cure. Curative care, on the other hand, is defined as care that tends to
overcome disease, and promote recovery. So a Medicare beneficiary who is
terminally ill with cancer, and who elects the hospice benefit, would expect
that her pain medications and therapies (including palliative chemotherapy)
would be covered by Medicare, but were she to receive chemotherapy for the
purpose of curing her cancer, the curative chemotherapy would not be covered.
This distinction between palliative and curative care seems easy enough.
However in reality, the palliative/curative divide is
not so easily discerned.
instance, a person with end-stage renal disease, who has been certified as
terminally ill, would probably be told that she could not elect the
Medicare hospice benefit until after she discontinued her dialysis.
Dialysis, of course, is the process of removing waste products and excess water
from the body. Without dialysis, a person with end-stage renal disease
would most likely die within a two week period. In other words, this
beneficiary would be told that in order to receive
Medicare covered hospice care, she would have to sign her own death sentence, a
death sentence with a time line of less than fourteen days. Talk about a
is this dilemma really necessary? Dialysis for an individual with
end-stage renal disease is clearly not curative. Then, therefore, it must
be palliative. And since it is palliative, it should be covered by
Medicare under the hospice benefit.
However, there remains yet another problem. Hospice programs that provide
care to terminally ill Medicare beneficiaries are paid a per diem. From
that per diem, hospice programs must pay for all the care that is rendered to
the Medicare beneficiary. The hospice per diem is simply not enough to pay
for dialysis. So despite the fact that they are otherwise qualified to
receive Medicare coverage for hospice care, beneficiaries with end-stage renal
disease, and other beneficiaries with terminal illnesses who are receiving
expensive life-sustaining, but not curative care, are barred from hospice care
because of the Medicare payment system. This is a travesty. It is a
travesty that the Centers for Medicare & Medicaid Services should remedy.