Kabin

We can't forget healthcare is a limited resource. Cost will always be important. Hospice is all about dying with dignity, comfort, and support. And if med changes don't support those goals you're doing something wrong.

Once again that doesn't mean the hospice agency needs to cover it without first trying formulary meds. And there's almost always a few more cost effective meds to try. This has been standard operating procedure for years.

Most hospices would try other neuropathic meds within formulary before trying exotic meds. There should be many old school and cost effective choices to try first (TCAs, anticonvulsants, local anesthetics, etc). If they don't work THEN one can consider exotics. That is representative of modern, cost effective medicine including today's hospice care. I'm not sure how this keeps turning into an old school hospice debate.

Yep, unless you need it. On the other hand, med coverage will soon be more complete and cost effective for most patients and families. It's probably more accurate to say the key is to not start a hospice business today.

Yes there are several. It just depends what it's being used for (neuropathic pain, antidepressant).

Although it will be less often, there'll still be cases where the patient may have to pay out of pocket. The patient has to be willing to play ball. If the patient refuses to try hospice formulary meds first then the patient will assume financial liability to cover that med as the Medicare D sponsor will also not cover it.

"Hospice has been a good business." Too good. Too many start ups falling over themselves to get in while the gettin' was good. What other business could one start and not experience the traditionally high new business start-up failure rate? Probably none. Of course that will change now. And there's a host of other reasons like more hospice agencies making it more difficult and expensive for CMS to track compliance, do audits, etc.

Yes, hospice has been a good business. CMS probably wouldn't mind seeing a few hospice agencies fail from reasons other than medicare fraud.

Exactly. Few seems to understand how far reaching this change is. It's more than covering the terminal diagnosis, it's bundling secondary diagnoses and conditions that contribute to the pt's decline, it's more cost burden on the hospice agency, and there's no planned increase in hospice reimbursements.

One of the larger hospice agencies, top 10.

In times like this it's probably best to be involved with hands on clinical. Try to avoid fluff programs, overhead assignments, and middle management jobs.

Hospice bundling in the past was only around the terminal diagnosis and included many caveats. Soon it will be bundling coexisting and additional diagnoses related to the term condition or related conditions worsening the terminal prognosis. Hospice agency cost burden will increase substantially. Soon enough it's gonna suck to be us. :)

As with many, we've been covering everything related to the primary term diagnosis for years and now just beginning to do the ground work in prep for covering any related illness. We're being instructed to look for at least 2 related illnesses to the primary terminal diagnosis. There's no way around it, it'll get expensive quick. We're being told the government's ultimate goal is to bundle all end of life costs.

Sorry, I wish I could delete it. That was a misleading new site.

It will get ugly for many hospice agencies very quickly. Hospice conditions of participation are pretty clear that hospice agencies can't cherry-pick patients. The patient is either hospice appropriate or not. Cost isn't an admission criteria. We've always done well covering meds and DME related to the hospice diagnosis but covering meds and DME related to second and third potentially terminal diagnoses will be daunting. And from what we're hearing Medicare has no plans to increase reimbursement rates. I'd guess that'll have to change within a year.