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Health Care Policy 1
Medicare May Restrict Good Care for Dying Patients
A recent report by researchers at HMS, HSPH, and RAND found that many health care providers believe that Medicare regulations block them from providing good care to dying patients. The study, led by Haiden Huskamp, HMS assistant professor of health economics, appears in the May/June
Health Affairs.
Researchers led by Haiden Huskamp discovered that many providers believe Medicare rules impede them from giving good end-of-life care. Photo by Graham Ramsay
In the first systematic interviews of health care providers on fee-for-service Medicare coverage and payment for end-of-life care, the providers said that patients with particularly high-cost needs at the end of life sometimes have problems gaining access to nursing homes, hospitals, and home health care services.
"Most interviewees praised the comprehensiveness of the Medicare hospice benefit, but many said that the level of hospice per diem rates—$98.96 per routine day—don't support the relatively expensive services that some patients need, such as costly pain medications or palliative radiation or chemotherapy," Huskamp said.
"The payment system was created almost 20 years ago and the types of services that were used for end-of-life patients in hospice were different back then," Huskamp explained.
Providers expressed concern about the impact of the new prospective payment system on home health agencies, one of the changes mandated by the Balanced Budget Act of 1997. Interviewees from one public hospital believed that local home health agencies were delivering lower-quality care and dismissing patients sooner than they should because of the change in payment systems. Under the prospective payment system, "there is an incentive to provide less," Huskamp said.
The study suggests remedies that would not necessarily add costs to the system and calls for further research in areas that pose particular problems to those who need end-of-life care. Numbering in the millions, these patients account for more than a quarter of the annual Medicare budget.
—Heather Ettinger
Copyright 2001 by the President and Fellows of Harvard College
