Once a patient is on hospice, what services does medicare take away?

[GilWest]

Just a thought.

 

[Nikki J]

As far as I can remember you should get your equipment first before hospice. In the care of the disease for which you are on hospice hospice replaces medicare but I believe medicare would cover an unrelated condition. ( broken leg for example). You want a not for profit hospice. I believe they get paid a set amount to care for you and some hospices are more generous than others. Try to interview a couple at least and also try to get feedback from people in the know ( not hospital/ nursing home admins and not physicians either) floor nurse at a nursing home would be a good resource

 

[lgelb]

There is a demo coming on stream that will allow for more flexibility in the "treat vs. give up" dichotomy that inhibits many from tapping into hospice. If you are heading toward a hospice, you might ask if they are applying to be part of the demo.

From Medscape:

The CMS is seeking 30 Medicare-certified and enrolled hospices from around the country to participate in the demonstration project. Participating hospice programs will provide hospice services at the same time patients can receive aggressive therapies.

The CMS will pay $400 per beneficiary per month to participating hospices for palliative services and providers furnishing curative services to these beneficiaries will bill Medicare for their services.

 

[Annie's Phil]

They way it was when my mother was ill, medicare allows you to opt for medical care or hospice care. When you choose hospice care then they will cover costs of palliative care only, i.e., it will not cover life-extending treatments. It will cover things like a bipap. I never checked into invasive ventilation and PEGs, but when my mother switched to hospice they ceased the parenteral nutrition she had been receiving for a few months. So I would be surprised if medicare covers ventilators and PEGs under the hospice benefit. Likewise, medical treatments for the disease, e.g., rilutek, wouldn't be covered. The big cost for the parenteral nutrition was the food itself, since it was injected directly into the bloodstream, but this wouldn't affect feeding through an existing PEG. So if a PALS already owns their ventilator and the PEG is already in place I don't think there's anything to prevent the PALS from continuing to utilized them while on hospice care. But I would definitely check on the medicare website on the details. It is not a one-time choice, however. A patient can opt to begin hospice care and cease medical care and then switch back again to medical care.

Phil

 

[Nikki J]

Does anyone know the rilutek question for sure? I remember being told you can't have hospice if you are trying to be cured of your disease but can be trying for palliation. It is true hospice would be paying for the medicines and would rather not spend the money but one could argue that rilutek is palliative. No one can call it curative,sadly!
Around here hospice services have 2 programs traditional hospice and palliative care. I do not think it is the demo referred to above as it has been around for at least several years. I don't know how it is paid for but patients are allowed to seek more aggressive treatment. It is usually cancer patients trying last ditch chemo I think.

 

[Annie's Phil]

I cut and pasted the following from the medicare website. As I read it, it only covers drugs for symptom relief, i.e., comfort. I don't think rilutek would meet this criterion. Hope this helps.

Phil
******************


Hospice & respite care

How often is it covered?

Hospice care is usually given in your home and includes these services when your doctor includes them in the plan of care for palliative care (for comfort) for your terminal illness and related condition(s):

• Doctor services
• Nursing care
• Medical equipment (like wheelchairs or walkers)
• Medical supplies (like bandages and catheters)
• Drugs for symptom control or pain relief (may need to pay a small copayment)
• Hospice aide and homemaker services
• Physical and occupational therapy
• Speech-language pathology services
• Social work services
• Dietary counseling
• Grief and loss counseling for you and your family
• Short-term inpatient care (for pain and symptom management)
• Short term respite care (may need to pay a small copayment)
• Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team

When you choose hospice care, you've decided that you no longer want care to cure your terminal illness and/or your doctor has determined that efforts to cure your illness aren't working.
Medicare won’t cover any of these once you choose hospice care:

• Treatment intended to cure your terminal illness. Talk with your doctor if you're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
• Prescription drugs to cure your illness (rather than for symptom control or pain relief).
• Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.
• Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
• Care in an emergency room, inpatient facility care, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness.

Contact your hospice team before you get any of these services or you might have to pay the entire cost.
Who's eligible?

People with Medicare who meet all of these conditions are covered:

• You're eligible for Medicare Part A (Hospital Insurance).
• Your doctor certifies that you're terminally ill and are expected to have 6 months or less to live.*
• You accept palliative care (for comfort) instead of care to cure your illness.
• You sign a statement choosing hospice care instead of routine Medicare-covered benefits for your terminal illness.

*In a Medicare-approved hospice, nurse practitioners aren't permitted to certify the patient's terminal illness, but after a doctor certifies the illness, the nurse practitioner can serve in place of an attending doctor. You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies every 6 months that you continue to be terminally ill.
Your costs in Original Medicare

• $0 for hospice care.
• You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home.
• You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
• Medicare doesn't cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

 

[Nikki J]

Thanks for the link

 

[Annie's Phil]

Below is the url that I cut and pasted from. Add www. in front of it and paste into your browser address bar. (Hopefully, this will avoid this post going to moderation.)

medicare.gov/coverage/hospice-and-respite-care.html

 

[Annie's Phil]

OK, it went to moderation anyway. So here's the hyperlink.

http://www.medicare.gov/coverage/hospice-and-respite-care.html

 

[vlcare]

My husband entered hospice care about two weeks ago. At the time he was using the Trilogy 100 and cough assist (paid for by Medicare).

His equipment costs are covered by hospice. We were allowed to keep the equipment we had been using for the last two years because to eliminate them would have caused pain and suffering. Hospice provides all daily drugs related to pain control. In addition, we have Medicare D coverage for drugs. We can obtain Riluzole and cardiac drugs through our drug plan.

Hospice is concerned with comfort of the patient and freedom from pain. Therefore, when my husband developed a urinary tract infection at his catheter site recently, a nurse provided treatment and hospice provided an antibiotic drug to eliminate the infection. Over time, they will provide whatever medications are necessary for palliative care.

Our hospice group provides a health care aide, who twice a week does bathing and hair washing.

Other than the above, we are basically on our own. I presently pay for a home health care aide to come in 4 hours a day to assist with turning (to prevent bed sores), feeding, toileting care and sitting (to allow me grocery shop, etc.). Eventually I will need more assistance.

Hospice is not for everyone. It is for end-of-life care. It is not open-ended. But if your doctor believes life will likely end in a 6 month period, then it is best to enter hospice. Where else would you have an immediate voice on the phone or a nurse at your side in during a frantic episode?

One way or another, Medicare will provide for allowable services--hospice or regular. It really never takes away anything.

vl

 

[Barbie]

VL, so sorry to hear that your husband has progressed. I remember you saying that he would not use hospice until it was near the end--so I know it is serious for you guys.

All my best,

B

 

[vlcare]

Barbie: Phil recently had severe abdominal pains and we went to the emergency room. We discovered what we did not expect: Phil, who had been in remission with non-hodgkins lymphoma for almost a decade, had developed a new lymphoma--an aggressive, transformative type (in his back near his spine). Because of the ALS, treatment by chemo, surgery or radiation was out of the question.

Unfortunately, because of the location of the malignancy, I can no longer transfer him to his power chair. He is essentially bedbound. We are taking it one day at a time. We spend a lot of time together. We are grateful for hospice care.

Regards,
Vicki

 

[zoohouse]

Vicki, I am so sorry. My brother died of lymphoma, but he remained quite comfortable right to the end. I hope that you are getting some rest, and that your husband is getting some relief. I will add you to my prayers.

Paulette

 

[lgelb]

It's a good point to remember, that Part D, not hospice, covers outpatient drugs such as riluzole (which is not intended as or taken as a "cure"). You can keep getting reimbursed for it. Even those in Med Advantage plans or Medigap plans have original Medicare as the payor for hospice; the hospice benefit is only administered by Medicare. That is why I mentioned Medicare's demo project in an earlier post.