Medicare now requires physician essays for hospice care, as if pre-authorizations weren't bad enough

Medicare is considering throwing more bureaucracy our way.

As MedPage Today reports, because Medicare was “concerned about a rising number of hospice patients who survive longer than six months,” they are now requiring physicians to write a narrative to “describe the clinical evidence supporting a life expectancy of six months or less.”

Even worse, this comes on top of a 1.1 percent cut in reimbursements to hospice care in 2010.

I wonder, as Medicare struggles to save money, whether they’ll ramp up the already burdensome pre-authorizations doctors have to get to obtain, for instance, various imaging scans. The penchant of throwing more hoops for doctors to jump through makes me very wary of how the government is going to run any proposed public plan.

Comments

Chuck Brooks
Perhaps this unsuprising growth in bureaucracy is really a new form of cancer, or perhaps something in the water or air or the Potomac Vapors seeping throughout the entire country.
Chuck Brooks
FutureWare SCG
Anonymous
Make it harder to get hospice benefits and you’ll see a lot more people dying in ICUs on ventilators, pressors, and CVVHD.
This is not a measure that will save any money.
And who care if my end stage COPD pt with advanced dementia lives 8 months instead of 6 on hospice? If hospice is able to keep him confortable and out of the hospital, it’s money well spent.
ElderGuru.com
While I can understand the red tape concerns, I wonder how many doctors readily approve hospice on request. Is the 6-month requirement seriously considered by physicians? How often do they say no?
Anonymous
Unintended consequences, they should look up the term. If that happens, I will never set up anyone for hospice. They can just get a bill from acute care.
Charlene
Good grief! Would Medicare rather have patients stay in the hospital for their last days…weeks? Physicians should be doing what they studied to do…practice medicine! Do they now have to hire an essayist to document, in proper English, why a patient needs Hospice? And, I never met anyone that has their expiration date stamped on their behind, so it’s the physician’s best guess as to how long a patient has!
Anonymous
This is such a dumb idea that I am unable to say anything else coherent about it.
Anonymous
Another unspeakably stupid idea brought to you by the Centers for Medicare Services.
Let’s just quash the Part B program rather than make it so administratively unworkable that no one will want to deal with it anyway, the way we are going.
Anonymous
Not to mention that this puts the physician in an untenable conflict of interest. The physician is obligated to represent the interests of the patient, not Medicare’s interest in saving money.
The best solution would be for Medicare to use its own staff to evaluate the need for hospice care, durable medical equipment, etc.
The Happy Hospitalist
that explains why I was asked to write “Patient expected to live less than six month” in my last progress note before discharge from the the hospital to hospice.
Apparently, that was my essay.
Anonymous
CMS provides yet another good reason for preparing advance directives and letting your loved ones know your wishes. What a farce! One almost hopes those responsible for this requirement suffer its consequences.
Anonymous
All the “pity the poor doctor” wailing would be tempered a bit if you had the experience I have had with reviewing cases that are enrolled in hospice when there is no oversight–some of the most ridiculous “terminal” diagnoses listed that you can imagine. Hemorrhoids, psoriasis, you name it. It is a natural result of the government paying that they are going to start doing things to stop themselves from being repeatedly and systematically scammed. To do less is malfeasance. Do more to enforce ethics of honesty and integrity among our colleagues, and encourage the system to be more bold to boot the scammers out of the program, and we will have less red tape burden on the rest of us.
Stuart
Anonymous:
The decision to pay for hospice care is between Medicare and the hospice provider. It is futile and inappropriate to expect the physician, who has no authority over either organization, to provide the needed financial oversight of the transaction. If Medicare is paying for hospice care for hemorrhoid patients, that is a failure of Medicare’s internal oversight procedures.
Anonymous
“……If Medicare is paying for hospice care for hemorrhoid patients, that is a failure of Medicare’s internal oversight procedures……”
Exactly.
That’s like the days when you could set up a mail drop, call yourself a DME vendor, get a bunch of Social Security numbers, bill a bunch of quad canes and manual wheelchairs and stuff that doesn’t grab much attention, get paid what you’re paid, and close the mailbox before Medicare got wise.
This stuff reflects failure of Medicare to do the most basic oversight. Don’t blame the doctors “conspiracy of silence”, blame Medicare lack of oversight and the medical board failure to police some of these basics. In the meantime, they spend money going after docs for failure to get the Urdu translator or figuring out if we’re going after the docs for undertreating pain or giving too many controlled drugs. Flip a coin.
And “pity the poor doctor” wailing……..get a clue pal. There’s a billing code for this, and Medicare actually pays for that essay. So there’s that much more money going out of the system.
Oh, and money like that, payments like that to physicians, doesn’t get counted as “administrative”. Makes the funny math easier when the single-payer advocates make their push for “Medicare for all”.

Medicare now requires physician essays for hospice care, as if pre-authorizations weren’t bad enough

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