Opinion | Dying With Dignity: A Look at the Advantages of the Medicare Hospice Benefit

Amid talks to raise the U.S. debt ceiling, reducing federal spending is squarely on the table. While much focus is on discretionary funding and other policies, potential Medicare cuts never seem far from the discussion — whether creeping into the debt limit debate or down the road. Now more than ever, policymakers should be aware of Medicare program benefits that save taxpayer dollars, while also enhancing care for some of the most vulnerable among us.

Based on recent research conducted by NORC at the University of Chicago, we know that hospice serves the taxpayer by increasing value and reducing costs, which contributed to $3.5 billion in savings to Medicare in 2019. The study also highlights the potential to significantly expand savings through earlier access to hospice services.

The Medicare hospice benefit provides end-of-life care and support to millions of seriously ill Americans and their families every year. For more than 40 years, hospice providers have helped ensure that patients receive quality end-of-life care in accordance with their wishes, which often includes remaining in their homes surrounded by loved ones. It covers a range of services including pain and symptom management, medical equipment and supplies, counseling, and respite care for family caregivers.

Authorized in 1982, the Medicare hospice benefit is an example of a government program that works for everyone. It compassionately supports the patient receiving the care services as well as their family members who often become their primary caregivers. Hospice improves the healthcare system by supporting care transitions through reducing ambulance (EMS) trips, emergency room visits and hospital readmissions, as well as unwanted, costly treatments that no longer align with a patient’s goals of care.

Hospice care saves money by providing the right level of care at the right time, which often means limiting the number of stressful and costly hospital visits to manage symptoms and complications when a patient is terminal. An additional conclusion highlighted by the NORC research is that hospice care serves as an immense benefit to patients, families, and caregivers by delivering increased satisfaction and quality of life, improved pain control, reduced physical and emotional distress, and reduced prolonged grief. As leaders of longstanding, mission-driven organizations, these heartwarming testimonials and experiences from patients and their families are what makes being part of this industry such a rewarding experience.

The research also demonstrates that the more patients and families utilize hospice services, the better their outcomes and stronger the cost savings to Medicare. Specifically, the NORC research identified an opportunity to deliver value through greater access to hospice care for patients with chronic diseases such as cancer, respiratory disease, and chronic kidney disease/end stage renal disease, with a projected savings to Medicare of 17%, 20%, and 25%, respectively.

The Medicare hospice benefit is a win for healthcare professionals and for American taxpayers, and must be seen as a proven model of a successful government program.

We often hear families of hospice patients say, “We only wish we had chosen hospice earlier.” It’s a common misconception that hospice care is only available to patients in their final days. Former President Jimmy Carter is an excellent example of someone who sought out hospice care earlier in his advanced disease state so he could spend his remaining time in comfort and surrounded by family. Recent media coverage suggests that many people are surprised he has spent nearly 3 months in hospice care.

It’s unfortunate that 50% of hospice patients receive just 18 days or less of hospice care when they become hospice-eligible — that is, when a physician determines their life expectancy is 6 months or less. Additionally, this median length of stay has remained consistent for many decades, illustrating the need to elevate our country’s understanding of hospice and the impact it can have on their end-of-life journey. More patients and their families could have access to the Medicare hospice benefit, improving their experience and support at the end of life and helping deliver savings by providing compassionate care in the most desirable care setting — wherever they call home.

The conversation about healthcare is generally focused on spiraling costs, and it is difficult to ignore the significant percentage of federal spending allocated to Medicare. However, the Medicare hospice benefit is not part of the problem; it is part of the solution.

Since hospice provides high-quality care and saves money in the long-run, policymakers should support policies that promote access and think about how to find a bridge between a patient’s serious illness diagnosis and a hospice referral. For example, more discussion about and access to advanced-care planning to reflect patients’ wishes would be valuable. More advance planning will help seriously ill Americans understand the choices that lie ahead and establish goal-focused care plans that align to the patient’s desires for their end-of-life journey.

By protecting and expanding access, we have the unique opportunity to do right by patients and their families by supporting their interests and well-being, while simultaneously delivering the cost savings necessary to maintain Medicare solvency.

Nick Westfall, MBA, is president & CEO of VITAS Healthcare, an end-of-life care provider. Jonathan Fleece, JD, is president & CEO of Empath Health, a hospice provider.