Published: March 16, 2008 12:34 am            

Explaining a growing problem

My name is Julie and I am employed locally by Hospice Care Group. I don’t know how aware the public is about the growing concerns with CAP calculations, but I would like to explain. Medicare has set a limit (CAP) on what they will pay on any Medicare beneficiary for hospice services. Roughly the CAP covers six months of service for an individual. After that six months anything you bill on that individual you pay back at the end of the year. This is money that the hospice agency has already spent on medications, supplies, equipment, and staff to provide quality care for that patient. The money is not available to give back. Hospice guidelines are very clear on who qualifies for our services. A life expectancy of six months or less is a main factor. CAP’s would not be an issue if every patient lived exactly six months or less. However, no doctor can put an exact time frame on a life that is not in their hands. God is the only one that knows the exact amount of time a person has to live on this earth.

A common misconception with hospice is that Medicare has put a limit on the amount of time a patient can spend on hospice. However this is not true. Medicare has no limit on the amount of time a patient can have hospice services. Medicare has only limited the amount of time a hospice can be reimbursed for services. This has caused some hospices to discontinue care after the six month cap is used. If a patient lives longer than six months it does not mean that they no longer qualify and as long as they do still qualify for hospice we will continue to take care of them. This does create a financial burden on our agency as well as many others. Recently there was legislation introduced in both the House and Senate that if passed will help to ensure that qualifying patients continue to have access to hospice services. The Preserving Access to Hospice (PATH) Act is supported by all of Mississippi Legislators. A huge thank you should be given to these Senators and Congressmen for their support in making hospice care available for many years to come.



Julie Godwin

Assistant Administrator

Hospice Care Group

Meridian

        

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