The Medicare hospice benefit, authorized by the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982, marked a significant expansion in the Medicare benefit structure. Initially implemented to provide a more humane and cost-effective alternative to traditional end-of-life care, the program's early experiences offer valuable insights for healthcare practitioners aiming to improve their skills in hospice care.
Understanding the Medicare Hospice Benefit
The Medicare hospice benefit was designed to provide comprehensive palliative care to terminally ill patients. By mid-1987, a significant number of community home health agency-based hospices were Medicare certified. This certification enabled them to offer essential services such as skilled nursing, medical social services, physician services, and counseling.
Key Findings from Early Program Evaluations
- Certification and Participation: The initial uptake of Medicare certification among hospices was slow but steadily increased over time. By 1987, nearly half of all community home health agency-based hospices were certified.
- Beneficiary Participation: The number of beneficiaries electing the hospice benefit increased significantly from 2,000 in 1984 to over 11,000 by 1986.
- Cost Implications: The average reimbursement per patient rose from $1,798 in 1984 to $2,337 in 1986. Despite concerns about cost-effectiveness, early evaluations suggested that the benefit could potentially save costs compared to conventional care.
Implementing Research Outcomes in Practice
Practitioners can leverage these findings to enhance their approach to hospice care:
1. Emphasize Certification and Compliance
The research highlights the importance of certification for providing quality hospice care. Practitioners should strive for compliance with Medicare standards to ensure comprehensive service delivery. This involves maintaining core services and adhering to guidelines for interdisciplinary team management.
2. Enhance Patient-Centered Care
The study underscores the need for personalized care plans developed by interdisciplinary teams. Practitioners should focus on creating tailored plans that address the unique needs of each patient and their families.
3. Address Financial Concerns Proactively
The financial risks associated with hospice care were a primary concern for many providers. Practitioners should work closely with financial advisors and administrators to understand reimbursement structures and manage costs effectively.
4. Encourage Continuous Education and Training
The differences in service provision between certified and non-certified hospices highlight the need for ongoing education. Practitioners should engage in continuous learning opportunities to stay updated on best practices in hospice care.
Encouraging Further Research
The Medicare hospice benefit study provides a foundational understanding of early program experiences. However, ongoing research is crucial for adapting to evolving healthcare landscapes. Practitioners are encouraged to participate in or support further studies that explore innovative approaches to hospice care delivery.
