Each year, Congress goes through its annual budget process to determine how to spend more than $6 trillion on America’s priorities. This year, as part of the discussions on how to spend Medicare’s $900 billion budget, we are being told the Medicare Trust Fund, which is projected to spend $415 billion in 2023 for Part A expenditures, which cover inpatient hospital, skilled nursing facility, nursing home, home health, and hospice care, risks going bankrupt by 2031 unless policymakers act quickly.
Policy and budget debates often revolve around cutting services to save money, raising taxes to pay for services, or a combination of both. When it comes to protecting Medicare, recent research points to an opportunity to reduce costs by giving Americans a service they increasingly want. Researchers from NORC at the University of Chicago recently released a new study showing that the total cost of care to Medicare for beneficiaries who used hospice was 3.1 percent lower in the last year of life than it would have been had they not received hospice care. In 2019, the last year data was not impacted by the pandemic, the savings totaled $3.5 billion. The NORC research found hospice is associated with lower Medicare end-of-life expenditures when hospice lengths of stay are longer than ten days, and even hospice stays of six months or more result in savings for Medicare. Yet, inexplicably, Congress’ Medicare think tank, the Medicare Payment Advisory Commission (MedPAC), has proposed reducing payments to hospices.
MedPAC’s proposals to cut investment in hospice care seem to butt up against their own data, which show consistently more Americans choosing hospice over the course of 20 years. Even with that growth, only 47 percent percent of Medicare decedents in 2021 were enrolled in hospice and the median stay was only 17 days. Put another way, the savings hospice helps achieve are lower than they would otherwise be, since so many beneficiaries and their families chose not to utilize hospice’s services, or they chose to do so very late in a person’s end-of-life journey.
Although encouraging greater use of hospice would yield greater financial savings, this is not the primary reason we should be working to get more people connected to its services. Rather, the most important reason to encourage greater uptake of hospice is that, as the NORC study (and many others) makes clear, hospice provides patients, families, and caregivers increased satisfaction and quality of life, improved pain control, and reduced physical distress, grief, and other emotional pain. Hospice offers beneficiaries and their families the opportunity to determine goals of care that will guide how they proceed through the end of their lives. Doing so allows them to decide where, how, and with whom they can spend their final days.
Six months ago, former President Jimmy Carter announced he was forgoing curative treatment after a series of short hospital stays and instead decided to receive hospice care and spend his time at home with his family. Hospice is allowing President Carter, in collaboration with his family, care team, and closest friends, to spend his remaining time in a way that honors his unique preferences and goals. As President Carter’s experience is demonstrating, hospice is not a one-size-fits-all approach. It means defining how you want to spend your remaining time and working with a team of compassionate professionals to help you achieve that vision. In one recent story, a World War II veteran flew in an open-seat cockpit to celebrate his 100th birthday, putting himself, and not doctors or hospitals, firmly in control of his life.
Yes, hospice saves Medicare money, and broader use of it would save even more, but that is not the core reason we need policymakers to protect this vital program. Hospice should be protected and encouraged because it gives individuals who are facing serious illness end-of-life peace during one of the most difficult periods they and their loved ones will ever face. Very few, if any, other parts of our health care system are set up to focus so intently on lifting up and honoring patients’ humanity in the face of illness. Congress wisely chose to make hospice a Medicare benefit 40 years ago. Today, utilization is increasing, and savings are accruing, but more importantly, individuals and families have been given a chance to control their end-of-life journey. As Congress weighs the future of the Medicare program, it should recognize the financial and quality-of-life value hospice provides patients, families, and payers, and support policies that ensure the program’s strength and sustainability for future generations.
Theresa Forster and Logan Hoover are hospice policy executives.
