HOSPICE: Patients of Uncertain Life Expectancy Lack Care
As the life expectancies of patients with chronic illnesses such as congestive heart failure, chronic obstructive pulmonary disease and end-stage liver disease are "nearly impossible to predict with any accuracy," many of those patients may have been denied Medicare hospice benefits, according to a study in today's Journal of the American Medical Association. Government guidelines require that a doctor and hospice director certify that a patient has no more than six months to live before granting Medicare hospice benefits. Dr. Ellen Fox of the Center to Improve Care of the Dying at George Washington University School of Medicine said, "I believe that it is impossible to predict with a great degree of accuracy exactly when someone is going to die of these diseases." The course of the diseases "tend to be ... erratic" and patients might be sick for days, months or years before dying, unlike cancer, where patients often decline steadily. The study examined 2,607 patients in advanced stages of congestive heart failure, chronic obstructive pulmonary disease and end-stage liver disease to determine whether life expectancies could be predicted by guidelines used for Medicare-hospice eligibility. Applying the guidelines "as liberally as possible," the researchers determined that "42% of the patients who died within six months would have been denied benefits" (AP/Washington Times, 11/3). The researchers note that a "likely implication of this study is that the goal of determining in advance -- with a high degree of accuracy -- ...which individual patients will die within 6 months is unrealistic" (Fox et al, JAMA, 11/3).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.