Do Medicare Rules Impede Good Care?
Medicare spends more than a quarter of its annual budget on care for those in their last year of life and covers more than 80 percent of decedents.1 Studies have documented poor quality of care, gaps in care, and patient and family dissatisfaction with care received by dying patients.2 Nineteen percent of Medicare decedents, nearly 360,000 beneficiaries, used the Medicare hospice benefit in 1998.3 In recent years we have heard providers report anecdotes about cases in which Medicare coverage and reimbursement rules may have impeded the delivery of high-quality end-of-life care to terminally ill Medicare beneficiaries. Among these anecdotes are that (1) skilled nursing facilities (SNFs) are transferring dying patients to hospitals in part so that the SNF does not incur the costs of the intensive treatments that the patients might need; (2) hospitals are discharging dying patients in response to diagnosis-related group (DRG) payment incentives; (3) patients are being dissuaded from elect
