Letters to Editor Address New York Times Hospice Article

The New York Times on Monday published several letters to the editor that address a Nov. 27 article about how the increase in hospice patients who live longer than expected has prompted CMS to demand hundreds of millions of dollars in repayments from facilities that exceed Medicare reimbursement limits. Summaries of the letters appear below.

• Joshua Hauser: Life and death "frequently don't follow an agreed-upon timeline," and "we should find a way to provide excellent care whether it comes one day before death or 500 days before death," Hauser, a physician from the Palliative Care and Home Hospice program at Northwestern University, writes in a Times letter to the editor. Hauser writes, "Even as we refine our ability to prognosticate, it will never allow us to give a patient the unwelcome news that 'you have six months to live' with anything that approaches certainty." According to Hauser, although Medicare "does not require such certainty, it may be interpreted that way by patients, families and even health care providers." He concludes, "This does not mean we should ignore prognostic information," but "it should be one of many factors we consider as we work to ease the burden that serious illnesses place on patients and their families" (Hauser, New York Times, 12/3).
  
  
• Elizabeth Nilson: The article "nicely captures the dilemma of hospice care providers trapped between their ethical obligations to care for dying patients and the economic reality of financial penalties" imposed by CMS, Nilson, an assistant professor of public health and medicine in the Division of Medical Ethics at Weill Cornell Medical College, writes in a Times letter to the editor. She writes, "When the pecuniary disincentives are serious enough," health care providers can find themselves in "an untenable situation, caught between competing goods, patient care and financial viability." Nilson concludes, "The use of economic tools to direct health care decisions ... should ensure that the financial incentives are aligned with moral obligations" to ensure that "physicians caring for the most vulnerable at life's end can maintain a fiduciary relationship with their patients" (Nilson, New York Times, 12/3).
  
  
• J. Donald Schumacher: "There is no simple solution" to the issue of Medicare reimbursement limits for hospice care, "one of the most complex regulatory issues confronting the hospice community," Schumacher, president and CEO of the National Hospice and Palliative Care Organization, writes in a Times letter to the editor. Schumacher writes that the organization has "long argued that hospice programs doing the right thing by caring for eligible patients and families should not be financially penalized through the cap" and has "proposed a thorough study of the hospice cap that would help providers, regulators and legislators understand what is working, what is not and what the implications for alterations to this admittedly flawed mechanism would be." He writes, "There is one very simple point that must be emphasized: No person in need of hospice care should encounter unnecessary barriers to quality care at the end of life" (Schumacher, New York Times, 12/3).