The Continuing Evolution of Medicare Hospice Policy

Authors

  • Chester A. Robinson,

    Corresponding author
    1. Tennessee State University
      Chester A. Robinson is an assistant professor of public policy in the Institute of Government at Tennessee State University. In 2005, he retired from the Centers for Medicare and Medicaid Services, where he held a variety of positions in legislation, regulatory policy, long-term care research, and Medicare program operations. His other research interests include the role of the bureaucracy in the legislative process, home medical equipment for the elderly and disabled, and health care reform.
      E-mail:olhc@hotmail.com.
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  • Thomas Hoyer,

    Corresponding author
    1. Centers for Medicare and Medicaid
      Thomas Hoyer held policy-making positions with the Centers for Medicare and Medicaid Services and its predecessor organizations from 1972 until his retirement in 2002. In 1982, he assumed leadership for the implementation of the Medicare hospice benefit and was responsible for the regulations that govern the benefit. His interest in hospice has continued through the years, and he maintained responsibility for hospice benefit policy in each of his successive positions until his retirement.
      E-mail:tomhoyer@aol.com.
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  • Carol Blackford

    Corresponding author
    1. Centers for Medicare and Medicaid
      Carol Blackford is the manager of the division of the Centers for Medicare and Medicaid Services that is responsible for determining policy and payment for the Medicare hospice program.
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Chester A. Robinson is an assistant professor of public policy in the Institute of Government at Tennessee State University. In 2005, he retired from the Centers for Medicare and Medicaid Services, where he held a variety of positions in legislation, regulatory policy, long-term care research, and Medicare program operations. His other research interests include the role of the bureaucracy in the legislative process, home medical equipment for the elderly and disabled, and health care reform.
E-mail:olhc@hotmail.com.

Thomas Hoyer held policy-making positions with the Centers for Medicare and Medicaid Services and its predecessor organizations from 1972 until his retirement in 2002. In 1982, he assumed leadership for the implementation of the Medicare hospice benefit and was responsible for the regulations that govern the benefit. His interest in hospice has continued through the years, and he maintained responsibility for hospice benefit policy in each of his successive positions until his retirement.
E-mail:tomhoyer@aol.com.

Carol Blackford is the manager of the division of the Centers for Medicare and Medicaid Services that is responsible for determining policy and payment for the Medicare hospice program.

Abstract

This case study traces the creation and evolution of Medicare hospice policy. The Medicare hospice benefit, created in 1982, emphasizes palliative rather than curative care. It focuses on quality of life for the dying patient and family and encompasses medical, psychological, and spiritual care. Because no standard hospice care practices existed before this benefit was implemented, Medicare rules almost exclusively dictated the structure and delivery of services. Despite initial concerns about low use, spending averaged 17 percent per year between 1991 and 2001, largely driven by increased enrollment, covered days, services provided, and inflation. A rich accumulation of research studies and analyses of specific aspects of the hospice program provides an opportunity for a retrospective analysis of the program’s genesis, impact on health care delivery, and implications for future policy decisions.

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