Predicting death was never a science. It became even harder when hospice began to attract a wider variety of patients. When Medicare rules were drawn up, programs cared almost exclusively for terminal cancer patients. Today, about 20 percent have other fatal conditions like lung and heart disease, AIDS, and Alzheimer's, for which death is harder to predict. These patients often spend longer in a hospice than a traditional cancer patient does.
Some experts contend that federal auditors have it exactly backwards.
Rather than penalizing hospices for helping patients live longer, more money could be saved by getting terminal patients into hospice programs quicker. These late enrollees miss the full effect of hospice, and they likely spend their last months in more-expensive hospitals. The government audits are slowing the growth of hospice programs. Earlier this year, a patient with a brain tumor was discharged after only three weeks when his doctor had second thoughts about certifying that the man had less than six months to live. Since the audits began, the number of long-term hospice patients nationwide has started to decline, after years of steady growth.