Recently, we sat down with our Chief Financial Officer, Jim Dale, to talk about paying for hospice. With over 25 years of financial experience, Jim brings a level of knowledge that can be utilized by all of our patients, families, and referral sources when discussing hospice care. 

Transitions Chief Financial Officer, Jim Dale

Tips from Jim: How to ensure your patients are financially informed

  1. Keep staff members informed about the Hospice benefit and services offered by care providers
  2. Schedule continued education and training from Transitions to support the entire IDT knowledge of hospice care and the coverage of services under various insurance plans
  3. Provide Information to patients and families regarding Medicare Hospice Benefits. Download the CMS informational booklet here
  4. Contact Transitions to speak with our experts about the hospice benefit or any question related to hospice care and insurance coverage

Here is what he had to say about hospice payments for now, and for the future: 

What do you see as the biggest financial misconception of hospice care? 

When patients and their families initially consider hospice care, the first question they ask, along with “what is hospice?” is almost always “how do I pay for it?” That is because a vast majority of people don’t know that hospice care comes at zero out of pocket cost for those patients under the Medicare benefit, as long as eligibility requirements are met. This means that all care services, including nursing, bereavement, medications, equipment and supplies are provided for the patient throughout their entire hospice journey – at no out of pocket cost to the patient, since there is no deductible or copay for hospice care under the traditional Medicare benefit.

How can we work to change these misconceptions and ultimately reach more patients who are in need of hospice care? 

It really is a constant effort of communicating with and educating patients and their families. As a healthcare professional and a referral source, it is important to make every effort to ensure that patients and their families know about this benefit. At Transitions, we often offer training programs to facility staff and patients that give a detailed description of hospice care and how to pay for it. To me, the more knowledge and awareness that is spread, the more patients will be willing to utilize end-of-life care services. Many times, this responsibility falls on referral sources and so it is vitally important that they’re educated on not just hospice care, but how the service is paid for.  This is where Transitions Hospice can help immeasurably.

What does the future of hospice insurance coverage look like to you? What do you see as the most important aspect to keep an eye on as we move into 2021? 

Medicare Advantage plans are becoming very popular, as these plans can sometimes offer additional benefits compared to traditional coverage for Medicare beneficiaries. We expect that Medicare will allow the Medicare Advantage plans to cover and pay the hospice benefit, rather than traditional Medicare coverage, just as it has done for other healthcare services.  Regardless of the type of coverage a patient has, whether traditional Medicare, a Medicare Advantage plan, or other commercial insurance, patients will always receive the highest quality, comprehensive care from Transitions Hospice. 

However, unlike traditional Medicare, these Medicare Advantage plans may require patients to incur out of pocket cost in the form of deductible or copay when electing hospice care, similar to commercial insurance plans. Essentially, while the Advantage plan may offer more extensive coverage, it could also mean an out of pocket cost for hospice care. 

I encourage patients and families to work with Transitions Hospice to make sure they are aware of the personal financial responsibilities that a patient might have, if any, under their current health insurance plan, including Medicare Advantage plans.

What should families do if they are concerned about their ability to pay? 

If families are concerned about their ability to pay, they can always contact a representative from Transitions. We are here to help and ensure that in the end, for both families and patients, they have full access to continued education and awareness of the options that are available. 

At Transitions, we care for patients no matter what insurance plan they use, and are always willing to work with patients who are worried about paying for hospice, even those without healthcare coverage. We care for all patients who need our help – and we will always prioritize our patients’ comfort and happiness over their ability to pay. 

A recent study completed by Trella Health supports how partnering with the right hospices and referring appropriate patients sooner can reduce end-of-life costs while also improving the patient and family experience. Key findings include:

  • Patients who did not receive hospice consumed $27,455 more in healthcare costs during the last three months of life.
  • Length of stay was strongly correlated with end-of-life spend.
  • Patients who were referred to hospice early saved an average of $14,000 in the last three months of life compared to patients who were admitted for a mid-term stay.
  • Costs for late-term hospice patients were on average $5,182 less than patients with no hospice care.
  • With only 7% of hospice-eligible patients referred for early hospice care, there is a significant opportunity for many providers to positively impact patients’ end-of-life care.

If you have any questions about paying for hospice, or would like to read more about Transitions in relation to hospice finance, click here.