Medicare rules restrict good care for dying patients

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Study suggests ways to revise payment system for end-of-life care

Many health care providers believe that Medicare regulations block them from providing good care to dying patients. Researchers from Harvard Medical School, the Harvard School of Public Health, and RAND discovered that fact by conducting systematic interviews of health care providers. The providers were asked about fee-for-service Medicare coverage and payments for end-of-life care. Patients who depend on a ventilator to breathe or have end-stage liver disease are sometimes denied access to local nursing homes, said one public hospital discharge planner. According to some of those interviewed, patients needing particularly high-cost ancillary services, including medications and lab tests, also experience problems gaining access to nursing homes. The research identified specific barriers to care and suggested remedies that would not necessarily add costs to the system. The researchers recommend a policy for increasing reimbursement in cases that require especially high-cost services. Since this revision might not be sufficient, they also recommend a study on the need for revising hospice rates.