In a letter to Representative William Thomas (R-CA), Chairman of the Ways and Means Subcommittee on Health, Schakowsky urged the chairman to change current hospice payment rates "as an interim solution so that the dying can be treated with dignity and receive the quality of care they deserve."  She specifically called on the chairman to "consider elimination of the market basket reduction for hospice providers and the restoration of the full Medicare update for fiscal years 2000 to 2002."

Schakowsky expressed particular concerns that at current rates, hospice providers are not reimbursed adequately for prescription drugs. As a result, many terminally ill patients are at risk of not receiving proper pain relief medication and hospice providers are forced to use less effective pain management procedures.

"This is an issue of great personal concern.  My family and I have had personal experience with palliative care and can speak for the tremendous value of the hospice benefit.  My father, who lived with me, died comfortably and peacefully at home, thanks to Palliative Care Center of the North Shore. In addition to medical care, hospice provided my father and our entire family with the comfort, the dignity, the support and the respect that we needed," Schakowsky said.

A copy of the letter to Chairman Thomas is attached.
 
 

October 20, 1999
 

The Honorable William M. Thomas
Chairman, Subcommittee on Health
Committee on Ways and Means
1136 Longworth HOB
Washington, D.C.  20515

Dear Chairman Thomas:

As you review possible changes to the Balanced Budget Act of 1997, I hope that you will consider elimination of the market basket reduction for hospice providers and the restoration of the full Medicare update for fiscal years 2000 to 2002.  This important change would provide critical short-term relief for hospice providers who are finding it increasingly difficult to care for the terminally ill who rely on their services.

As you know, the hospice per diem rate covers all costs related to terminal illness, including physicians' oversight services, counseling, prescription drugs, and home health aides.  Unfortunately, the hospice rate has not kept pace with inflation and new technologies that have improved pain management capabilities.  The market basket reduction required under the BBA worsens the situation.  I am particularly concerned that the per diem rate does not provide adequate reimbursement for prescription drugs.  In 1982, when the hospice benefit began, drug costs compromised $1.06 of the average $41.46 per diem home care rate.  In 1998, the inflation-adjusted rate for 95% of all Medicare hospice patients was $97.11, with $2.48 allocated to prescription drugs.  However, average drug costs per patient day are actually $12 to $14 a day.  Treatments such as Duragesic, a pain relief medication for cancer patients, costs $36 per dose.  Zofran, an effective anti-nausea drug, costs $100 a day.

These higher costs are coming at a time when the hospice population is demonstrating a greater need for complex and more expensive care.  Patients are being admitted to hospice programs later in their illnesses, resulting in a higher utilization of more intensive services.  Without adequate reimbursement, hospice providers will face enormous difficulties in providing quality care for the terminally ill.  Access to care, especially for those with the most severe and costly needs, will be jeopardized.

Hospice care is a compassionate and cost-effective approach to caring for the terminally ill and their families.  My family and I have had personal experience with palliative care and can speak for the tremendous value of the hospice benefit.  I want to thank you for considering this change in hospice payment rates as an interim solution so that the dying can be treated with dignity and receive the quality care that they deserve.

Thank you again for your efforts on behalf of Medicare beneficiaries and for your consideration of this issue.

      Sincerely,

      Jan Schakowsky
      Member of Congress