{'fraction_non_alphanumeric': 0.02453271028037383, 'fraction_numerical': 0.009929906542056074, 'mean_word_length': 5.161870503597123, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Fighting an unexpected threat to hospice care: Medicare fraud and abuse.

When Medicare first started covering hospice care in 1983, the value of end-of-life care for patients, families, and Medicare itself seemed beyond dispute. Who could argue against the simple premise that patients in the final stages of a life-limiting illness would benefit more from the palliative care, pain management, and multiple support services offered through hospice care than from curative treatment that had outlasted any hope of success? As much for the compassion hospice represented, policy makers embraced it for another reason—it could save Medicare from the high costs of lengthy hospital stays and futile treatment regimens. Much of the early promise of hospice care has been largely fulfilled in today’s delivery system. By 2008, over 1 million beneficiaries elected hospice services. Of all Medicare beneficiaries who died that year, fully 40% used hospice, up from only 23% 8 years earlier (MedPAC, p. 145). Broader public acceptance of hospice, increased physician awareness and support for it, and wider availability have all worked to improve access to and use of this important benefit. Yet, the future of hospice faces an emerging threat to its integrity, value, and quality— rapid growth in the number of agencies that, based on reported practices and behaviors, seem to be more interested in maximizing margins than providing high-quality hospice and palliative care. Suspicions about the motives of many relative newcomers are driving increased scrutiny and possible payment reform that, if implemented hastily or carelessly, could end up undermining decades of work by the architects of the hospice movement.