AEGiS-11IAC: HIV and hospice reimbursement.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

HIV and hospice reimbursement.

Int Conf AIDS 1996 Jul 7-12; 11:18 (abstract no. We.B.171)
Reiter GS; Hospice LifeCare and River Valley HIV Clinic of Holyoke, Holyoke, MA, USA. Fax: (413) 534-6465.

ISSUES: Effective and compassionate hospice care for persons dying from AIDS requires a combination of traditional palliative and restorative treatments. Current hospice reimbursement is based primarily on the needs of patients with cancer; funds are sufficient for analgesics, nursing visits and durable medical goods. Because palliation of AIDS requires more costly therapies, hospice funding is often inadequate for persons dying from AIDS.

PROJECT: We reviewed the unique palliative care needs of patients with HIV, criteria that providers can use to create palliative care plans, ways that communities are currently providing end-of-life care, the impact on patients and families of changes in care givers at the end of life, and possible means to increase access by patients in hospice to costly yet effective palliative treatments.

RESULTS: We found that patients with HIV have unique needs at the end-of-life, palliation of many opportunistic infections (Ols) and cancers is best achieved through aggressive treatment with the same drugs used earlier in the disease. Providers and patients can base end-of-life care on rational criteria. Typical reimbursement for hospice care is fixed at $525-700 (US)/week. Appropriate terminal care of a patient with HIV, CMV, and other common conditions costs in excess of $500 (US)/week for medications alone. With hospice funds inadequate, providers either avoid hospice referrals until the final days of life, or hospices absorb costs that exceed their reimbursements. Patients and families who are not referred to hospice do not receive timely and appropriate hospice based counseling or social services. Possible means to increase access to high cost treatments for hospice patients include: nationally recognized "outlier therapies" which would be reimbursed by private and public insurers outside the usual reimbursement mechanism, negotiating direct "hospice discounts" for certain medications with drug companies, and development of affordable secondary insurance for hospices.

LESSONS LEARNED: Communities often provide effective end-of-life care to patients with HIV, but with a loss of continuity, and exclusion of HIV patients from the full range of grief counseling and social services available through hospice. The impact on patients and families of breaks in continuity of care during the patient's last days are substantial. More work is needed to increase access of patients with HIV to hospice and the best end-of-life care.

Keywords: AEGIS, Hospices, Hospice Care, Palliative Care, Terminal Care, Acquired Immunodeficiency Syndrome, Health Services Accessibility, Health Services Needs and Demand, Reimbursement Mechanisms, Referral and Consultation, Neoplasms, Death, Family, HIV Infections, Analgesics, United States, Human, economics, ICA11

960707
WeB171