Medicare spells out rights of hospice patients

NEW YORK (Reuters Health) - Terminally ill Medicare beneficiaries have the right to decide how they receive end-of-life care, according to new regulations from the Centers for Medicare & Medicaid Services (CMS).

The goal of hospice care is to make terminally ill patients comfortable at the end of life, offering treatment for pain and other physical and psychological symptoms but not "curative" treatment. Currently, according to CMS, there are nearly one million Medicare beneficiaries receiving care from over 3,000 Medicare-approved hospices nationwide.

In the first overhaul of regulations governing hospice providers since 1983, the new Medicare Conditions of Participation (CoP) include explicit language on Medicare hospice patients' rights and a detailed list of those rights that did not exist under the previous regulations.

Specifically, the new regulations state that patients who choose hospice care over curative treatment are entitled to participate in their treatment plan, to refuse treatment, to choose his or her own doctor, and have the right to receive effective pain control.

"As more patients and their families come to understand and select hospice care, we felt it was critical to outline what rights patients have to control the care they receive in their final days," Kerry Weems, acting administrator of CMS, said in a written statement.

"End-of-life care has changed markedly in the past 25 years," she added, "and it is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights."

In addition to the new patient rights' section, the new regulations also require that patients' needs be initially assessed within 2 days of electing the hospice benefit and that a comprehensive assessment occur within 5 days, and that updated assessments be done at least every 15 days thereafter.

There is also a requirement that each patient receive a full drug profile that examines issues ranging from the effectiveness of current drug therapies to potential drug interactions to drug side effects. To facilitate this, the regulation calls for a treatment team to consult with a pharmacist or other qualified individual to make sure that drugs meet the needs of every hospice patient.