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August 1, 2019

The Role of Medicare Reimbursement in Determining Access to Palliative Radiotherapy During Hospice Care

Author Affiliations
  • 1Center for Bioethics and Social Sciences in Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 2Department of Medicine and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
  • 3Center for Bioethics and Social Sciences in Medicine, Institute for Healthcare Policy and Innovation, the Department of Radiation Oncology, University of Michigan, Ann Arbor
JAMA Oncol. Published online August 1, 2019. doi:10.1001/jamaoncol.2019.2308

At the end of life, patients with cancer can continue to require intensive intervention to alleviate symptoms. When enrolled in hospice, however, they may find expensive treatment modalities, even those administered with palliative intent, inaccessible. This is because current reimbursement artificially divides the continuum of disease management into arbitrary phases of care: Medicare parts A, B and D for curative therapy and the Medicare Hospice Benefit for hospice care. The mechanism of reimbursement can disproportionately dictate availability and access to certain types of care. This is problematic because some treatment modalities (eg, diuretics for heart failure) can span both phases, and many palliative therapies have been empirically shown to improve quality of life and lengthen life.1 We use palliative radiotherapy as an example to illustrate some of the unintended consequences of this approach.

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