A few important details on hospice care

In response to the front page story in The Gazette (“The cost of dying,” Nov. 14) on Medicare and hospice, the article raised some important questions and issues that should be clarified.

Payment for health care at the end of life is a critical conversation for our country. The article correctly stated that more than 40 percent of patients who die in the U.S. now use hospice services. The cost of hospice care - $11.4 billion in 2008 - may seem high indeed until placed in context. The total budget for Medicare is about $400 billion, and 27 percent to 30 percent of that amount is spent on hospital care in the last year of life. That means we spend 10 times as much money taking care of people in the hospital during their last year as we do on hospice services.

The Nov. 14 article also pointed out that there is a difference between for-profit and not-for-profit hospices. Without drawing a conclusion that one is better or worse, it's important for hospices to be transparent about this point. We work as medical directors for not-for-profit hospices in our community, serving all who seek end-of-life care, regardless of ability to pay. All hospices are required to go through a rigorous process of documentation for regular recertification of patients, in order to avoid (and sometimes discover) fraud, such as the Florida situation demonstrated.

Dr. James Bell, Medical Director, St. Luke's Hospice and Palliative Care

Dr. Ken Cearlock, Medical Director, Mercy Hospice and Palliative Care