Hospice Reform and What’s at Stake

In this compelling episode of Who Cares, hosts Elyssa Katz and Dr. Steve Landers dive deep into the state of hospice care in America, examining how the hospice benefit has evolved and why hospice reform is urgently needed. The conversation kicks off with a focus on two crucial SEO terms—hospice benefit and hospice reform—which are discussed within the first few sentences to maximize search visibility.

They begin by framing hospice as a “national treasure” that’s been a vital part of Medicare since 1982, serving more than 1.7 million Americans each year. But while over half of Medicare beneficiaries receive hospice care, the average length of stay remains alarmingly short—just 18 days. This severely limits the full potential of the benefit.

Dr. Landers describes how hospice is often misunderstood as “giving up care,” when in fact it offers a more holistic, comfort-oriented model. The Medicare hospice benefit was designed to deliver personalized, interdisciplinary support—including nurses, social workers, chaplains, physicians, and even volunteers—to patients at the end of life. But outdated policies and funding models are threatening its effectiveness.

Key issues covered include the stagnant reimbursement rates, the problematic per diem payment structure, and the rising cost of labor that hospice providers can’t keep up with. The conversation also tackles Medicare sequestration, CAP limits, and the growing burnout among hospice workers due to financial and policy constraints.

A major reform opportunity discussed is concurrent care, which would allow patients to receive both hospice and curative treatments at the same time—something proven effective in the Medicare Choices Model. They also advocate for telehealth flexibility, extending bereavement support, and adapting care models for special populations like dementia patients, who often fall through eligibility cracks.

The episode takes a hard look at fraud too, noting how bad actors threaten the system’s credibility. But the hosts warn against using a sledgehammer approach, emphasizing that most providers are delivering high-quality care. “Use a scalpel, not a sledgehammer,” becomes a recurring refrain.

By the end, listeners will understand that hospice reform must be careful and constructive. Cutting corners on reimbursement or overburdening providers with audits could do more harm than good. Instead, smart reforms can reduce costs while improving outcomes for both patients and caregivers.
Whether you're a policymaker, healthcare worker, or simply someone who wants to ensure dignity at the end of life, this episode offers a powerful look at what’s working—and what’s not—in American hospice care.

00:00 Future of Hospice Care Debate
06:28 Boosting Hospice Access and Reimbursement
08:58 Hospice Care Access Challenges
11:22 Hospice Care: Financial and Support Challenges
17:22 Reforming Hospice: Timing and Challenges
19:38 Hospice Challenges for Dementia Patients
23:45 Hospice Telehealth and Reform Needs
28:09 Refining Hospice Oversight Challenges
31:47 Optimizing Hospice Without Hurting Care
34:46 "Concurrent Care Key in Hospice Reform"
37:41 Hospice Payment Discussion Challenges