Medicare Reimbursement for Hospice Care

To the Editor: In an effort to attack the regulations with what appears to be a modest familiarity with the types of patients who dominate admissions to hospices, Drs. Brody and Lynn exaggerate, perhaps for effect, the problems connected with prognostication of survival.¹ Unfortunately, the “average” clinical course for many patients with untreatable and advanced cancers is relatively predictable in the last months of life. Even good supportive care does not often alter the relentless course of the disease. Because approximately 90 percent of the patients admitted to hospices fall into this category, some understanding of the natural history.