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Having worked for two hospice agencies as an intake nurse, one for-profit and another NFP, I've witnessed the different attitudes toward patient selection. I found the FP wanted to admit as many patients as possible with preference for those with a potential long stay and really shied away from the ones that were very close to death. It's this type of business practice that makes the cap seem necessary.

However, if Medicare loosed up on the strict admission guidelines, extending hospice to those with a life expectancy of 1 year or less, everyone would benefit. More patients would have access to expert palliative care, Medicare would save money (studies show that hospice care saves our government a lot of money) and hospices wouldn't get stuck having to pay back so much money for services already rendered. While large FP hospices are usually able to pay back cap amts, smaller and NFP hospices can really be hit hard by large repayments.

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