When asked to identify radiation as cancer care or palliative care, the answer is often non-binary. So why do Medicare hospice services so often label it as strictly the former? Probably because there is a flat per diem rate of hospice reimbursement whether a patient has friendly dementia or metastatic cancer from stem to sternum. So it’s easy to see why hospice providers are reticent to sign-on for the price of palliative radiation, regardless of how many quality life years could be gained. In fact, those extra QALYs could even mean the patient outlives her maximum annual hospice reimbursement altogether. Sound screwy? That’s the subject of this editorial drawing the logical conclusion that if early hospice enrollment saves the healthcare system time and quality life years, perhaps that system shouldn’t include hospice payment structures that clearly disincentivize enrollment of a sizeable chunk of cancer patients in discomfort.  TBL: Moving to a concurrent care program would likely lower overall costs while ensuring commonsense appropriate cancer palliation. | Perumalswami, JAMA Oncol 2019


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