U.S. rules require clearance for long hospice stays

New government rules -- enforcement kicked in last month -- require hospices to send doctors or nurse practitioners for face-to-face visits with Medicare patients who have been on hospice more than six months to certify that the patients are really sick enough to need the program. The new rules came in response to lengthening hospice stays as services expanded beyond cancer patients to those with slower-moving and less predictable illnesses like heart failure, Alzheimer's, and chronic obstructive pulmonary disease. Government spending on hospice grew from $2.9 billion in 2000 to $10 billion in 2007, according to a 2009 report from MedPac, the Medicare Payment Advisory Commission that recommended the tougher stance on long stays. During those years, the number of hospice providers rose from 2,300 to 3,200, with most of the growth in for-profits.