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Life Expectancy Unclear for Some

November 2, 1999

CHICAGO (AP) _ The life expectancy of patients with certain chronic illnesses is nearly impossible to predict with any accuracy, and as a result many people may be denied federal hospice benefits they actually deserve, a study found.

Congestive heart failure, chronic obstructive pulmonary disease and end-stage liver disease _ which together account for almost 2 million hospitalizations and 175,000 deaths annually _ all run an unpredictable course, researchers reported in Wednesday’s Journal of the American Medical Association.

Unlike cancer, in which the patient often declines steadily, these diseases tend to be more erratic. Patients may be very sick for days, months or years before something sudden, such as a lung infection or heart attack, kills them.

The problem arises when these patients are considered for Medicare hospice benefits, since the government requires a doctor and a hospice director to certify that the patient has no more than six months to live.

``I believe that it is impossible to predict with a great degree of accuracy exactly when someone is going to die of these diseases,″ said Dr. Ellen Fox of the Center to Improve Care of the Dying at George Washington University School of Medicine and Health Sciences.

Hospices provide dying patients with such things as pain relief, spiritual help and assistance in putting their affairs in order.

Fox and her colleagues studied 2,607 patients in advanced stages of the three illnesses to see if life expectancies could be predicted by guidelines most often used to determine Medicare-hospice eligibility.

The researchers applied the guidelines as liberally as possible, classifying as many patients as they could as having less than six months to live.

Still, 42 percent of the patients who died within six months would have been denied benefits, researchers said.

The study did not explore how many of the patients actually received hospice benefits. Nor did it estimate how many qualified patients might be missing out.

Medicare paid about $2 billion to about 375,000 hospice beneficiaries in fiscal year 1997, the most recent year for which figures are available.

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