A history of the Medicare hospice benefit.

Since the inception of the Medicare hospice benefit, hospice has marked a new approach to managed care. Its focus on cost-effectiveness has made it one of Medicare's most successful managed care options. Various restrictions were placed on the hospice program; but, in return for these limitations, advocates of the program received an opportunity to create a program entirely different from other Medicare providers. The challenges of operating a hospice include electing hospice care, candid communication, and the relationship with other providers. These challenges will continue to burden hospices until discussions of death can be direct, clear, and knowledgeable.