Medicare to Test Paying Separately for Hospice Blood Transfusions: What It Means for End-of-Life Care Access

If you’ve ever had a family member in hospice care, you know that Medicare pays the hospice provider a single daily rate (the per diem) to cover everything, from nursing care to most medications and supplies. This system works well for routine care, but it hits a snag when non-routine, expensive services—like a blood transfusion—are needed.

The Improving Access to Transfusion Care for Hospice Patients Act of 2025 is designed to fix that snag. It mandates that the Center for Medicare and Medicaid Innovation (CMI) start testing a new payment model within one year. This test will separate the cost of blood transfusions from that all-inclusive daily rate. If a hospice patient needs a transfusion, Medicare will pay for it separately, using the exact same rate they would pay if the patient wasn’t in hospice. Essentially, the hospice provider won't have to eat that cost anymore.

The Real-World Cost of Bundled Care

For a patient, a blood transfusion can be vital for comfort and quality of life, even in the final stages of an illness. However, when the cost of a transfusion is bundled into a fixed daily rate, it creates a financial disincentive for the hospice provider to offer it. If the transfusion costs more than the daily rate, the provider loses money. This bill aims to remove that financial barrier, potentially opening up access to necessary care that was previously being rationed or denied simply because of the payment structure.

The Catch: Evaluation Metrics and Utilization

While this change sounds like a clear win for patient access, the bill includes some interesting fine print about how the CMI must evaluate the test. When CMI checks to see if this separate payment model is working, they have to look at several key utilization metrics—and this is where things get complicated.

The CMI must compare patients in the test group against a control group, specifically tracking things like: how often patients used the emergency room, how many days they spent in the Intensive Care Unit (ICU), and how much chemotherapy they received in their final days. The goal is likely to ensure that paying separately for transfusions doesn't lead to over-utilization or inappropriate, costly interventions right at the end of life.

The Double-Edged Sword of Data

For regular folks, this means the test is a bit of a double-edged sword. On one hand, your loved one might finally get the transfusion they need for comfort. On the other hand, the intense focus on utilization metrics—like ER visits and ICU days—could create a new kind of pressure. If a hospice provider knows that their utilization numbers are being scrutinized, they might hesitate to approve a necessary transfusion if they think it could lead to a hospital visit, even if the transfusion is medically appropriate.

This bill is a major step toward recognizing that end-of-life care isn't always predictable and that expensive, necessary interventions shouldn't be penalized by a fixed payment system. However, the success of this test hinges entirely on how the CMI balances the need for increased patient access against the risk of driving up unnecessary costs and hospital use.