Medicare hospice referral criteria for patients with amyotrophic lateral sclerosis: a need for improvement

We conducted a retrospective review of 97 consecutive patients with amyotrophic lateral sclerosis (ALS) who were accepted into hospice care from a tertiary ALS center. Five patients met Medicare criteria at time of hospice enrollment. The mean number of hospice days was 85 (range, 1-534). All but 2 patients met hospice criteria proposed by the Columbia University ALS group. The present Medicare hospice criteria should be changed to reflect the reality of patients dying of ALS.