Two, there's actually a cap in terms of the average amount of dollars spent per person receiving hospice care. And that's one of the things that MedPAC has recommended cutting. So it's a very odd construct when essentially if the cap is cut, you're going to have a theoretical six month benefit that nobody can actually get for six months because the amount of money available to care for the person isn't enough to do that. We would never do that with a hospital, emergency room. We would never do that with a community physician. We don't cap the amount of care that someone is eligible to get in that same way. But with hospice, we've made such a determination. Going all the way back to 1983, the budget office was thinking, "We want to make sure that hospice doesn't bankrupt the country. So we're going to do two things that are really important. One, we're going to limit the benefit to a prognosis of six months. And we're going to make sure that we cap the amount of money that we spend. And then that way we can be sure that it doesn't bankrupt the country." Journalist: And this doesn't work today? as the demographics change people don't only die of cancer and there are many more people in this pool. What we're doing is we're actually causing some folks to be either not accepted on hospice care or discharged from hospice care which can move them to a much more expensive care setting, all in the name of a benefit that was established long ago. Journalist: The way this was originally sold was that it would essentially save money. Do think there's a change in the way we think of hospice needing to save money? Patient % Change from Base Year % Decedent Growth by Principal Diagnoses from Base Year Unknown 0.3% Native American 0.4% Other 0.5% Asian 1.7% * Categories correspond to those used by CMS in the Hospice Limited Data Set Hispanic 6.4% African American 8.2% Caucasian 82.5% % of Patients by Race for 2017 Edo Banach: The problem is that Newsline / Spring 2020 11