Connor heard of hospices in other states having to pay back money, but now she knows her hospice won't hit the caps for a long time, if ever.

Medicare caps the benefits each hospice receives each year. Each hospice is allotted a certain amount per day and per patient, but Medicare only covers patients for 180 days.

Medicare multiplies the cap by the number of patients admitted in a particular year to calculate the hospice's Medicare allowance for the year.

"We have people living longer than six months," Connor said of the hospice that serves about 26 patients a day.

But the hospice also has people who come to the hospice for only a day or two. In 2007, average length of stay was 51 days.

Connor said this is a result of physicians referring patients in "the last days instead of the last months."

Hospice Alliance of Wyoming had an average length of stay of 197 days in 2005.

Connor said she was "shocked" to hear that some Wyoming hospices were having trouble with Medicare's requirements.

"It is something we all agreed we would watch," Connor said. "Always, each month we track and trend these numbers."

Spirit Mountain Hospice in Cody, which serves about 11 to 13 people each day, has not exceeded its cap either, said director Linda Harbron. The same was reported during interviews with officials at larger facilities in Laramie and Cheyenne.

"Looking into the future, it could be a possibility," Harbron said.

With the demographics of Wyoming shifting to an older population, Harbron said the need for hospice care will increase.

A woman in Meeteetse, who is served by Spirit Mountain, has been on the hospice benefit for a year and a half, Harbron said. She has end-stage lung disease and has never improved enough to be removed from the benefit.

"Sometimes they just live longer," Harbron said.

Even so, she said this one woman does not have a huge effect on the hospice's numbers.

Lois Armstrong, president of National Alliance for Hospice Access, said there are two factors that can lead to a cap problem: the percentage of cancer patients a hospice serves and who sends the facility patient referrals.

Cancer patients, the reason the Medicare hospice system was established, tend to live shorter periods of time on hospice than other patients, such as someone with diabetes or heart disease. The more cancer patients a hospice serves, the less likely it is to exceed the cap.

The National Alliance for Hospice Access estimates only 25 percent of hospice patients nationwide are cancer patients.

Connor said about half the patients at Central Wyoming Hospice have a cancer diagnosis, and she receives referrals from several sources.