The hospice industry is booming with a $14 billion revenue, but with Medicare footing 90% of bill, the eligibility of many of the patients is being brought into question, reports a Bloomberg article.
The number of Medicare-covered patients in hospice care more than doubled between 2000 and 2009, and it seems many are staying in hospice longer than would be expected.
Medicare compensates on a per-diem basis, and lengthier stays increase profitability, according to federal data.
There’s been a 60% increase in the average time patients spend in hospice since 2000, when for-profit hospice care gained in popularity, the article says, citing Medpac data. Additionally, the average stay of the 10% of patients who remained in hospice the longest rose 71% to 240 days.
“That means at least 110,000 patients weren’t facing imminent death when they were admitted—although doctors said they were,” says Bloomberg. “To qualify for Medicare hospice coverage, patients must have a prognosis of six months of less to live, certified by two doctors.”
There are several settled or pending lawsuits against hospice companies regarding admitting patients who didn’t qualify for end-of-life care, with prosecutors saying one company “bilked” Medicare by paying bonuses to employees and doctors to admit patients who weren’t dying, according to the article.
With a base of 1.1 million patients enrolled in Medicare and 1,800 for-profit providers, hospice has been largely fueled by nursing homes, thanks in part to compensation based on enrollment numbers and nursing home doctors who double as hospice medical directors.
Even if patients didn’t actually qualify for hospice care, which by definition is for the terminally ill, hospice marketers have been encouraged to “admit, admit, admit,” according to Joyce White, a former marketer for Vitas Healthcare, a Chemed Corp. unit that is the nation’s largest hospice chain, Bloomberg reports.
White, the former Vitas employee, alleges that salespeople were paid based on patients’ length of stay due to Medicare’s compensation system, says Bloomberg; a Vitas spokesperson says the company compensates its marketing representatives based on overall growth, not length of stay.
Read the full Bloomberg article here.
Written by Alyssa Gerace
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Hospitals and SNFs don't want hospice patients because it would up their death statistics. They also withhold pain medication with fears of "addiction" or death from overdose. So hospice is the only place patients can go to get adequate pain medication and to die peacefully in safe, caring surroundings with family by their side. Also, many patients are opting from at-home hospice care where they can receive adequate pain medication and be in familiar surroundings.
As a fundraiser for a nonprofit community based hospice agency, I can tell you that there are a large number of hospice agencies who are more concerned about providing this important service their community than making a profit. Agencies like these provide hospice services to people regardless of their ability to pay. A great example of this is bereavement services. Bereavement services are a required part of the hospice service model through Medicare, yet Medicare does not reimburse hospice agencies for this service. The agency I work for is so committed to providing this service to its community that we provide bereavement services free of charge to the entire community whether or not we provided hospice care to their loved ones. We fundraise to ensure that everyone in our community has equal access to these services with or without Medicare reimbursement. It is a fact that not all hospices are the same. There are those who care so much about their community that they provide services above and beyond Medicare reimbursements.
I believe the largest difference in what is stated in the previous comments is a for-profit hospice versus a non-profit hospice. When you have stock holders and owners putting pressure on their employees to make more money, make a profit, – the mission of providing care for those who are facing a terminal illness is a second thought – not the first thought.