Hospice firms draining billions from Medicare

[jsr]

http://www.washingtonpost.com/business/economy/medicare-rules-create-a-booming-business-in-hospice-care-for-people-who-arent-dying/2013/12/26/4ff75bbe-68c9-11e3-ae56-22de072140a2_story.html

Hospice firms draining billions from Medicare
By Peter Whoriskey and Dan Keating, Published: December 26

Over the past decade, the number of “hospice survivors” in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer.

The proportion of patients who were discharged alive from hospice care rose about 50 percent between 2002 and 2012, according to a Post analysis of more than 1 million hospice patients’ records over 11 years in California, a state that makes public detailed descriptions and that, by virtue of its size, offers a portrait of the industry.

The average length of a stay in hospice care also jumped substantially over that time, in California and nationally, according to the analysis. Profit per patient quintupled, to $1,975, California records show.

This vast growth took place as the hospice “movement,” once led by religious and community organizations, was evolving into a $17 billion industry dominated by for-profit companies. Much of that is paid for by the U.S. government — roughly $15 billion of industry revenue came from Medicare last year.

[enough]

1. So maybe what Hospice is doing is working as well as or better than other forms of care.

When you sign up for Hospice, you stop getting other kinds of medical care. You stop going to the doctor, you stop going to the hospital, you stop getting all kinds of tests. It's a very different approach to care. Hospice is not in addition to regular care. It is instead of regular care.

The thing this article doesn't address is: How much profit for other kinds of medical services would the same patient be generating if he or she was not in Hospice.

I'm not saying it's good that Hospice profits are growing. I don't think medical care of any kind should be a profit-generating business. But we need to take into account that these hospice patients would be getting other kinds of care if they were not in Hospice.

[bbgrunt]

3. this is a very important aspect of this issue. thank you for pointing it out

[haele]

2. Wonder if some of this is people using hospice rather than a nursing home.

There was an issue with San Diego Hospice recruiting patients who were not - or had not been fully evaluated to be - qualified for Hospice (as in, a fatal condition with a prognosis of less than six months to live) and billing Medicare for hospice-specified funds.
They got millions of dollars for patients who ended up leaving hospice care (in- and out-patient) after a year (they got better and were no longer eligible) or who were "boomeranging" back and forth from hospice eligiblity, six months of hospice, release for a few months, then return with another six month prognosis.
I'm not sure what the difference between funding and why there might be a reason to consider pallative hospice care rather than a nursing or care-taking facility (either in home nursing or at a nursing home).

Unless a prospective patient didn't have long-term care insurance and the hospice was "being nice" in putting them on hospice to save the family or the patient some money - as well as get hospice funds from Medicare. As in someone who wasn't considered bad off enough to for the state to pay for to put in a nursing home, but not really capible of caring for themselves without some sort of oversight and was too old for SSDI and could be diagnosed with a condition that could be fatal.

The six-month prognosis for hospice acceptance is there because using "going on pallitive care" as a prognosis for approving hospice treatment is tricky.

Haele

[jwirr]

4. One of the guidelines used to determine care levels is asking which form of care provided is the

cheapest yet best for the patient. That is do I go to a nursing home? a foster home? hospice? or can I actually stay in my own home with home health care providers coming in as needed. And from what I have seen it works to control costs while still giving the patient good care. We have used this method here in MN for years.

[haele]

5. Problem is that federal funding for Hospice care is specifically for end of life

There were people who were applying for federal funds for Hospice care, both in home and in facility, for two/three years of palliative care during "rough periods" in their condition, rather than getting in home nursing because they didn't have long-term care insurance and weren't otherwise covered under their Medicare - or didn't have medicare.

People go into Hospice for both long term and final-stage palliative care. Unfortunately for the people who have a fatal condition in which they have good months and bad months, and can linger, they have to cover hospice on their own if they don't fall under the 6 months left prognosis. This can leave many families in a financial bind.

While it's very kind of the hospice to "fib" a bit for some of their long-term patients, it's not fare to the people who depend on the Medicare Hospice fund for their end of life, especially when the funds are being depleted at a higher rate than expected.

San Diego Hospice began loosening up their paperwork, and ended up with millions more from the Federal Government to care for the higher patient numbers - even as they were going through bankruptcy because they really did try to provide good care. It just snowballed with them, taking in more patients who did not qualify for federal hospice funds and who did not need a high level of care, and using that money to keep afloat while trying to maintain the level of quality they had a reputation of providing.
They were to "good heart, bad idea" case. There were other Hospices in CA who barely provided any care at all - Medicare Fraud factories. The places that could not pass nursing home regulations, and called themselves "hospices" to warehouse people at end of life and pocket as much money as they could.

Quality hospice is expensive, and like many federal programs that face congressional rules, the funding for it is not keeping pace with the cost of quality care.

Haele