Medicare’s Program of All-inclusive Care for the Elderly or PACE has been a godsend for a small group of vulnerable patients around the country, allowing them to age in place, with medical and social supports, and avoid moving into a nursing home. But, the federal government opened up PACE, which had historically been operated by not-for-profit agencies, to for-profit companies. Eleanor Laise reports for MarketWatch on the frightening consequences of allowing for-profit entities to administer PACE.
PACE programs care for older adults in very poor health, with multiple chronic conditions. Nearly half of them suffer from dementia, and most of them are dual-eligibles, with both Medicare and Medicaid. PACE programs are paid a flat fee to manage each participant’s care and allow them to age in their communities.
It goes without saying that, like Medicare Advantage plans, companies can make a killing off the PACE program if they limit the costly care their participants receive. And, though the program was once only open to non-profit companies, CMS opened it to for-profit companies more than a decade ago.
Under the administration of non-profits, the PACE program had a wonderful reputation. Now, as for-profits are taking over PACE, it’s a different story altogether.
One patient under the care of InnovAge—a for-profit PACE program—died, allegedly needlessly. She was admitted to the hospital, severely dehydrated and with sepsis. According to the patient’s daughter, InnovAge was MIA, failing to properly monitor her mom’s condition or even discuss it with her daughter.
The daughter described for-profit PACE as all-inclusive neglect of elderly participants, “PANE,” with financial growth and profits as their priority. The result is delayed care, difficulty getting specialty care and poor care coordination. One former employee alleged that InnovAge was “denying [patients] access to thousands of medically necessary services.”
An internal audit in 2016 found that hundreds of participants in California were waiting long periods of time for specialty visits. There was no record of a specialty visit for one participant experiencing heavy bleeding. A month later, the patient went to the emergency room. One employee who reported these issues to a superior ended up leaving after her reports were dismissed.
The Centers for Medicare and Medicaid Services has stepped in, seemingly doing too little too late. It has halted enrollment in InnovAge’s Sacramento location, but why not at all locations? It’s the same poor management everywhere.
“Auditors found instances of ordered services being cancelled, not provided, or unreasonably delayed without any clear rationale,” CMS wrote to InnovAge. How can CMS continue to pay InnovAge to care for the participants already enrolled in its PACE program when the reason for CMS ending new enrollments is failure to provide medically necessary services!
CMS is paying InnovAge an average of $94,000 for each of its enrollees. Former CMS administrator and InnovAge board member Tom Scully takes pride in the fact participants have fewer ER visits and hospital admissions than people in traditional Medicare. We are left to wonder how many of these participants were deprived of medically necessary care when InnovAge kept them out of the ER and the hospital.
Where’s the oversight of InnovAge and other for-profit PACE programs you might wonder? Notwithstanding oversight requirements, precious little monitoring and reporting has occurred.
Here’s more from Just Care:
- PACE helps older adults stay in their community
- For-profit PACE programs: Cause for worry?
- Trump administration attempts to privatize traditional Medicare
- Medicaid coverage of home and community-based care
- People with Medicare and Medicaid in Special Needs Plans at extra risk
