Ava Kofman writes for the New Yorker on the profiteers who have turned hospice care into a $22 billion dollar a year industry. Rather than being about dying with dignity, hospice is too often all about the money. Since quality varies tremendously, it’s critical to choose a hospice agency carefully.
Today, about half of all Americans choose hospice at the end of life. With hospice, people deemed to have six months or less to live choose to forgo treatment for their medical conditions and instead receive palliative care to ensure their comfort. But, now that corporations see the dollar signs in hospice, electing hospice care can pose risks for patients. (N.B. People with Medicare can opt out of hospice at any time and receive Medicare-covered treatment for their conditions.)
People tend to learn about hospice from their treating physicians. But, some for-profit hospices hire staff to scout out hospice patients. Hospice staff offer vulnerable people free medicine, nursing care and more if they’ll sign up for hospice, regardless of whether they actually qualify for hospice.
Hospice agencies sometimes set “ungodly quotas” on their sales teams, expecting them to find large numbers of people who qualify for the hospice benefit. To meet their quotas, hospice staff recruit people into hospice who are not terminally ill but who the hospice agency can certify as terminally ill.
At AseraCare, Kofman reports that staff are trained to turn chronic conditions like shortness of breath into a terminal condition, so that patients qualify for hospice. The corporations know exactly how to tap into government dollars. Often, they are running nursing home chains as well. Private equity also is in the hospice business.
Much like Medicare Advantage plans, which often have histories of committing fraud or of settling fraud claims with the government, some hospice companies have similar histories. But, the government continues contracting with them. Consequently, Kofman reports that “companies in the hospice business can expect some of the biggest returns for the least amount of effort of any sector in American health care.”
Medicare pays a flat daily rate to the hospice, even if it delivers few services. Medicare only requires the hospice to send a nurse to visit hospice patients twice a month. Medicare does require repayment from hospice agencies if their hospice patient population overall lives longer than six months. But, the agencies can get around that–they simply drop patients before the six months elapse.
Hospice should ensure a person’s end of life is as good and comfortable as possible. It also should reduce health care costs because comfort care is far less expensive than hospitalizations at the end of life. But, in the hands of profiteers, who take the money paid them and don’t offer compassionate care, it is a huge waste.
The Centers for Medicare and Medicaid Services (CMS) appears to do a poor job of overseeing the hospices it contracts with. One review of hospices found that most hospices had serious failings. Hospice agencies did not manage pain as required or have trained staff. But, as with Medicare Advantage plans, CMS almost never punishes the bad actors.
What will Congress do about this?
Here’s more from Just Care:
- Private equity-owned hospice and home health agencies drive up Medicare spending, jeopardize quality of care
- Medicare hospice benefit has become a luxury
- Choose your hospice carefully
- Pre-hospice care allows people to stay in their homes
- Hospices misleading patients, overbilling Medicare
