Hospice care, as you know, is comfort care provided to people who are dying—specifically, those certified by doctors as having less than six months to live. Hospice care began in 1974 as a non-profit enterprise. That has changed. As a New Yorker article notes, “…hospice evolved from a constellation of charities, mostly reliant on volunteers, into a twenty-two-billion-dollar juggernaut funded almost entirely by taxpayers. At the start of this century, for-profit enterprises made up thirty percent of the field. Today they represent more than seventy percent.” Private providers cost Medicare three times that of their non-profit counterparts.
For-profit hospice
companies use a variety of schemes to enroll patients. They’ll prey on sick
people, duping them into the program by claiming that it’s free home health
care. Or they’ll ask oncologists to turn over their “last breath” cases. Or
they’ll bribe physicians to bring them new patients by offering all-expense
trips to Las Vegas. Or they’ll put doctors on their payrolls. One doctor was
employed as medical director by eight hospice companies, receiving $400,000 for
his services. Over the course of twenty years, he had referred approximately 763
patients to hospice care.
Many of the patients
enrolled with for-profit hospice companies are not on the brink of death. In fact, most of
Medicare spending on hospice is for patients whose stays exceed six months. (Note
that during their hospice stay, patients must forgo curative care, such as chemotherapy
or dialysis or lifesaving medications.) The federal government demands
repayment from hospices when the average length of stay of all patients exceeds
six months. Companies avoid this outcome in a number of ways. They’ll dump patients
(one company discharged 93 percent of its patients alive). Or they’ll
shut down, keep the money, buy a new license and Medicare billing number, and
transfer their patients to the new entity. They have even been known to overdose
patients who are staying on the service too long. (One hospice owner texted his
nurse, “He better not make it tomorrow.”)
When looking for hospice
care, choose for a non-profit organization!
For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.
You are so right, Connie. There is also an interesting commentary on the same in Atul Gawande's book, Being Mortal.
ReplyDeleteI'm sending this to a friend who is bitter that Hospice did not care properly for her mother. Her mother was fairly stable, put there for a short period, but died within a few days. My friend remains inconsolable.
ReplyDeleteThankfully, I have only good things to say about St. Joseph Memorial Hospice - Santa Rosa who were a great help with my dad. It costed nothing and they fulfilled his needs and wishes.
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