Hospice care is for the dying.
Unless — as a Washington Post story last week suggests — there’s more money to be made by caring for healthier patients.
Hospice, once the domain of religious and community organizations, has grown into a $17 billion industry dominated by for-profit companies. Most of that money — some $15 billion — came from Medicare last year.
As the for-profits grew, so did the length of time patients stayed in hospice. The number of patients discharged without dying skyrocketed, as did the profit per patient.
This matters financially. Some 60 percent of Medicare’s hospice spending is on patients who outlive their six-months-or-less prognosis.
And that’s largely a function of the for-profit chains. MedPAC, the hospice watchdog established by Congress, says the average patient in a nonprofit hospice is served for 69 days; the average in for-profits is 102 days.
It appears that Medicare has made it lucrative to enroll patients in hospice well before death. And the big chains are taking advantage. According to the Post, about 78 percent of the patients enrolled in Asera Care’s Mobile, Ala., hospice care left care alive.
There are a variety of whistleblower suits pending against four of the 10 largest hospice companies, alleging that they have deliberately enrolled patients who aren’t near death and don’t belong in hospice. The Justice Department has joined some of those suits.
Rather than wait on the result of these lawsuits, Medicare would do well to tighten its hospice rules, particularly by removing the ability of hospices to recertify the eligibility of long-term patients on their own.
The world of hospice, at least financially, is far different than it was when the rules were written.