The Boston Globe's 11/19/12 feature on selling hospice care to the public focused on the most benign aspects of that process. While it is true that hospice care in America was built through the commendable efforts of committed volunteers and grossly underpaid health care professionals, the current industry has morphed into the fastest growing “product” purchased with Medicare dollars. What was once mostly a calling for the truly compassionate has become a huge business in the private sector, replete with venture capital firms competing for acquisitions.
Not surprisingly, in this environment, the total number of hospices has more than doubled over the last decade.
Considering that almost all of the national hospice bill is funded by Medicare, it's no surprise that interested parties have noted the fact that palliative care is the only federally funded benefit that includes generous coverage of pharmaceuticals, medical equipment and round-the-clock access to professional support. When entering hospice care, patients agree not to seek procedures to improve their health, such as surgeries, chemotherapy or additional hospitalizations. Many of the health care professionals I speak with are worried that too many patients are now sent to for-profit hospice settings before an appropriate time and do not receive the care that could restore their health for a longer period.
Sadly, the profiteers have learned to capitalize on an aspect of Obama’s 2010 health care law by influencing hospitals to send Medicare patients into end-of-life care instead of readmitting them. This enables the medical center to avoid paying the penalties required by the new law if they were to accept a patient back into in-patient care within 30 days of discharge. Thus these incredibly important decisions are too often framed in financial terms instead of focusing on what will provide the best care for individuals.
But at the same time, lengthier stays in hospice increase profitability for the new crop of “hospice chains” backed by investors and other professionals looking for remuneration. In a well-publicized case investigated with the help of the FBI, members of a medical staff in Kansas wanted to discharge a patient in very good health but hospice managers (whose pay was based on enrollment headcounts) were opposed. Another case in Pennsylvania focused on a nursing-home physician referring patients to a hospice that provided compensation to the doctor in turn for the business.
Those of us who are baby boomers have gotten accustomed to being able to purchase the best of everything. But when it is time for our parents and then our own cohort to depart this earthly plane, we might find ourselves wishing for the good old days when hospice care was provided on a shoestring budget by self-sacrificing stalwarts. Because when we think about the size of our generation hurtling toward the inevitable, we can calculate that the numbers are simply not going work no matter what marketers tell us.
Helen Meldrum is associate professor, Natural and Applied Sciences at Bentley University.