Monday, February 11, 2013

Keeping a Watchful Eye on the Growth in Hospice Care

By E'Louise Ondash, RN


When we talk about hospice and its purpose and services, it is a good news/bad news discussion.

According to the National Hospice and Palliative Care Organization’s annual report, about two in five deaths occur under hospice care – slightly over a million deaths in 2011. Since the early 1980s, when Medicare began offering a hospice benefit, hospice has become a multibillion-dollar industry which has grown at a rate “that would please even the most ambitious financial manager,” one health care reporter recently commented.

According to an Inspector General’s report in 2011, Medicare payments to hospice programs have increased from $3 billion in 2000 to $13 billion in 2010. The number of for-profit hospices also has soared. In 1992, only 13 percent were for-profit; in 2009, that number was 56 percent.

In the last three decades, hospice has provided invaluable services to patients and families, but with the increasing competition, some in the industry seem to have adopted rather dubious business practices. Many of the largest hospices and the organization that represents them have spent millions on lobbying the federal government, and some hospices have been the target of federal fraud investigations.

Because of the tremendous increase in recent payments, government auditors are examining records of hospices throughout the country to see if patients truly qualify for care that is paid for by government. The plan on the drawing board is to decrease reimbursement rates by 11.8 percent through the next decade. Demographers and actuaries are no doubt looking at the 70-some million aging baby boomers and advising that current reimbursement rates are not sustainable.

I think most nurses would agree that there has been a growing awareness of hospice, its philosophy and its services – both among the professional community and health care consumers. This is a good thing; hospice and palliative care was for many years a mostly unknown concept. There were few options for end-of-life care except a hospital bed.

I recall instances from several years ago in which patients’ prognoses were grim, yet they or their families were still encouraged to continue with expensive therapies that had little-to-no chance of success. There was no assistance or support for any other decision or even to explain the options.

In the current situation, I hope that government auditors don’t throw out the baby with the bath water. They should take into account that, according to a 2007 Duke University study, Medicare saves an average of $2,309 per patient when a death occurs within the realm of hospice rather than in a hospital.

I also hope that programs to care for the long-term chronically ill are not victims of this audit. Many hospices have instituted these programs, which have proven to save health care dollars. Under long-term palliative care, patients and families are given resources, guidance and care management to help keep them out of hospitals and make decisions about their future care.

Have you seen or experienced instances where hospice care has kept health care costs down?

What is your overall impression of hospice services in your area?

Tell us about it.

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