Category: Hospice/Palliative Medicine

 

Large multi-agency, multi-state hospices are fast become the primary source of end-of-life care in the U.S.

According to a new study, chains cared for nearly half of all hospice patients in 2011, a dramatic increase from a decade before when small organizations (mostly non-profits) provided three-quarters of all care. And my own review of their financial reports suggests the biggest chains have grown even more since 2011.

The paper, authored by David Stevenson of Vanderbilt University and Jesse Dalton, David Grabowksi, and Haiden Huskamp of Harvard Medical School, was published in the January issue of Health Affairs (firewall). The authors did not look at the relative quality of care at any of these facilities. Nor did they calculate how long patients remained in hospice care at the chains. But they shed valuable light on how the business of end-of-life care is changing.

Hospice care is overwhelmingly funded by Medicare. And payment rates are generous enough that for-profits have long made inroads into this care model. The new study shows that, like many in the medical care industry, hospices are scrambling to consolidate so they can benefit from the economies of scale and marketing advantages of being big. Publicly-traded companies are responding to investor demands for increasing revenues.

Small non-profits still served more patients than for-profit chains in 2011, but Stevenson and colleagues found their share has been shrinking rapidly. In 2000, they cared for about 53 percent of enrollees. By 2011, they were caring for only about 37 percent. Over the same period, the for-profit chains’ share of enrollees grew from about one-quarter to nearly half. Non-profit chains accounted for roughly another 10 percent.

in 2000, a typical for-profit chain operated 5.6 agencies with 2,300 enrollees. By 2011, those firms owned an average of seven agencies with an average roster of 2,700 Medicare patients, according to the study.  By contrast, a typical mom-and-pop for-profit cared for only one-tenth as many people–about 220.

In some cases, corporate hospices are not just growing, they are getting huge. The paper reports that in 2011, the five largest for-profit chains owned 283 agencies with 190,000 patients. But the biggest players have grown even more since.

Hospice Is Becoming a Chain Business – Forbes

Good piece about the dilemma faced by all hospices – is this patient going to die within 6 months?

One can sympathize with hospice organizations caught in this squeeze. Determining which patients will likely die within six months has always been difficult, especially with conditions like heart disease or dementia, whose trajectories can be unpredictable. To avoid being penalized if they guess wrong, hospices are taking no chances.

At least, that’s true of hospices operating according to the regulations and honoring the movement’s historic mission. The Post attributed much of the jump in discharges to the way for-profit hospices have come to dominate the field, enrolling ineligible seniors for long stays to bolster corporate bottom lines, then dumping them to evade Medicare sanctions. (The Times has also reported on growing hospice costs.) Whistleblowers and the Justice Department have sued several large national chains to stop these practices.

But I worry about families who have agonized about the decision and finally called for help, then feel betrayed when hospice withdraws, even though their relatives can regain hospice care when they decline further. They shouldn’t get caught in this crossfire.

Bounced From Hospice – NYTimes.com

Long article about hospice, and the possible abuse of the system by for-profit hospices.

Hospice patients are expected to die: The treatment focuses on providing comfort to the terminally ill, not finding a cure. To enroll a patient, two doctors certify a life expectancy of six months or less.

But over the past decade, the number of “hospice survivors” in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer.

The proportion of patients who were discharged alive from hospice care rose about 50 percent between 2002 and 2012, according to a Post analysis of more than 1 million hospice patients’ records over 11 years in California, a state that makes public detailed descriptions and that, by virtue of its size, offers a portrait of the industry.

The average length of a stay in hospice care also jumped substantially over that time, in California and nationally, according to the analysis. Profit per patient quintupled, to $1,975, California records show.

This vast growth took place as the hospice “movement,” once led by religious and community organizations, was evolving into a $17 billion industry dominated by for-profit companies. Much of that is paid for by the U.S. government — roughly $15 billion of industry revenue came from Medicare last year.

At AseraCare, for example, one of the nation’s largest for-profit chains, hospice patients kept on living. About 78 percent of patients who enrolled at the Mobile, Ala., branch left the hospice’s care alive, according to company figures. As many as 59 percent of patients left the AseraCare branch in nearby Foley, Ala., alive. And at the one in Monroeville, 48 percent were discharged from the hospice alive.

Medicare rules create a booming business in hospice care for people who aren’t dying – The Washington Post