For-Profit Hospices Discharging Patients Before Their Time

According to a recent New York Times article, the Medicare Payment Advisory Commission has found that approximately 20 percent of hospice patients in the United States are being discharged from care before they die. Of this number, the article suggests, only a small percentage is due to a change in care decisions by the patient or their family. The majority of these discharges are initiated by hospices — not patients.

Credit: healthcareworkersalary.com

The report suggests that this high number of involuntarily discharged patients is due to the rise of for-profit hospices in recent years. The article cites a study published in JAMA Internal Medicine that suggests a reason for this: While Medicare reimburses hospices on a fixed-rate daily basis, the cost of patient care fluctuates over time.

Thus, it is more profitable for hospices to discharge patients before the cost of care peaks as they near death.

The first few days of hospice care are “high intensity” days, including meetings with the patient and their family to set up care plans. Toward the end of a patient’s life, the cost of care also rises due to increased need for hospice staff visits. Thus, it is more profitable for hospices to discharge patients before the cost of care peaks as they near death. The study also found that for-profit hospices tend to enroll patients in care for longer periods of time — meaning there are more lower-cost days between initial enrollment and death. This translates to higher profit margins for the institution.

The JAMA study also found that patients who are discharged from hospice cost the medical system more money than if they had stayed in hospice, because they seek symptom treatment in emergency rooms. Many are also admitted to the hospital, where a large percentage of them die. For-profit hospices also tend to take patients into care who reside in nursing homes and assisted living facilities rather than private residences, thus saving money on travel costs and time.

When considering whether hospice care is right for you or a loved one, keep in mind that a doctor can make a referral, as well as family, friends, or patients themselves. Look to this Consumer Reports article for a list of points to research when making this important decision. The Washington Post has also published an online consumer guide with information on over 3000 hospices that participate in Medicare.