For Profit Hospice


I hesitated to republish this article for fear of tainting some wonderful hospice providers. Yet the “for profiting” of many services from prisons to schools has demonstrated  consistent decline in quality as companies provide fewer services, over-bill for those they do provide, hire unqualified staff because they are available at lower wages.  All this in service of a bigger bottom-line.

Again, there are many decent non-profit hospices which provide a wonderful service. Here in Marin we have Hospice By the Bay, for example. But you will notice that in the SF Bay area, the same Vitas Hospice written about in this article operates several facilities whose sole purpose is to extract the most money from Medicare while providing the least service.

This long article, from Huffington Post, is a major research by several people, with many facts and figures, graphs and photos. I will not publish the whole article, but hope that you will follow the link to read the rest. It is enlightening.

How Dying Became A Multibillion-Dollar Industry

Development and data reporting by Shane Shifflett.
Additional reporting by Chris Kirkham.
Design by Hilary Fung.

Evelyn Maples’ last day as a hospice patient wasn’t anything like her family imagined when the nurse from Vitas Healthcare first pitched the service two months before.

On the morning of Dec. 31, 2011, Maples’ daughter, Kathleen Spry, found her mom unconscious and gasping for breath, with her eyes rolled back in her head. Maples was at a Vitas inpatient facility on Merritt Island, 30 miles from the home the two women shared on Florida’s east coast. No one from Vitas had called to warn the family that the woman everyone called “granny” was in sharp decline, Spry said. No one from Vitas had sought treatment for the blood infection that had made her severely ill, despite the family’s standing request that she receive life-saving care in the event of a crisis.

Key Findings

The U.S. hospice industry has quadrupled in size since 2000. Nearly half of all Medicare patients who die now do so as a hospice patient — twice as many as in 2000, government data shows.

 
Since 2006, the U.S. government has accused nearly every major for-profit hospice company of billing fraud.

 
Hospices bill by the day, and stays at for-profits are substantially longer than at nonprofits (105 days versus 69 days).

 
In 2009, for-profit hospices charged Medicare 29 percent more per patient than nonprofits, according to the inspector general for the health service.

 
The average hospice stay has increased dramatically since 2000, regardless of diagnosis, a HuffPost analysis of Medicare data found. This has led to a surge in expenditures: $15 billion in federal dollars in 2013.

 
Despite widespread allegations of fraud and abuse, regulators have consistently rated hospice as a lower priority for inspection than traditional health facilities like hospitals.

 
The average U.S. hospice has not undergone a full inspection in more than 4.5 years, a HuffPost analysis of Medicare data found. HuffPost found 866 hospices that haven’t been inspected in more than 6 years. Nursing home inspections, by contrast, are required by federal law at least every 15 months.

 
Over a recent three-year span, 55 percent of all U.S. hospices were cited for a violation, many care-related, HuffPost found. HuffPost found 20 providers that were cited for more than 70 violations each during that time.

 

Frantic and near tears, Spry called her son, David Dunn, who demanded an ambulance. Maples was taken to a nearby hospital, where she recovered from the infection. But her fragile health was permanently compromised, her family claims. She died a month later.

Hospices exist to provide comfort to people who doctors determine are at the end of their lives, with six months or less to live. The paramount objective, according to the National Hospice and Palliative Care Organization, a trade association, is to make patients comfortable, with a focus “on enhancing the quality of remaining life.”

But Maples’ family claims she never belonged on hospice, and that she was recruited for the purpose of inflating the company’s Medicare billings.

In a complaint letter to the Florida attorney general, Dunn alleges the company enrolled his grandmother “for the sake of billing the government for payment for their own financial gain.” The company misled the family about the purpose of hospice — emphasizing benefits such as at-home nursing care and free medications, without explaining that hospices don’t provide curative treatments, according to Dunn. Once enrolled, Dunn alleges, Vitas gave Maples a powerful cocktail of drugs against the family’s wishes, and repeatedly bumped her up to the most intrusive and expensive levels of care.

The final straw was the apparent confusion over Maples’ “full code” status. It’s a designation rarely seen in hospice, because it means the family wants the kind of life-saving treatment that hospices don’t provide.

When Dunn tried to cancel the service, he was ignored, he says.

“It’s like she was a prisoner in their system.”

David Dunn, Maples’ Grandson

“Once she was on hospice, they did whatever the hell they wanted to do,” Dunn said in an interview. “It’s like she was a prisoner in their system.”

According to Dunn, Vitas’ actions hastened Maples’ death.

Allegations like those leveled by Maples’ family against Vitas have become increasingly common over the past decade as the hospice industry has undergone a titanic shift. What once was a collection of mostly small, religious-affiliated nonprofits is now a booming, $17 billion industry dominated by national chains.

These large companies have proved tremendously effective at expanding hospice’s reach. More than 1 million people die each year while receiving hospice services in the U.S., according to the major hospice trade association. Nearly half of all Medicare patients who die now do so as a hospice patient — twice as many as in 2000, government data shows.

(Read the rest at Huffington Post.)

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