[UPDATED] For-Profit or Nonprofit, Hospice Is Not a ‘Hustle’
By Jim Parker
The recent article by the New Yorker and ProPublica that branded “hospice” as a profiteering “hustle” was an outrageous misrepresentation of the provider community.
Starting with the headline, the story uses “hospice” as a monolithic term that makes little distinction among individual providers — heralding its overgeneralized and oversimplified perspective. In many instances information that was accurate at face value lacked sufficient context to fully elucidate the subject matter.
The article begins with a rehash of the AseraCare False Claims Act (FCA) and anti-kickback lawsuit which was filed in 2008 and settled in March of 2020. The court actually ruled in favor of AseraCare, with the stipulation that the U.S. Justice Department would have additional time to seek further evidence. Rather than continue to litigate the case, the company settled for $1 million.
While I cannot personally dispute the accounts of the whistleblowers in the case, AseraCare did garner support from industry stakeholders. The National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO), for instance, filed a joint amicus brief with the court. AARP also filed a brief in support of AseraCare.
The NHPCO and NAHC amicus brief argued that a “disagreement among physicians as to an individual’s terminal prognosis based on a review of the individual’s medical record gives rise to an FCA violation, ignores the well-recognized difficulty of accurately predicting the end of life and threatens to undermine Congress’s goal of ensuring access to the Medicare hospice benefit where a physician has concluded, in his or her clinical judgment, that a patient is terminally ill.”
The prognosis guessing game
Even when a hospice plays by the rules, death does not. Establishing the required six-month prognosis is a complex and ambiguous process. These estimates of the patient’s lifespan typically represent clinicians’ best guesses as to how long the patient will survive. Physicians do not have a crystal ball that tells them exactly when a person will die.
Further complicating the issue are changes that have occurred among the patient population during the past decade. When the Medicare Hospice Benefit became a permanent program in 1982, its parameters were designed specifically for cancer patients.
Today, patients are enrolling in hospice with a wider range of diagnoses, some of which have a much less predictable trajectory than most cancers. Dementia-related illnesses are a clear example.
Dementia patients represented 20.9% of hospice enrollees in 2019, up from 9% in 2002, according to NHPCO. The average length of stay for those patients reached 126 days in 2019, compared to 92.6 days for the overall hospice population. For comparison, cancer patients that year were in hospice for an average of 45 days.
This issue may get worse before it gets better. Hospices can likely expect a more substantial influx of dementia patients in the coming years. The number of dementia patients is expected to rise by 40%, or 139 million people globally, by 2050, according to data from the World Health Organization (WHO).
This is a significant driver of patient recertification, a practice that The New Yorker piece appears to call into question.
Read Full Article |
