[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.

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Home Health Spending Flat As Health Care Utilization Rebounds

Home Health Care News | By Robert Holly
 
Spending on home health care stayed mostly flat in 2021, a new analysis from the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) reveals.
 
The steady spending on home health care last year came despite a sharp dip in government funding tied to the public health emergency (PHE). The decrease in PHE-related funding was generally offset by a rebounding of health care utilization across the board, according to the analysis, published online Wednesday by Health Affairs.
 
“Federal COVID relief funding had a greater impact on growth for nursing care facilities and home health care than it did for other professionals or dental services, as nursing homes and home health care agencies received a large amount of supplemental funding in 2020,” CMS statistician Micah Hartman said during a conference call with members of the media.
 
Specifically, national health expenditures on home health care totaled $125.2 billion in 2021, a year-over-year increase of less than 1%, according to the CMS analysis.
 
From 2015 to 2020, national health spending on home health care climbed from $89.6 billion to $125 billion. The largest year-over-year jump came in 2020, when spending increased by more than $12.6 billion over 2019 largely because of COVID relief.

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CDC Expands Updated COVID-19 Vaccines to Include Children Ages 6 Months through 5 Years

Following FDA action, [December 9, 2022] CDC expanded the use of updated (bivalent) COVID-19 vaccines for children ages 6 months through 5 years. Children ages 6 months through 5 years who previously completed a Moderna primary series are eligible to receive a Moderna bivalent booster 2 months after their final primary series dose. Children ages 6 months through 4 years who are currently completing a Pfizer primary series will receive a Pfizer bivalent vaccine as their third primary dose.

Updated COVID-19 vaccines are formulated to protect against some of the more recently circulating viruses.

Most importantly, COVID-19 vaccines are critical to providing ongoing protection as immunity wanes and the virus continues to mutate.

The vast majority of children in this age group have not received any doses of a COVID-19 vaccine. CDC is working to increase parent and provider confidence in COVID-19 vaccines and improve uptake among the 95% of children who are not vaccinated or who have not completed the COVID-19 vaccine primary series. Parents should talk to their child’s health care provider to ensure their child is up to date on their COVID-19 and other vaccines.