As the director of a small non-profit hospice in Atlanta Georgia, I am concerned about the practice of hospice in this state. I am grateful for the increased scrutiny that we are under by Medicare because I am witness to the abuse of many of the larger for profit national chains whose marketing practices are questionably ethical. These practices contribute to the skyrocketing cost of medicine.
The hospice lobbyists claim that it is much cheaper for the government to provide hospice care at the end of life rather than incur the costs of hospitalizations. This is absolutely true. However, this also provides the perfect foil for many of these providers to abuse the system.
I commend MedPac’s (Medicare Political Action Committee) recommendation to investigate the marketing practices of hospices.
I am appalled at the way some hospice representatives walk into assisted living facilities and promise the staff that, if they refer a minimum number of patients, they ( the hospice) will provide them with a fulltime nursing assistant. For assisted living facilities meant to provide assistance with activities of daily living this is an offer that is hard to refuse (and seldom is). Those of us who do not offer this are at a competitive disadvantage. This takes the choice away from the families because the assisted living facility will influence the referral based on their needs, not what is in the best interest of the patient/family.
I say go OIG (Office of Inspector General), look closely at the conflict of interest in these agreements.
I am also comforted by MedPac’s recommendation that the length of stay of patients come under closer scrutiny.
Hospice is for people in the last six months of life. While no one has a crystal ball and many times we agonize over whether to discharge patients, we have clear criteria for every diagnosis to help us decide. When I hear about hospices keeping patients for two years I have to wonder how they are able to justify that.
Another problem is that here in Georgia there is no Certificate Of Need. We have over 148 hospices (probably more by now), and only four of us are non-profit. The competition is fierce.
Finally let me say that Hospice, when it is done properly, is a wonderful system of care. It has been an absolute privilege to care for people at the end of life. Nothing is more rewarding than helping people die with minimal pain, with the patients and their families getting the support they need from a group of dedicated professionals and volunteers.
Perhaps if we decrease the profit potential of hospice care, the larger for profit chains will no longer be interested in providing end of life care, and we can go back to practicing hospice as it was originally meant to be practiced with Americans dying more peacefully in the care of providers who are providing hospice for the right reasons.
I say, bring on the scrutiny.
Talya Bloom, RN