Profiteering: Patient-Centered vs. Profit-Driven Hospice Care – Part 3

RESEARCH FINDINGS ON PATIENT CARE QUALITY

Recruiting healthier patients

Research studies by The Washington Post, the federal government and other organizations indicate that some for-profit hospices are enrolling patients who are not terminal.¹⁴ This allows these hospices to collect the per-diem rate established by the Medicare Hospice Benefit, while not providing the more expensive care that critically ill and/or dying patients often require.¹⁵ 

Additional research by MedPAC – the Medicare watchdog group established by Congress – supports this healthy-patient recruitment concern. According to MedPAC, the average number of days patients are staying in hospice is increasing, particularly at the for-profits. The average length of stay in a for-profit hospice is 102 days compared with just 69 days in not-for-profit care.¹⁶ Longer lengths of stay for less sick patients yield more revenue, but this puts non-terminally ill patients in the wrong healthcare setting.

In combination, these two documented practices in for-profit hospices – discharging patients before death and enrolling patients who are not actually dying – serve to increase profitability while decreasing the overall quality of hospice patient care.

Reduced Access to Nursing Care and
a Narrower Range of Care Services

In research conducted by The Washington Post, Yale University School of Medicine, and the Icahn School of Medicine at Mt. Sinai in New York, discrepancies were found between for-profit and not-for-profit hospices tied to nursing care, pain management, bereavement support, and the array of treatment options offered. Key points from this research:

Final days of life: While both not-for-profit and for-profit hospices sent nurses to see patients at some point during the last two days of life, a patient at a for-profit hospice was 22 percent less likely to see a nurse in that critical time period, indicating a lower level of responsiveness.¹⁷

Per-day spend: For-profit hospices spent 17 percent less per patient per day on nursing visits; not-for-profit hospices spent about $36 per day per patient, while for-profit hospices spent just $30 per day.¹⁸

Range of patient and family services: Patients at for-profits hospices were also less likely to receive the full array of treatment options for pain and symptom management that were offered in not-for-profit settings.¹⁹ Not-for-profit hospices also provided more intense services, such as continuous nursing and inpatient care, for those patients with difficult-to-control symptoms.²⁰ Specifically, not-for-profits offered about 10 times as much of this type of care per patient-day as the for-profits.²¹ Finally, for-profit hospices were less likely to offer comprehensive bereavement services to families.²²