MedPAC has voiced concern over the growth of for-profit hospice agencies since the year 2000 and the profit they make by taking in patients with long lengths of stay. Under the new recommendations, hospices would be reimbursed at a higher rate when a patient first begins hospice services, with the rate decreasing the longer a patient stays on service. It also includes a payment for higher cost of care near time of death.
I'm personally not opposed to these recommendations. They do make sense - caring for patients with short stays on hospice care costs an agency more money that caring for patients who are on hospice long-term. I'm also in the school of thought that thinks making a profit off of dying patients seems a bit wrong.
I am a bit concerned, however, that once hospice agencies are no longer incentivised to bring on the not-so-sick patients, that more and more of them will focus on the bringing in patients with shorter lengths of stay. I firmly believe that hospice care works best the earlier a patient comes onto service. The work of pain and symptom management and preparing a patient and family for an inevitable death can't happen effectively in a matter of days. Using hospice as a last-ditch effort to control symptoms in the last few days of live robs the patient and their loved ones of an essential service.
What do you think of the new recommendations for hospice reimbursement reform? Do you have an opinion of for-profit vs. non-profit hospice agencies? Leave your comments below.