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.
I would take not-for-profit any day. The profit motive is very strong. Altho there could be fraud and abuse in the NFP too. I strongly support hospice and palliative care, but not the profit motive if it attaches to these areas.
My mother received 76 days of “hospice care” in late 2008, through Allina Health System. Medicare was billed $15,376 for these services (supposedly 28 visits and 25.5 hours of “contact time”) and paid $12,131. In my opinion, the services were minimal, unnecessary and had little impact on my mother’s health and quality of life. We quickly ascertained that there was a strong profit motive. We requested that she be taken off hospice on 12/24/08. No change was noted, and she continues to be well and has even shown some signs of improvement. The system needs overhaul.
It seems counter-intuitive to at first to have a for-profit hospice. However, there are health care professionals that would be encouraged to deliver the type of care they are passionate about, that still need to make a living. Individuals with the drive to go out and create organizations need the flexibility that for-profits afford. I think it limits options for end of life care. On a personal note, my husband received terrible hospice care from a non-profit. I now know that the profit status had nothing to do with the care he received. Perhaps, if profits were riding on the line, the care would have improved. The need to protect the repuation of the business would require it, if nothing else.
I am currently working as a nurse for a state wide FOR PROFIT hospice. I am taken back by all the negative comments about for profit hospices. Our company was founded by a man that did not want to be attached to a hospital organization so he took out a buisness loan, when taking out that loan he was force to have the status of FOR PROFIT. Both for and non get reimbursed the exact same amount of money from Medicare. We like to have patients on for longer than 15-30 days then the patients can get full services such as breavement, grief counseling, and help families with acceptance. I currently have several patients that have transfered to our hospice from NON PROFIT hospices because we provide better care. I also think that the status does not determine how well you are cared for. I believe that the quality of the staff is what determines excellence in care. I encourage families to look at all their options before choosing a hospice, that way when they choose us I know its because we provide the best care!!!!!!!!!!!!!!!