Friday, January 07, 2005

Everybody's in it for the Money

The latest issue of Medical Economics has a rather cynical article about hospice care:
When Medicare began to reimburse for hospice care in the '80s, it caused a sea change in the business structure of hospices. They went from the largely charity funded, volunteer-staffed organizations of the '60s to nonprofits and a few large for-profit companies.
Medicare reimburses the hospice roughly $122 for every day the patient is in hospice care. In return, the hospice provides meds, medical equipment, regular nurses' visits, pastoral care, and visits by home health workers and social workers. A nurse and doctor must be on-call 24/7.
If a hospice averages 30 Medi-care patients a day—and most larger companies average more than 30—it will generate more than $100,000 in Medicare re-imbursement each month. It doesn't take an accountant to see there's a profit to be made here. Three of the largest companies are showing impressive earnings or growth.

The article goes on to give several examples of hospice company reps trying to inappropriately get patients for their hospices. The author concludes:
I've had negative experiences with various hospices, but I'm still a strong proponent of hospice care. They're not all alike, and there are several things a physician should consider when ordering hospice care for a patient.
Most important, does the patient want hospice services? Some patients and families don't want strangers dropping in during this difficult time. It's very easy nowadays for a physician to have hospital beds, pain meds, and other medical goods delivered to a home without a hospice being involved.
If the decision is made to order hospice care, consider several things when choosing a company. What is its structure? How aggressive is the company? If it's spending a lot of money soliciting your business, do they have their priorities straight? Are they focusing on care or profits? Ask your patients who have lost loved ones to terminal illness if they used a hospice. What did they think of it? Were the nurses caring and responsive? Did they fulfill their obligations?
Lastly, keep your focus on the dying patient. Find out what's important to him, and decide whether a hospice can or is willing to provide for his needs.

We all need to make a living. But our highest priority should be to do what is best for the patient.

1 comment:

Anonymous said...

It's actually Liz from (I Speak of Dreams).

In 1991, hospice care made the difference between a miserable end-of-life for my dad, and a meaningful one, for him and for me and my sisters. I believe that the hospice we used was a small not-for-profit. It was the local priest who got us together with the hospice, as the physicians wanted Dad in the hospital.

But it is not for everyone--even with hospice care, a home health care worker, and three able-bodied, practical women (me and my sisters) it was exhausting. Practical nursing isn't for everyone. Being able to, for example, change your dad's diaper isn't an experience every person wants to (or should have).

One thing that made a big difference for us: is there continuity of care? Does the same person (or team) visit every time?

Another thing: we were able to manage dad's care--not every family can, and shouldn't be made to feel guilty if they can't.

just met you, by the way, via Chronicles of a Medical Mad House (I think).