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Profiting from the Dying

WHAT IS HOSPICE CARE?

The idea of hospice care started in the early 1980s, and evolved to offer terminally ill patients an alternative to hospital care at the end of their lives. Originally established for cancer patients, the hospice care industry has grown to include care for people with Parkinson’s Disease, ALS, dementia, Alzheimer’s, and other terminal illnesses requiring medical and palliative services.

To qualify for hospice care, two doctors must certify that a patient is expected to live no more than 6 months. However, as with all things health-insurance and health-provider related, obtaining hospice services is not so simple and eligibility is far from clearly defined. Statistics aren’t widely available on how many patients are denied hospice care, but a 2012 study published in the journal Health Affairs found that 78% of 591 hospices surveyed had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs. Nonprofit organizations will typically work to achieve a balance so that less complex patients subsidize the patients who need more intensive and expensive care. For-profit hospices, by contrast, may decline complex patients altogether to maintain a profit margin. Such clinical decisions are left to the hospice’s discretion.

HOW MANY PEOPLE NEED HOSPICE CARE?

In 2016, the last year for which there are statistics available, 1.43 million Medicare beneficiaries received hospice care, and 48% of Medicare decedents were enrolled in hospice at the time of their death. Over half of hospice recipients—54.2%—were in hospice for 30 or fewer days, with the largest group of beneficiaries (27.9%) in care for only 1-7 days. These statistics show that many if not most people are not taking advantage of hospice in time, turning hospice into “crisis care” rather than the “comfort care” it is intended to be.

PROFITING FROM THE DYING

While some are being denied hospice care, others are being enrolled too soon. Government lawsuits against hospice providers charge negligence and malfeasance for, among other things, signing up people who are not terminally ill in order to get greater Medicare/Medicaid reimbursement. Government reports show that the median rate of hospice patients discharged before death has climbed steadily since at least 2000, peaking in 2012-2013 at nearly 1 patient in 5 (recent data indicates a slight decline). Hospice providers have also been accused of denying nurse visits and trips to the hospital.

While people receiving hospice care may be less at risk for unnecessary tests and procedures, they might be more at risk for neglect and too little care. When care is being delivered by for-profit entities, the risk is that the focus is on the profit and not the quality of care.

NEW REGULATIONS

In January of 2017, the Centers for Medicare/Medicaid Services, or CMS, and Health and Human Services, HHS, published the first significant new regulations affecting Home Health Agencies (HHAs) in almost 30 years. Originally scheduled to take effect in July of 2017, implementation was delayed until January of 2018. The regulations establish Conditions of Participation (CoPs) for HHAs in order for them to receive Medicare and Medicaid reimbursement. Among the criteria are enumerated patient rights and home health aide training and competency. In addition, significant changes to a patient’s plan of care must be communicated to the patient, their caregiver and the physician directing the patient’s care. The new regulations also add protections against unwanted discharge or transfer by requiring that a doctor agree to any such plan.

CONTACT YOUR ATTORNEY

If your loved one has either been denied hospice care, enrolled in error, or if you believe their care is not meeting their needs, contact Dave Thomas at The Thomas Law Firm for a free consultation regarding their legal rights.

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Thomas Law Firm
Located at 945 East Paces Ferry Road, Resurgens Plaza, GA 30326.

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