The Washington Post and a few other local media outlets around the country have started to look into hospice providers who place patients on service who don’t need the service. Anecdotally, we have heard many times that patients who would be better served by home health are admitted to hospice and end up either being discharged or experiencing a quicker demise. While most hospice providers do provide ethical and necessary services, there are some who look at patients with dollar signs in their eyes.
Another media outlet, WTSP in Tampa, Florida recently conducted its own investigation and interviewed the children of hospice patients. The interviews exposed several incriminating details regarding how certain hospices operate and the tactics used to admit patients who should be seeking other services such as home health, nursing home or rehab center care, or outpatient therapy. WTSP also interviewed a hospice case worker, Nancy Chase, who filed a federal whistleblower lawsuit alleging that a certain hospice in the Tampa area recruited patients who did not need services.
Nancy Chase detailed the allegations by stating the hospice provider frequently used quotas such as 3 patient admissions for every 1 nurse per week. WTSP was able to verify the allegations by reviewing internal memos provided by Chase. The hospice provider under investigation is a non-profit provider in the Tampa area and owns several hospices and a home health agency.
A recent OIG report has discovered some other alarming details of unscrupulous hospice providers. OIG inspectors discovered that almost one out of every three patients did not receive information about hospice care during the admission process. Further, patients had no clue that by electing hospice care, they were stopping all future treatment for illness. Instead, patients would only receive palliative care to ease pain and suffering. Physicians were also complacent in approving hospice care and providing very little supporting documentation to show the need for hospice.
Hospice providers know that the margins for services are much higher than home health and therefore produce much larger profits. Also, hospices are aware that a patient that is healthier and taken on service sooner rather than closer to death is much more profitable since not as many services are required. The report corroborates this financial dealing with one in three hospice patients stopping services because – sit down for this one – they didn’t need hospice because they weren’t dying.
An acceptable range for patients to leave hospice care and seek additional treatment due to an improving condition is about 15%. But as the report indicates, new for-profit hospices seem to be the group that has an abnormally high percentage of patients who leave hospice care due to improved condition. More than 30% of for-profit patients leave the care of for-profit hospices due to improved health.
Two states were called out for their higher than normal discharge rates for living patients. Alabama providers discharged 35% of their patients and Mississippi discharged 41% of their patients. In people terms – about 2 out of every 5 patients admitted needed to be discharged and discontinue services due to their ability to survive and receive treatment for their illness.
This is a report that outlines the negative side of hospice. Many hospices do provide essential and compassionate care to those patients who need it. Also, as pointed out by WTSP, non-profit agencies are guilty as well. But as many know in the healthcare community, the first to be accused and often publicly called out are the for-profit providers, whether they be home health, hospice, or a nursing facility.
You can expect that in the coming months and year, more focus will be placed on hospice compliance. It would not be shocking for hospices to one day require a document similar to a home health Face to Face that would require more substantive documentation from the patient’s physician certifying the need for service. We will be following OIG action and will keep you informed of changes.