Friday, May 25, 2012

Who Cares if The Patients Die? - Apparently Not Some Hospice Marketers

An article in USA Today suggests that marketers for hospices are pushing even more aggressive measures to recruit patients, regardless of the consequences.

Marketing Hospice to Prevent Re-Admission

Per USA Today,

Hospice marketers, exploring possibilities for new revenue to help continue the industry's remarkable growth, are looking to exploit a provision in the 2010 health care law by persuading hospitals to send Medicare patients into end-of-life hospice care instead of readmitting them to the hospital.

Such a move, the hospice marketers say, will enable hospitals to avoid paying the Medicare penalties required by the new law when hospitals discharge patients and then have to readmit them within 30 days: Instead of readmitting the patients, hospitals should send them to hospice care, which also is covered by Medicare, according to a USA TODAY analysis of marketing materials.

Patients with severe heart problems and pneumonia tend to decline quickly and often move in and out of hospitals, said hospice marketing specialist Rich Chesney, who proposed the idea.

It might be better, Chesney said, if a hospital CEO hired people to talk to family members about hospice, instead of a doctor, who is more focused on not losing a patient. Chesney made his proposal recently at a conference sponsored by the National Hospice and Palliative Care Organization, an industry trade group. [Chesney is apparently the President of Healthcare Market Resources, whose slogan is "growing bottom lines with information." - Ed]

'If (hospices) make that part of their business and their revenue stream, that's sound business,' said Stan Massey, chief marketing officer for Transcend Hospice Marketing in Holland, Ohio. Massey recently wrote a blog recommending hospice marketers talk to hospital CEOs instead of the doctors who usually decide who is eligible for hospice care. Those conversations, he wrote, 'must be framed heavily in terms of financial benefit.'

Ignoring the Hospice Mission

Lost in the marketers' thinking seems to be any notion of the hospice mission. Hospices are supposed to provide compassionate palliative care to patients at the end of life who do not want any further aggressive intervention. Good hospice care is likely to make the last days of such patients more tolerable.

However, generally hospices intentionally do not provide any care beyond palliation, such as, for example, antibiotics for acute infections, transfusions in the case of acute blood loss, or surgery for acute trauma. Should a patient who is not at the end of life be erroneously admitted to hospice, and then suffer some new acute problem, that patient is at risk of bad outcomes, including death because of denial of the sort of care available in acute care settings. Thus, admitting patients to hospice who are not at the end of life or have not given truly informed consent for hospice care may lead to patients dying prematurely, or suffering suffering preventable complications of treatable diseases and injuries.

Aggressive marketing of hospice, particularly pushing hospice for patients just because they seem likely to be re-admitted to a hospital, especially by having marketers try to go around patients' own physicians, risks admitting patients to hospice who should not be in hospice. Thus such aggressive hospice marketing may lead to needless, and wrongful deaths of, injuries to, and morbidity for patients who should have received more aggressive treatment.

The USA Today article did note:
Health care analysts and ethicists, however, say such proposals are contrary to the intent of the health care law, which is to provide better care, not to put more patients into hospice care for which they are not ready.

The proposals warp the 'whole idea behind hospice,' said Josh Perry, a business and ethics professor at Indiana University.

In addition,
Good hospices have been working with hospital CEOs for years, said Carolyn Cassin, president of the National Hospice Work Group, a coalition of the 25 largest not-for-profit hospice organizations. But the goal, she said, was to make sure patients received the care they needed. She said she was surprised to hear it characterized as a marketing approach to cut costs.

While hospice care costs less than hospital care, at $151 a day for Medicare patients, it's meant for people who are going to die. In hospice care, patients agree not to seek care to improve their health, such as more surgeries, hospitalizations or chemotherapy. After a doctor certifies that he expects a person to die within six months, Medicare covers hospice care.

Experts say they fear patients will be sent to hospice before their time and miss the proper care that could restore their health. Penalties, Perry said, are a 'good thing' to hold hospitals accountable. 'This isn't about extending hospice.'


We have previously discussed, most recently here, allegations that specific for-profit hospice corporations were admitting patients who were not at the end of life just to make more money. The current USA Today article suggests that the phenomenon of hospices enrolling inappropriate patients just to enhance revenue could be more widespread than previously appreciated. The more often hospices enroll patients who are not at the end of life, and/or have not given true informed consent for hospice care, the more patients are likely to suffer needless and wrongful morbidity and injuries, and the more patients are likely to needlessly, and wrongfully die prematurely.

It seems to me that unexpected morbidity of, injuries to, or premature death of hospice patients who were not obviously already at the end of life could lead to civil litigation, and even criminal investigation.

Furthermore, the realization that hospices, once considered the most humane of health care institutions, are more frequently run for profit, and may put profit ahead of their mission should provoke re-examination of our haste to encourage more and more patient care to be given by for-profit organizations in an era of "greed is good."

If we really want better health care, we will have to change policies, practices, and laws so that leaders of health care organizations are motivated more by the desire to help patients than by the desire to become rich.


Judy B said...

I thought I had reached a level of outrage that could not be topped, but this information did it. A for-profit hospice is totally obscene!

When is the outrage going to reach the general public? Thank you, Dr. Poses for continuing to reveal all of this!

Afraid said...

Policy makers do not ever seem to understand that self interest always undermines the intended results and twists them into opposition of the stated goal.

Sad, withe policy and administration by non-doctors and nurses we get worse results and more expensive healthcare.

Time to get the administration out.

Anonymous said...

This is no surprise. The US Government pays lip service to the elderly. Its true mission is to allow old people to die. If it was any other, it would be spending taxpayeers' dollars on medications and medical care for the destitute and newly destitute (thanks to the economy) rather than enriching the vendors of electronic medical records and electronic ordering devices which have ZERO proof of improving outcomes or reducing costs. What a sham. This applies to both sides of the aisle, though the nod goes to the Romney led as being most mercenary.

Anonymous said...

Between hospice corporations and the casket/ funeral corporations, death sure is not a dying business.

There is gold in dying. The hospital administrators will be taken by the hospice strategy to massage their numbers and maintain their multi-million dollar compensation packages.

Doctors will feel huge pressure from the nag nurse case managers to put patients in hospice, the angels of death.

In my experience, hospice=kervorkian; and case managers are useless when they need to do something for the patient that the doctors (rather than administration) want.

The day when credentialing will include the number of hospice referrals is soon upon us.

Anonymous said...

I work for a non-profit hospice and the things I encounter every day with the for- profit hospice just make me sick to my stomach. It is all about profit and not about what is best for the patient. Unethical, greedy companies will have there day when CMS starts to do the aggressive audits. I can sleep at night knowing we are doing what is best for the patient's/families and not admitting patient's that are not appropriate therefore wasting Medicare money.

Anonymous said...

I work for a not-for profit hospice and I see a huge emphasis on saving money. You guys don't understand that even so called not for profit hospitals make LOTS of money. The CEO's of these not for profits make millions. This is just a description of their tax status. This does not describe their business. They are ALL about profit.

Roy M. Poses MD said...

Note that what we have written about for-profit hospices, above (in 2012), and more broadly here:
does not mean that all non-profit hospices are saintly.