For-profit hospice care has grown at a stupendous rate, possibly complicating the financial aspects of transferring a patient out of hospital care, concludes a study recently published in the Journal of Law, Medicine and Ethics.The Quagmire: How American medicine is destroying itself.
For-profit hospices grew 128 percent between 2001 and 2008, according to "In the Business of Dying: Questioning the Commercialization of Hospice." By contrast, government-run hospices grew by just 25 percent, while non-profit hospices grew by just one percent.
The study's authors suggest that for-profit hospices have focused on both aggressive marketing efforts and "cherry-picking" of particular patients to boost profits.
"It turns out that in part they're doing it because they are very selective about the types of patients that they treat. So there's clearly a strategy whereby they're going to target the patients that are least costly to care for," Joshua Perry, one of the study's authors, told Healthcare Finance News.
Medicare pays the same per diem rate for hospice care no matter their illness, creating a perverse incentive to select patients who would remain in hospice care longer. That means patients with dementia would likely be preferable over those with cancer, notes Perry. Conversely, hospitals may find it more difficult to move cancer patients--who are very expensive to treat--into hospice care.
However, a spokesman for the National Hospice and Palliative Care Organization said such practices would be illegal.
Why are high-risk pools having so much trouble?
Perhaps as a result, many Americans remain clueless about what’s in the Affordable Care Act — and even whether it still exists. As recently as late February, a poll conducted by Kaiser Family Foundation found that nearly half of Americans thought that health reform had been repealed or said they didn’t know whether that was the case. Within that context, it’s not surprising that so few Americans are rushing to sign up for a special insurance program that, up until recently, had relatively stringent requirements for participation.
The obstacles that these early deliverables have encountered have prompted even some reform supporters to wonder whether the Dems were overly ambitious about what they could accomplish immediately. In addition to the high-risk pools, for example, a new insurance regulation banning some bargain-basement insurance plans has prompted HHS to issue 1,370 waivers to businesses and other policyholders to exempt them from the program, as I recently reported. “It was a huge lift — it was always going to come out of the gate more slowly than they thought,” Peter Harbage, a health-care consultant and former Clinton administration official, told me, referencing the high-risk pools. “It’s like turning around an aircraft carrier.” Nevertheless, having made big promises about the immediate benefits of health reform, Democrats might be under growing pressure to deliver.
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