Megan Steiner has worked in nursing homes in and around Detroit for nearly 20 years, and almost always finds which patients near death receive care from nonprofit hospice organizations and which patients receive care from commercial hospices. I knew I was getting care.
“There was a really definite difference,” said Steiner, 45, a certified practical nurse. Looking at their charts, “nurses, pastors, social workers, and other non-profit patients were consistently the most frequent visitors.”
When nursing home staff requested supplies and equipment, nonprofit hospices were quick to respond. By contrast, “if you call and say, ‘I need a special bed,’ it could take days for commercial purposes. Patients sitting in uncomfortable beds can take days.” It takes,” she says.
Ms. Stayner, now a private nurse on duty and certified Desdura A Hamburg, Michigan study also found that nonprofits were more active in maintaining patient registrations, while forprofits ostensibly removed patients from hospice because they no longer met the criteria for “live discharge,” or deterioration in health. , were found to be more likely to re-enroll later.
“People seemed to be leaving when they still needed services,” Steiner said. “I didn’t think there was a logical reason.” But analysts say longer enrollment and discharge could increase hospice profits and help avoid financial penalties. are doing.
Over the years, researchers have reported that, in fact, there are significant overall differences between for-profit and non-commercial hospices.new A study based on the experience of family caregivers Provide additional evidence.
Medicare began covering hospice care 40 years ago. At the time, most hospices were nonprofit community organizations that relied heavily on volunteers. Since then, it has become a growing industry dominated by commercial enterprises.
In 2001, 1,185 nonprofit hospices and just 800 commercial hospices provided care for terminally ill Americans who were expected to die within six months. 20years later, Nearly three quarters of the 5,000+ hospices nationwide They were commercial, and many were affiliated with regional or national chains.
Interim CEO Ben Marcantonio said the change was probably inevitable. National Hospice and Palliative Care Organization, along with some government hospices, represent both types. About half of the Americans who die each year are now in hospice. The number of Medicare beneficiaries enrolled in hospice increased from 580,000 in 2001 to 1.7 million in 2020.
“The growth of commercial providers is primarily in response to growing needs,” Marcantonio said. “This has evolved within a health care system that not only accepts but encourages commercial providers. It would probably have been unrealistic to think that hospices would be permanently exempt from that coverage.”
But the proliferation of for-profit hospices has raised concerns that there is a shortage of dying patients and their families to improve corporate profitability.
of Latest report from MedPAC, In 2020, for-profit organizations received 20.5 percent more from Medicare than they spent providing services, according to an independent agency that advises Congress on Medicare spending. Nonprofits with higher his daily spending per patient had an average margin of 5.8%.
“Unless we make a change, we’re not going to profit from the business,” said chief policy officer Larry Atkins. National Partnership for Healthcare and Hospice Innovationrepresenting approximately 100 non-profit hospices.
“There are a lot of sophisticated players doing decent work on the commercial side,” he concedes, with some reluctance.
In 2017, Barbara Reese found her 85-year-old mother dying of cancer at her home in River Ridge, Louisiana. Her commercial hospice “she was very accommodating to us,” she said, even when her family requested it. Advice at 2am Her hospice provided all necessary supplies and medicines, and dispatched nurses on a regular basis.
“They came when we were really in trouble,” Reese said. Her mother passed away peacefully, and three years later, when her father died in a nursing home at the age of 95, her family turned to the same for-profit hospice.
However, many studies have shown that nonprofits provide better care as a group. A 2019 study found that all hospices within a geographic area receive the same daily rate for each Medicare beneficiary, but patients enrolled in nonprofits are paid more by nurses, social workers, and therapists. getting more visits. Research by consulting firm Milliman.
For-profit organizations are more likely to release patients before they die, a particularly devastating experience for families. “This violates the implied hospice contract to care for patients for the rest of their lives,” Dr. Atkins said.
Dr. Joan Tenno, a health policy researcher at Brown University, and her team reported on these in 2015. ‘Troublesome migration’ There, the patient was discharged, hospitalized, and then readmitted to hospice.
This situation occurred in 12 percent of patients at for-profit institutions affiliated with national chains and 18 percent of patients enrolled in for-profit institutions not affiliated with chains, compared with 18 percent of patients enrolled in non-profit hospices. Only 1.4 percent of patients.
Dr. Tenno’s latest researchA research team, conducted in collaboration with the RAND Corporation, analyzed the family caregiver survey introduced by Medicare in 2016. Using data from 653,208 respondents from 2017 to 2019, the researchers ranked about 31 percent of commercial hospices as “underperforming,” well below the national average. , compared with 12.5 percent for nonprofits.
More than a third of nonprofits were “high performers,” compared to just 22 percent of for-profits. In 2019, the Department of Health and Human Services The Office of the Inspector General also reported Most of the hospices identified as underperforming were for-profit, he said.
Aside from these differences, the hospice industry is plagued with fraud in several states.research by los angeles times In 2020, a number of new for-profit hospices in California are accredited and have Medicare claims, according to the State Comptroller.
That number far exceeds needs, with dozens of hospices sharing a common address, the auditor noted, adding that “many indicators point to large-scale hospice fraud and abuse in Los Angeles County. There are,” he concluded. Last year, the state imposed a moratorium on hospice permits.
Nationwide in November Hospice Association Requests Medicare We are also calling for action in Nevada, Arizona and Texas, where similar patterns of growth and abuse are emerging.
Researchers and critics also point out: Private alarm A stock investment company bought a hospice organization, resell within a few yearsReduce costs through measures such as staff reductions. Most of these acquisitions were previously nonprofits.
For many years, advocates, researchers and industry leaders reform list They believe that everything from enhancing how Medicare conducts quality surveys to moving from a prorated payment model to more individualized reimbursement will combat fraud and improve service.
“Obviously we need more oversight, but we also need to modernize our payment programs to meet patient needs and make it harder for people to abuse the system,” said Oregon, a longtime advocate of end-to-end policy. Democrat Rep. Earl Blumenauer said. – Life Legislation, said in an email.
Families seeking reliable and compassionate hospice care for their loved ones, on the other hand, should do research in order to select a healthcare provider, at a time when they do not need to do so. “It’s not as simple as avoiding all commercial pursuits,” Dr. Tenno says. “There is variability, so we have to look closely at the data.”
of medicare.gov website It mentions other quality measures as well as which hospices are non-profit. ( Nationwide Hospice Search also provides such information. caring info site General guidance is provided from the National Hospice and Palliative Care Organization. )
Dr. Tenno advised caution when more than 40 percent of hospice patients have dementia or are in nursing homes or nursing homes, both of which lead to high profit margins.
A quality hospice provides not only the most common hospice service, ‘routine home care’, but also more advanced care, including inpatient services when needed. Look for a hospice with a four- or five-star rating, although some geographies don’t have a star rating, she added.
Although many family caregivers still give hospice care high ratings despite its changes and challenges, the need for improvement is clear.
“It’s a small part of the healthcare system, but it’s a very important one,” Dr. Tenno said. “Even if you fail, people don’t forget.”