NAHC/HAA Respond to Recent Misleading Article About Hospices in the Washington Post
January 7, 2014 10:21 AM
The Washington Post recently published an article entitled, “Hospice firms draining billions from Medicare.” The Hospice Association of America (HAA) – a National Association for Home Care & Hospice (NAHC) affiliate – took umbrage with many of the article’s implications and offered a detailed response in the form of a Letter to the Editor signed by Carla Braveman, RN, MED, CHCE. Braveman has served as Chair of HAA and as the Hospice Representative to the NAHC Board of Directors for the last four years.
NAHC delayed publication of its response to maximize the potential that the Letter to the Editor would be printed in the Post. While Ms. Braveman’s letter was not published, it is supplied below in its entirety:
To the Editor:
Hospice care is highly regarded by patients, families, and health practitioners alike because it provides effective comfort, relief, and support to terminally ill individuals and their loved ones. We read with great concern your recent investigative report, “Hospice Firms Draining Billions from Medicare” (Washington Post, Dec. 26, 2013). The article implies that hospices are taking advantage of the Medicare program on a widespread basis by admitting patients who “aren’t actually dying” and keeping those patients on service in order to reap profits —an implication we believe to be far from the truth. It has been my experience that the great majority of hospice providers ethically fulfill their mission of caring for the dying, not bending the rules for profit. And while Medicare bases eligibility requirements on a six-month prognosis, recent data from the Medicare Payment Advisory Commission (MedPAC) indicates that the average length of stay in hospice is less than 90 days. Additionally, hospices throughout the nation report that the incidence of patients coming onto hospice care in the last few days of life has increased dramatically. This means that patients and/or their families are delaying care beyond the point at which hospice can provide the greatest benefit. This also means that many of these same patients may be utilizing intensive, costly and futile care that separates them from family and friends, provides little benefit, and diminishes quality of life in their final days.
We also take issue with the authors’ premise that data from the state of California is typical of the nation as a whole. Health care practices vary widely by geography, including end of life care, Extrapolation of data from one state to the entire country fails to recognize this known phenomenon. Additionally, we believe it is important to recognize that live discharges from hospice occur for a wide variety of reasons – those of us working in hospice are very familiar with the circumstances under which patients or family members decide that they have acted too soon and should pursue curative care. It is also frequently the case that a patient may enter hospice but actually improve as the result of the expertise and care rendered by the hospice team. Hospices address these situations through education of the patient about their improved condition, and discharge the patient to more appropriate care.
The Medicare hospice benefit is currently undergoing considerable change. As mentioned in the article, the Centers for Medicare & Medicaid Services (CMS) has taken numerous steps in recent years to increase accountability, and is conducting a thorough review of the payment system with the goal of addressing inappropriate incentives. We strongly support efforts to safeguard the hospice benefit against inappropriate use. At the same time, it is essential that these efforts be undertaken with great care. In contrast to the 8.7 percent figure cited in the article, most recent MedPAC data estimates hospice Medicare financial margins for 2014 at 7.8 percent. This figure excludes the impact of the 2 percent sequester and the cost of numerous nonreimbursable services offered by hospice programs (for example, family bereavement for 13 months following death; volunteer programs; massage, music and other therapies). If the costs of these many services were included they would significantly reduce the average margin for hospice.
We must all do our part to ensure that hospice remains a viable choice for terminally ill patients and their loved ones. Articles of this type may unwittingly discourage use of hospice care, thereby denying terminally ill patients and their families access to vital services that support and comfort them during and in the aftermath of one of life’s most difficult journeys. Under these circumstances, no one is well served.