Guest Blog: Hospice & Acuity Levels

There has been much discussion about hospice appearing in the media lately.  One of the reasons for this may be the rapidly-growing number of Americans who take advantage of their hospice entitlement.  As more of us use hospice services, more attention is given to the industry by those responsible for payment of costs associated with the benefit...namely, Medicare and Medicaid.  Unfortunately, this governmental attention gives some "experts" an opportunity to play to the seamier side of healthcare...and they have made no exception for hospice.

The effort to find out whether or not Medicare and Medicaid money is being spent wisely has a legitimate basis and has spurred some serious investigations.  It has also stimulated a flurry of well-intentioned, but misguided media speculation regarding "abuses and misuses" in the hospice industry.  Unfortunately, it seems to be our human nature to give the "negative press" more attention than it deserves.  Some of the more recent articles have gone so far as to suggest a correlation between a hospice organization's tax status (“for profit” vs. “not for profit”) and the quality and/or level of care it provides.

Since all hospices are reimbursed for services provided at a pre-determined daily rate set by the Center for Medicare /Medicaid Services (CMS), it has been alleged by some attention-seeking journalists that "for profit" hospices tend to "cherry-pick" patients who have fewer care needs and longer projected life expectancies in order to maximize the hospice’s reimbursement leaving the sicker and more complicated shorter-stay patients to receive their care from the "not for profit" agencies.   This kind of statement would suggest the “not for profit” hospice doesn’t have a choice in the matter.  In fact, no hospice has the choice.  As prescribed under Medicare rule, hospice is a "patient-centered" service.  It is the patient who chooses which hospice program he or she wishes to have provide the needed care, not the other way around.  

In addition, determination of life expectancy is, at best, an “educated guess”.  It would be remarkable to learn that “for profit” hospice programs were able to precisely predict a person’s life expectancy while the rest of the entire medical establishment cannot.  It might be well for the researchers to look a little more closely at this question.

As with many service industries, there is always a risk that some individuals will find ways to take advantage of both their customers and the good names of the companies by whom they are employed.  However, with few exceptions, hospice agencies continually seek ways to improve and assure the quality of their customer services and welcome the scrutiny of appropriate consumer protection services.  The vast majority of hospice programs in America strive to maintain a level of transparency which affords any of the oversight agencies an opportunity to see what they do and how well they do it in terms of providing care and services.

Whether the agency is a "for profit" or, "not for profit" should have no correlation to the length of stay, or the quality of the services provided.   While "not for profit" implies some perception of doing "social good", the "for profit" hospice agencies have also developed organizational efficiencies to assure the highest quality of both their patient care and their business practices.  In fact, the majority of hospice companies in the U.S. are "for profit" agencies having made a business determination to structure themselves using a model that eliminates the need to depend on funding solicited from the very same community they serve.