Hospice Care System Has Become ‘Big Business,’ USA Today Reports

Hospice care, once viewed as a charitable service, has now become a "big business," USA Today reports. When hospice care began in the 1960s and early 1970s, it was seen as a volunteer service offered by providers "to ease the suffering of the dying." However, a "major shift" came in the 1980s when Medicare started paying for care for the dying, and the number of for-profit hospices "soared." From 1992 to 1998, the number of Medicare beneficiaries who used hospice care more than doubled, to 360,000 in 1998, according to an analysis by the General Accounting Office. While hospices can provide "medical magic," USA Today reports that it is "easy to abuse the system" because the patient "always dies" and "no one can complain" that the care provider should have saved his or her life. Some families, however, have started to charge that hospices allowed needless suffering to continue or provided care that was "negligent." As a result, hospices have come under increasing scrutiny from government investigators.

Fighting Fraud
Esther Goodrich, CEO of Genessee County Hospice in upstate New York, a not-for-profit facility that is facing a lawsuit from a family over care given to a son, says that hospices "have taken a beating" since the Clinton administration stepped up fraud efforts. "The regulations pile as high as our heads. If you fill out a form incorrectly, and if you do it intentionally, you can end up in jail," Goodrich said. Hospices now often having to prove that patients were near death when they entered the facility. USA Today reports that today's "tighter time frame" -- the average length of stay in hospice care has dropped to 48 days in 1999 from 90 days in 1990, according to the Institute of Medicine -- doesn't "give some families enough time to prepare for the death." Goodrich says hospice workers are often the "target" of intense emotion from a family that has just seen a relative die. But Ron Panzer, a former hospice nurse in Michigan and a current patient advocate, says that cases of abuse "are just the tip of the iceberg in a big iceberg field." Panzer said, "The reality is that hospice is no different than any other part of health care; it's just not being reported." Joanne Lynn, director of the RAND Center to Improve Care, says there is not enough information to oversee hospice care. "We are in the throes of social change, and we don't have much measurement. We should do a random sampling of hospice care and learn what we are doing," Lynn said. In June, a panel assembled by the IOM recommended studies "to show exactly how hospice care is being delivered" in a report. Additionally, the National Hospice and Palliative Care Organization has started a two-year study of 15 hospices and 1,800 patients to determine whether the patients "died with dignity and without unnecessary pain." USA Today reports that the study, which costs $750,000 and is funded by the Robert Wood Johnson Foundation, is "just one of several underway," and the IOM "wants more" (Davis, USA Today, 8/20).