Hospice enrolling well patients to kill them?

The online headline of the WaPos latest on the Medicare hospice benefit (in fairness to the author, they typically don’t have control over headlines; but the article itself has such competing themes, it would be hard to figure out the headline):

Lethal doses: the dangers of hospice care

The hospice industry is booming, but concerns are rising about treatments for patients who aren’t near death.

If you stopped at the headline, and sub-headline you would get several ideas:

  • Hospice is enrolling patients who aren’t dying
  • Lethal doses of medicines are being given, meaning either euthanasia or homicide is occurring (depending upon the state there is no legal difference between the two)
  • Hospice is booming, presumably due to enrolling and then killing patients who aren’t dying

Not sure where to start, so I will just make a few points (busy day).

  • There are legitimate worries about long hospice stays, particularly that go beyond the presumptive period of 180 eligibility for hospice. But, the business model for hospices getting rich by enrolling non dying patients into hospice is not to kill them, but to bill Medicare for their care for a long time. Hospice is reimbursed on a per diem amount. The financial maximization incentive is to serve them longer, not shorter. Long hospice stays are a problem, but this article’s mashup of enrolling patients who aren’t dying to get rich and then killing them quickly makes no logical sense together.
  • There are some very bad stories in this article. At least one of them is essentially an accusation of homicide. If I talked to a reporter about the care described, I would definitely take the next step and talk to the district attorney in the county in question.
  • There is a story of a patient getting better, but the hospice continuing to provide care without acknowledging this reality and continuing to provide hospice. This is one example of the traditional long stay hospice concern. Purposefully giving your patients fatal overdoses is directly contra to the financial motive of wanting to bill Medicare for a long time for patients who don’t need hospice.

To say that this article went for the sensational is a bit of an understatement. However, it bizarrely throws together different types of sensational narratives in a way that makes little sense. They are bilking Medicare via long stays! They are killing their patients with overdose! Logically, there could of course be examples of both, but this story does not do a good job of setting these cases against the general context of hospice care. And given that this is a part of a series on hospice, I would expect better in a newspaper of this stature.  

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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