Weekend Listening: For-Profit Hospice Care As Big Business

In this 2009 file photo, Dr. Joel Policzer checks on Lillian Landry in the hospice wing of an Oakland Park, Fla. hospital. Unlike most of Policzer’s patients she made end-of-life decisions. (AP File)
In this 2009 file photo, Dr. Joel Policzer checks on Lillian Landry in the hospice wing of an Oakland Park, Fla. hospital. Unlike most of Policzer’s patients she made end-of-life decisions. (AP File)

Say it ain't so. A great many of us have found hospice services to be lifesavers — or perhaps I should say deathsavers — when loved ones were dying. But this week, On Point aired a particularly eye-opening segment about the financially questionable side of for-profit hospice care — yet another area where American health care may go awry in pursuit of lucre. Listen to the hour here, and here is On Point producer Stefano Kotsonis' write-up the segment:

By Stefano Kotsonis
On Point producer

The for-profit hospice care is a growth industry in this country. But taxpayer beware. (And it is the taxpayer who is footing the bill, big-time.)

Investigations published in JAMA Internal Medicine (Journal of the American Medical Association), JMLE (Journal of Law, Medicine and Ethics), the Washington Post, Huffington Post, MEDPAC (which advices Congress on Medicare issues) and others do not paint a pretty picture.

Huffington Post investigative reporter Ben Hallman’s report is just out. It had an especially eye-catching headline: "Hospice, Inc: How Dying Became A Multibillion-Dollar Industry."

On Point with Tom Ashbrook invited him on to talk about it this Wednesday, June 25.

Too many of these for-profit hospices are gaming U.S. law and cherry-picking patients, finding ways to reap big profits from the Medicare system, taking people who will take longer to die –- and sending them home if they take too long to die, so they can maximize profits. And some of them –- including big, national corporations — have been sued repeatedly by the federal government for their practices. Patient for patient, the for-profits cost the US Treasury a lot more money.

Our guests took pains to make clear that not all for-profits are bad and not all nonprofits are good.

But the problem is real, as even J. Donald Schumacher, head of a top industry trade group, the National Hospice and Palliative Care Organization (NHPCO), allowed: “…You can get a hospice license in this country and not be [inspected by regulators] for [up to] 20 years.”

Schumacher insists the problem is confined to a few outliers. Maybe, maybe not. I’d need somebody to explain to me whether ‘just a few outliers’ could, by themselves, cause the national bill for hospice care to increase well more than five times over since 2000. (In 2000, Medicare-funded hospice care cost you and me and the rest of us a little under $3 billion. In 2012, we paid out $15.1 billion. HuffPo’s Ben Hallman puts our current annual tab at $17 billion.) Talk about the little outlier that could.

Investigative reporting can be a blood sport sometimes. At its worst, a reporter comes up with a handful of damning anecdotes and used them to tar a whole segment of society or the economy. I thought our guests –- including investigative reporter Ben Hallman — were very measured. At their worst, in rebutting those investigations, industry officials spend our listeners’ time dodging questions and tossing out red herrings like confetti.

As great as it was to have Schumacher on, he represents both the for-profit and nonprofit sectors. You can’t pin the worst practices of a few national hospice corporations on him. That’s why we invited on to the show top officials from Vitas, a big national hospice chain that has been investigated several times and is currently facing a federal lawsuit. We felt they should be the ones to answer Hallman et al.

They declined through their publicist, who emailed to tell me the HuffPo story was “sensationalistic” and “misleading.” They were glad, they wrote me, Schumacher was doing the interview instead [paraphrasing here]. We were disappointed. I felt they had a duty, if not to worried listeners, if not to their client-patients, then at least to their shareholders, to address the charges that have been levelled against them on several fronts.

At the end of the hour, the conversation changed direction: The taxpayer and patient bottom lines aside, the personal bottom line remains. Our guest, Dr. Diane Meier of Mt. Sinai and a real expert on this subject, was the main voice of authority at this point. The takeaways from Dr. Meier and several other experts we spoke to are:

Choosing a hospice for your loved one is a tough decision too often left to the most trying of times. Don’t leave it to the last second. Don’t let the hospices recruit you –- they are coming to you (although a caller and hospice marketer said he resented being described as one of many “trolling hospital hallways for clients”), and you have to judge them worthy of your custom –- and the public dollar. Not all no-profits are good, not all for-profits are bad. A little shopping around when you’ve got some spare time, one day long before you have any cause to, will make your life and your loved one’s life a heck of a lot easier.

Readers, hospice experiences you'd like to share?


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