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Good palliative care at the end of life can be a boon to patients and their families, all of whom agree that care comes at home, or in an inpatient facility like this hospice of the AIDS. Still, the oversight of the industry is important, say federal investigators.
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Good palliative care at the end of life can be a boon to patients and their families, all agree that care comes at home, or to a hospitalization facility like this AIDS hospice. Still, the oversight of the industry is important, say federal investigators.
Bromberger Hoover Photography / Getty Images
We all hope for some peace at the end of life, for ourselves and for our loved ones. Hospice services can play a big role, relieve pain and provide spiritual and emotional support. But a federal report released Tuesday synthesized patient and Medicare payment data back to 2005 and found that as the hospice industry grows, some hospice providers are limping into Medicare and neglecting patients.
The report calls for Medicare and Medicaid services, which is a key player in funding hospice palliative care services, to increase its level of control in order to improve the detection of these problems.
Hospice services are an increasingly popular Medicare benefit. In 2016, Medicare paid $ 16.7 billion to hospice providers. A decade earlier, it was $ 9.2 billion. And, unlike many other health care providers, hospices are not paid by service rendered. They are paid per patient, per day, "regardless of the number of services they provide and regardless of the quality of care they provide," says Nancy Harrison, a Deputy Regional Inspector General at the US Department of Homeland Health. health and social services and the
Although patients can generally rely on the hospital to relieve their suffering, the report shows that the needs of patients have sometimes been ignored.
"We found that hospices offer fewer services on weekends than during the week. Harrison said, "Much less, in fact, and patients would suffer as well on weekends as on weekdays."
Other forms of neglect were noted in the report. a hospice billed Medicare for more than two weeks of high-level care without ever visiting the patient, simply calling his family and asking him how he was going.
Federal evaluators also found that some palliative care providers were looking for Patients who live in nursing homes or assisted living settings have been able to bill Medicare for a level of service that some patients did not need, but that cost the government nearly four times more than basic home care.
Therefore, in 2012 alone, Medicare paid $ 268 million for hospital care on a regular basis expensive and expensive for patients who did not need it.
The report also highlights how some hospice palliative care companies make money in case of outright fraud. Derrick Jackson, a long-time HHS special agent, remembers a case that occurred in 2014 when a Mississippi hospice owner had enrolled clients who were not terminally ill and n & # 39; 39, were therefore not eligible for the hospice. The owner was sentenced to nearly six years in prison and had to repay nearly $ 8 million.
Jackson says patients in this case did not even know that they had enlisted in a hospice. "Often, these hospice owners will sell themselves as 'we will clean your house for free' – in other words, a housekeeping service.Other times, he says, new clients were elderly, isolated people who just wanted "Someone to come and"
The consequences of enrolling in the hospice when you do not need it are serious, Harrison says.
"When a patient elects palliative care, he gives up his entitlement to Medicare. She says, "in fact, they give up healing. And if they do not know that they are doing this, they might not be the best choice for their future. "
The Inspector General's report contains 15 recommendations to improve the system.Medicare and Medicaid Services, or CMS, should analyze more data to spot scams and then share that information with the inspectors. hospice and the public
CMS provided no one for an interview for this story. "Ensuring patient safety and access to quality care at the hospital and in all institutions of certified care is paramount for the work of CMS.The agency takes on the oversight role of the Medicare Palliative Care Program and aggressively focuses on reducing and eliminating fraud, waste and abuse . "
Harrison, lead author of the critical report, believes that it is crucial that the government because the hospice will eventually affect us all. "
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