As nonprofits ceased to dominate the hospice field in recent years and for-profits became the majority players—according to the
New York Times, for-profits controlled
63 percent of the sector as of 2013—
quality of care has arguably decreased while
fraud and overbilling has increased.
NPQ has been following the changes
to the hospice industry for years, and while it is possible these
issues plaguing hospice can be chalked up to correlation, not causation,
it seems more probable that the hospice industry’s lack of standards
coupled with its high profit potential make it ripe for fraud by
dishonest providers.
With profit margins as high as 16 percent, it comes as no surprise that for-profit companies want a piece of the pie and
have eagerly joined the industry. The
New York Times
estimates that since the year 2000, the number of for-profit hospice
providers has “more than quadrupled.” In this time, dozens of lawsuits
have found for-profit outfits guilty of a wide variety of infractions
ranging from
inappropriately accepting patients into hospice,
to substandard care, overbilling, and even causing untimely death.
Throughout it all, hospice providers have received “slap on the wrist”
penalties with no real changes to the industry occurring.
Part of the reason there are few changes being made to the industry
is that the field itself is rather subjective. In the face of terminal
illness, some physicians and patients opt for aggressive treatment,
whereas others do not. In some cases, it seems to be as much a personal
decision as it is a medical one. While the
National Hospice and Palliative Care Organization
has put out a tip sheet on compliance, even this indicates that “each
patient and his or her symptoms will differ.” The subjective nature of
the field does not lend itself to strict standards and, to
reiterate previous NPQ conclusions, may be another reason that hospice should stay within the nonprofit sector. Without a profit motive,
nonprofit organizations are better able to focus on quality care and keep the patients’ best interest front and center.
With Humana entering the game, now there’s a new player with added
cause for concern. Humana is partnering with private investors to
purchase two hospice providers, Kindred and Curo. Both providers have
already faced steep penalties:
Kindred for overbilling and Curo for
providing kickbacks to physicians
referring patients to its facilities. Humana’s foray into hospice
represents one of the first insurers to do so and, as one of the largest
private Medicare agencies, they stand to reap in huge profits as they
work with patients from health through death.
What is particularly concerning about Humana’s involvement is that Humana would benefit from its customers
opting for hospice over expensive end-of-life treatment. The
New York Times article explains:
“An insurer that can steer patients towards its hospice
has ‘better control,’ said Rob Smith, an analyst with Capital Alpha
Partners. After giving consent, dying patients can be shifted to the
hospice program, and while an insurer would lose out on money it
received from Medicare to cover that person, a company like Humana could
count on the revenue generated by its hospice business. ‘Your other
pocket is filled by Medicare,’ he said.”
The same issues plaguing the hospice industry stand to be exacerbated
in the case of Humana unless the company sets its own high standards
for hospice eligibility. When hospice providers operate independently,
they still need to convince patients to come to their facility. That
would explain why providers such as Curo provided incentives for
physician referrals. With Humana dominating private Medicare and owning
its own hospice outfits, they can technically funnel patients into their
facilities.
With Humana entering the hospice field,
it’s only a matter of time before other insurers jump on board as well.
This idea of ’til-death-do-us-part healthcare from for-profit entities
smells incredibly fishy and opens up an already problematic industry to
even more duplicitous behavior. Meanwhile, patients and families are in
their most vulnerable position and need help that is not clouded by
greed. While the hospice field seems to be moving away from nonprofit
hospice providers, it stands that this is the best model for the
industry.—Sheela Nimishakavi
Full Article & Source:
’Til Death (or Lack of Profits) Do Us Part Healthcare: Humana’s Debut in Hospice
