Fraud, marketing just part of problems with hospice system

Paul Kleyman

About Paul Kleyman

Paul Kleyman is director, ethnic elders newsbeat, for New America Media and the national coordinator of the Journalists Network on Generations, a group of 1,000 journalists who cover issues in aging.

Photo by Richard White via Flicker

Photo by Richard White via Flicker

A Huffington Post exposé in June, “Hospice, Inc.,” rekindled some thoughts I’ve long had about the split personality of the journalism on complex topics like aging.

One week, readers see richly reported news features, usually by health care or feature reporters, about the struggle of elders and their families caught in this country’s messy long-term care system. The next, readers get stories by political, economics reporters on bipartisan budget debates (how much to cut this year) or exposés that aim for accountability, but don’t help most families.

The Huffington Post project got me thinking – what’s the responsibility of an investigative team posting an approximately 7,000-word, six-month investigation? How can they get beyond house-of-horrors revelations?

In “Hospice, Inc.,” economics reporter Ben Hallman and colleagues uncovered a troubling trend in for-profit hospice care, but didn’t cover a more pervasive development in end-of-life care: the relegation of dying patients to painful and unwanted high-tech medical interventions.

The report prompted a dismayed reaction from Huffington Post blogger David Casarett, M.D., a palliative care physician for a nonprofit hospice, who called the article “not very helpful to patients and families who need hospice.”

Without connecting to the context of this country’s fragmented and easily gamed system of such care, fright-fraught reporting does little to move the national health care debate beyond the language of skewed ideas like “death panels” or slashing government rather than making it more effective.

I recently posted a piece on a study in PLOS One by Stanford University’s V.J. Periyakoil, M.D., and her research team. They surveyed 1,100 doctors and found that, just like the American public, 90 percent of them said they would prefer being comforted at life’s end if their condition was no longer amenable to medical intervention. Yet, there’s been a significant jump in recent years in the number of U.S. patients treated by 10 or more physicians in their last six months.

In fact, the median length of hospice service declined in the U.S. in 2012 to 18.7 days. The industry trade blog, Home Care Technology Report, observed, “While the Huffington Post article highlighted some national statistics showing that patients are spending a longer time in hospice, a deeper look into the numbers reveals that almost half of terminally ill patients (48.5%) enter hospice within the last two weeks of their lives. 61.4% of patients are on service less than 30 days, and 35.6% are on service less than eight days. In other words, almost two-thirds of patients are not entering hospice soon enough.”

That, says Periyakoil – and pretty much everyone else doing actual care – is simply too late for seriously ill people to reap full benefits from palliative control of their pain and symptoms, and to reduce stressful emergency room crises.

The HuffPost findings are certainly significant. Hallman and his colleagues show that that for-profit hospice ownership has increased since 2000 at double the rate of nonprofits. And, “Since 2006, the U.S. government has accused nearly every major for-profit hospice company of billing fraud.”

They showed that average for-profit hospices stays are substantially longer than at nonprofits (105 days versus 69 days). Yet didn’t the disturbingly short median hospice stays prompt questions, such as what’s wrong with that other end-of-life care? The shrinking lengths of stay in American hospices smell of high-tech invasive care imposed beyond what anyone desires.

In response to my e-mailed question about “Hospice, Inc.,” Stanford’s Periyakoil replied, “The true question is: what are the needs of patients in the last years of life and how can we best serve them? What we cannot afford to do is ignore the needs of seriously ill older adults in the last two years of life as they will become frequent flyers in the hospitals — which is how they expend 32 percent of the Medicare budget in that period.”

Any system awash in billions of dollars calls for exposure of incompetence, corruption and gaming. The trouble is that, while HuffPost’s “Hospice, Inc.” seems thorough and may well prompt public action, it would benefit from the context of those who need hospice care and other end-of-life issues. The quest for decent care as our lives slip towards the end begs for insights in terms of what individuals and society wants and can achieve – with a little help from good journalism.

1 thought on “Fraud, marketing just part of problems with hospice system

  1. Richard PeckRichard Peck

    Hear hear to Paul’s central message. The long-term care “victim” has long been a staple of healthcare journalism and, while there’s no shortage of egregious examples of elder abuse by such facilities, both consumers and operators deserve so much more than that. The complex, expensive world of long-term care needs positive exploration of best practices and consumers’ ability to access them. It’s tough enough to have to deal with such services without going in with a victimized attitude. Richard Peck, author of The Big Surprise

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