California Society of Anesthesiologists Bulletin Spring/Summer 2014 - (Page 60)

NEWS California and National News By Stephen H. Jackson, MD, Editor Emeritus Hospice 'For-Profits' Costing Medicare Billions More Than Planned During the past decade the number of hospice "survivors" has increased far beyond what had been predicted. Part of this unexpected population boost includes "recruited" patients enrolled by for-profit hospice corporations. Hospice patients are supposed to die, but these "recruits" aren't actually dying. Instead, they are living far longer than a truly terminally ill patient would! In order for a patient to enter a Medicare hospice program, two physicians must certify that the individual is terminally ill, with a life expectancy of six months or less, and accepting palliative rather than curative care. The healthier patients are far more profitable because they require fewer resources and live longer. In fact, they even are discharged (in some cases "dumped") alive! An analysis of over 1 million hospice patients' records in California, between 2002 and 2012, showed that the proportion of alive discharges increased by 50 percent, the average length of hospice 60 | CSA Bulletin care rose, and the profit to the hospice care providers quintupled to almost $2,000 per capita. The hospice movement, originally spurred by community and religious organizations, has been largely supplanted by for-profit corporations in an industry that receives $17 billion a year, $15 billion of which is paid by Medicare. AseraCare, a large for-profit chain, discharged nearly 80 percent of its Mobile, Ala., patients alive, while the figure was approaching 60 percent in Foley and almost 50 percent in Monroeville. But let's not pick on Alabama. How does this happen? Well, Medicare pays hospices approximately $150 a day regardless of the level or intensity of care provided. Of note, the most expensive days for hospice care are immediately after enrollment (making arrangements for equipment, stabilization if needed, etc.) and the last week of life, and thus, the longer the patient lives, the greater the number of days that will generate the most profit. So, healthier patients who need less care and live longer require fewer hospice resources on a per-day basis. Thus, the incentive for the for-profit hospice industry is to identify and sign up patients well before their legitimately predicted time to die. 

Table of Contents for the Digital Edition of California Society of Anesthesiologists Bulletin Spring/Summer 2014

Editor's Notes
President's Page
Peering Over the Ether Screen
The Dark Side of Quality Reilluminated and Reimagined
The Perioperative Use of Beta Blockers
ASA Director's Report
Physician Well-Being
Upcoming CSA Anesthesia Seminars
Our Stories
From the Executive Director
Our Stories
Practice Alert
On Your Behalf: Legislative and Practice Affairs
CSA Political Alert
Taking the CSA Grassroots and GASPAC Program from 'Good' to 'Great'
CSA Winter Anesthesia Seminar 2014: Midwinter Educational Interlude
California and National News
News from the Districts

California Society of Anesthesiologists Bulletin Spring/Summer 2014

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