Feds to Hospice Patients: Die Faster, Please

The Government is going after hospices to repay Medicare when their patients don't die fast enough.

The result: Many hospices will go broke and have to close.

A perverse interim measure: Some hospices are trolling nursing homes looking for more patients. That way they can use the new money to pay Medicare back for the old patients who didn't die fast enough.

[Ms. Youngstown, a] Hometown Hospice nurse, said that after she visited her charges — doling out their pills, and turning the sweet potatoes in their ovens — she trolled for new patients at nursing homes and senior centers.

At the small hospital here, she said, the nurses joke about her “marketing” forays: “They’ll say, ‘Here comes Nurse Kevorkian. She has no shame.’ And I’ll say, ‘Look, I have to have a paycheck, too.’”

Something is seriously wrong with this picture.

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    kurt vonnegut had a solution: (5.00 / 1) (#4)
    by cpinva on Tue Nov 27, 2007 at 01:56:16 AM EST
    the "ethical suicide parlors". no muss, no fuss, no bother. painless and quick, in a pleasant atmosphere, attended to by actual medical professionals, unlike the amateurs handling most executions.

    Death by choice......... (5.00 / 1) (#11)
    by avahome on Tue Nov 27, 2007 at 07:53:15 AM EST
    there is something to be said for the ability to choose.......languish or quick and dirty.  Think back to JackieO........one good push of morphine and it's lights out. Peace..

    Hospice may be used by we ordinary people...... I doubt the rich or near rich use this option.  When my Mom fell ill there were no openings in Hospice so she languished in a nursing home until death.  There has got to be a better more merciful way to die.


    wile, get your facts straight, (5.00 / 1) (#7)
    by cpinva on Tue Nov 27, 2007 at 06:41:09 AM EST
    the gov't isn't in charge of the hospices, medicare just pays some of the bills. your comment is totally inappropriate.

    "NHS" is National Health Service (none / 0) (#17)
    by jimakaPPJ on Tue Nov 27, 2007 at 10:04:51 AM EST
    that's England (I believe)and the government is in charge.

    I'm for NHC, but denying the problems isn't the way to make sure they don't happen here.


    hmmm (5.00 / 1) (#9)
    by Deconstructionist on Tue Nov 27, 2007 at 07:14:43 AM EST
      Less than 1 out of 10 hospices face repayment demands for exceeding reimbursement caps. Most of them are for profit facilities in poor areas. The cause of the overpayments under the regulations was the choice of the for profit facility managers to persuade people to move from nursing homes to the hospices so that the hospices could be paid more money  by Medicare (and the nursing homes less). When confronted with demands to repay money received which exceeded caps, the for profit hospices borrowed money to pay past amounts due but did not alter  their policies to prevent future overpayments from being received which ensured that future repayments would be required, and in fact some of them seem to have increased recruitment of people whose likely lifespan will cause the hospices to run into the caps and exacerbate the problem.

      So businessmen seeking profits have made very bad business decisions and now want a bailout?


    I recently bowed out as a volunteer for (none / 0) (#12)
    by hellskitchen on Tue Nov 27, 2007 at 08:12:01 AM EST
    a for-profit hospice.

    I brought communion to several people weekly. I loved the volunteer work until I was sent into a nursing home.  The chaplain informed me that the director wanted to "get into this nusing home."  I didn't pick up on what was going on with the first resident I visited, except that she seemed very lively compared to my nursed-at-home ladies.  

    Then I was assigned to another resident at the nursing home.  This woman clearly was in a terminal state and the level of care I witnessed was deplorable.  The nurse's aide provided by the hospice was rough with her patient.  When I asked her to be more gentle and provide the woman with some cover while she bathed her, I got a torrent of verbal abuse from the aide. It seems that the nursing home aides are supposed to assist the hospice aide, but they disappear as soon as she comes.

    It occurred to me then that the director was not selling true hospice care, but was selling hospice care as additional hands - i.e., supplementing their staff.  IOW, they're telling one thing to the nursing home and another to the hospice staff and volunteers.

    This, in addition to the fact that they provided no support or training for volunteers made me decide to look for a non-profit hospice group.


    die faster (none / 0) (#1)
    by RalphB on Mon Nov 26, 2007 at 11:35:09 PM EST
    Oh my God, this is simply awful.  This is not my government.

    Don't worry (none / 0) (#2)
    by scarshapedstar on Tue Nov 27, 2007 at 12:30:06 AM EST
    The free market will solve this problem. Give it time.

    Soylent Green is people! (none / 0) (#6)
    by jerry on Tue Nov 27, 2007 at 06:10:45 AM EST
    Don't worry (none / 0) (#21)
    by sarcastic unnamed one on Tue Nov 27, 2007 at 11:54:43 AM EST
    Gvt health care will will solve this problem. Give it time.



    I say it's time to (none / 0) (#3)
    by Nowonmai on Tue Nov 27, 2007 at 01:04:05 AM EST
    Dump a terminally sick relative of those gov't jackasses who made such stupid decisions, into a hospice and tell em to get the hell out when when he/she hasn't died yet, and then demand a refund of the money back.

    Just wait until (none / 0) (#5)
    by Wile ECoyote on Tue Nov 27, 2007 at 05:48:35 AM EST
    the gov't is in charge of all healthcare.  

    This doesn't seem to be an issue with countries (5.00 / 1) (#8)
    by Molly Bloom on Tue Nov 27, 2007 at 06:44:31 AM EST
    that have NHC. As long as the government isn't run by compassionate conservatives, I don't see this as a problem. But you are right, if the country is stupid enough to elect Bush clones...

    Not according to these articles. (none / 0) (#10)
    by Wile ECoyote on Tue Nov 27, 2007 at 07:17:22 AM EST
     NHS refuses to pay for cancer drug which could extend man's life; A 41-year-old father of four is being refused treatment with a cancer drug that could prolong his life by several years because it would cost the National Health Service too much.

    or this one:

    NHS refuses to provide surgery for smokers; SMOKERS are to be asked to give up their habit before they are put on the waiting list for routine operations such as hip replacements and heart surgery.

    LOL, Compassionate conservatives fault.  Sure, the low-level GS that will make the life and death decisions will be an evil conservative, while the politician redistributing the wealth will be an passionate progressive.


    Aside from the fact that Your insurance company (5.00 / 1) (#13)
    by Molly Bloom on Tue Nov 27, 2007 at 08:39:05 AM EST
    doesn't behave any different - they too make medical decisions based upon economics and deny coverage whenever and as long as possible- so tell me again how the system we have currently in place is soooo much better...

    Its a fact, Jack, that GOP appointments, at least since 1980, are to people who are openly hostile to their positions when it comes to programs conservatives hate- e.g. James Watt, Rita Lavelle, Anne Gorsuch, Clarence Pendleton, Gale Norton, Elaine Chao to name the obvious ones.

    The strategy is simple enough: claim government is incompetent and then set out to prove it by purposely governing incompetently.

    If you haven't figured this out, you are not paying attention. It may take awhile, but if NHC comes to the US and if, the GOP hasn't changed its ways, they will appoint someone tasked to make it fail.


    Molly (none / 0) (#15)
    by Slado on Tue Nov 27, 2007 at 09:37:34 AM EST
    The problem is you won't be able to sue a NHC system and there will be no checks and measures.

    At least today you can sue an insurance company if it incorrectly denies coverage.  

    You won't be able to sue uncle Sam when it decides to let you wait 18 weeks to get a CAT SCAN.

    That's what happens in NHC systems and those who pretend that other systems work better then ares are fooling themselves.

    Maybe we can do it better in America but I don't have much faith.  


    according to the WHO, (5.00 / 2) (#18)
    by cpinva on Tue Nov 27, 2007 at 10:15:38 AM EST
    several countries (great britain, France) with NHC do it far better than we do, for far less cost per patient. paul krugman recently devoted a column to this, check the nyt's archives.

    this isn't to necessarily suggest that their system would work well for the US, but it shows the fallacy of the "socialized medicine" cant so popular with republicans and their insurance company cronies. since neither have any particular interest in the health of their fellow americans, i'm inclined to take their stated concerns with the proverbial truckload of salt.


    Did you really say great britain? (none / 0) (#22)
    by Slado on Tue Nov 27, 2007 at 11:56:23 AM EST
    A government promise of 18 week wait times is enough to tell me that you should stop using them as an example.

    Simply put removing capatalism from the health care system in this country will ruin it and it's impossible.  

    Think about how unsolvent Social Security, Medicare are in this country and now add on top national Healthcare?  

    Maybe it could work if individual states tried it but more then likely the result would be a two tier system.   Private hospitals for the rich with cutting edge technology and public poorly run hospitals for the rest of us.

    Think public schools in NY vs. private and that would probably give you a good idea.


    Social Security isn't insolvent (5.00 / 1) (#23)
    by Molly Bloom on Tue Nov 27, 2007 at 12:04:17 PM EST
    Try again.

    If your stockbroker (1.00 / 0) (#40)
    by jimakaPPJ on Wed Nov 28, 2007 at 09:11:26 AM EST
    recommended a "buy" on a company with Social Security's balance sheet he could be sued.

    Does that tell you anything?

    Does unfunded obligations mean anything??

    How about declining profits while costs increase??

    How about having its cash invested in a "bank" that pays about 500% under market???

    Yes mamm, Social Security is in wonderful shape.

    I think your lens are clouded.


    My lens is fine. Your understanding of finance? (none / 0) (#47)
    by Molly Bloom on Wed Nov 28, 2007 at 08:40:49 PM EST
    not so much.

    Your demonstartion (none / 0) (#51)
    by jimakaPPJ on Thu Nov 29, 2007 at 10:36:25 AM EST
    of that understanding leaves many doubts.

    May I suggest an LED??


    My I suggest remedial math? (none / 0) (#53)
    by Molly Bloom on Thu Nov 29, 2007 at 07:02:00 PM EST
    Also (none / 0) (#24)
    by Molly Bloom on Tue Nov 27, 2007 at 12:08:12 PM EST
    the issue of public versus private schools isn't an issue of being "government" run. It is an issue of cherry picking. Private schools don't typically take problem students or students with poor academic ability. If private schools were required to take all students, I suspect their track records would not be all that great.

    Odd, where I live (none / 0) (#25)
    by sarcastic unnamed one on Tue Nov 27, 2007 at 12:26:01 PM EST
    it's often the parents of the kids who are having problems in the public schools who take their kids out and put them in private schools.

    And the private grammar and HS I went to, back in the day, took anyone who could pay. Plenty of dumb and incorrigibles enrolled there.


    Well thats a scientific sampling. That settles it. (none / 0) (#26)
    by Molly Bloom on Tue Nov 27, 2007 at 12:40:47 PM EST
    As someone who has grandchildren (1.00 / 0) (#41)
    by jimakaPPJ on Wed Nov 28, 2007 at 09:33:30 AM EST
    enrolled in a private school after watching the local school up close and personal, I can tell you a couple of things.

    1. They will take any child whose family/friends/scholarship can pay the freight.

    2. They do have a much higher standard of classroom discipline than public schools. If the parents don't agree with that, then they can leave. And that is written into the contract.

    Question: Do you now or have you ever had a child enrolled in a private school??

    There is truth (none / 0) (#42)
    by Deconstructionist on Wed Nov 28, 2007 at 09:46:32 AM EST
    on both sides.

      For the most part, private schools will fill available slots with any child whose parents can pay the tuition. At some private schools, however, all of the slots can be filled with better performing or at least higher potential children and those schools are selective on bases beyond ability to pay. Moreover, loath as we may be to admit it, probably the the most reliable predictors of student achievement are the affluence, educational background  and social status of the family. Across, racial, ethnic, gender, and even "intelligence"  lines children from affluent families with strong educational backgrounds tend to perform best.

       So, we have the dual selectivity. Some private schools are selective, and for most private schools the students are drawn from a self-selected group of families in which the affluent and well educated are over-represented compared to the general population.

      On the other side though, private schools are not required to provide for "special needs" children including intellectually or behaviorally challenged children and those children are under-represented in privaye schools compared to the general population.   The relative lack of those children in private schools does both make it easier to teach and skew test results.

      (Yes, I went to a private school for elementary school and I now have a child in private school.)


    Very true.... (none / 0) (#43)
    by kdog on Wed Nov 28, 2007 at 09:53:47 AM EST
    My private high school prided itself on academic excellence, and was fairly selective.  My brother's private high school, otoh, was a diploma mill, where kids who got expelled from public school went.  They'd take anybody with the cash.

    Indeed (none / 0) (#44)
    by jimakaPPJ on Wed Nov 28, 2007 at 01:35:23 PM EST
    children from affluent families with strong educational backgrounds tend to perform best.

    And at one time it was mostly the involvement of those families with the local school system that demanded excellence within the school system. As classroom discipline collapsed and the learning environment collapsed with it, they left. We can see what the new "owners" have done with it.


    An over-generalization, (none / 0) (#45)
    by Deconstructionist on Wed Nov 28, 2007 at 01:55:26 PM EST
      but true in many cases. I live in town in  a "nice middle class" neighborhood but not an "upper-class" one.   When school age approached we debated whether to move to a better school district in the suburbs or  use private schooling.  We decided to go the private school route because we like everything about our house and neighborhood except the public schools.

     We were actually criticized (not by name but by general reference to the "wealthy" ) by teachers' union officials , community spokespeople and a column in the local paper  for abandoning the public schools as if our children exist to serve the schools rather than vice versa.


    is not LA Unified.

    In our district parental involvement is legendary, and the schools' state rankings reflect that involvement.

    Of course, the school district is ranked against other Cali school districts, so that may not be saying much...


    You made a statement,. It was untrue. (none / 0) (#28)
    by sarcastic unnamed one on Tue Nov 27, 2007 at 12:51:45 PM EST
    Deal with it.

    You haven't proven it was untrue (5.00 / 0) (#29)
    by Molly Bloom on Tue Nov 27, 2007 at 01:56:55 PM EST
    At best you have proven that it was not true in your limited experience.

    Learn logic.


    that would be 18 weeks, (none / 0) (#35)
    by cpinva on Tue Nov 27, 2007 at 06:08:29 PM EST
    for non-emergency services, vs no treatment at all, in the united states, for the poor and uninsured. hmmmmm, tough call there. monty, i'll take door #2, the 18 weeks (and dropping) wait for gov't funded, non-emergency treatment.

    nice try there slado, do come again.


    Don't you know, all lawsuits are frivolous? (5.00 / 1) (#19)
    by Molly Bloom on Tue Nov 27, 2007 at 10:33:33 AM EST
    The GOP is working overtime at every level to deny those lawsuits because they are all frivolous, don't you know.

    I am only partially joking.

    The stories of care denied are overblown. Why aren't the countries with NHC all rising up against this monstrosity? Take France for example. People turnout in elections there in greater numbers than here. Don't you think that if the care there is so awful a candidate would have stepped forward and said "lets get health care like the US!" and voters would have elected that candidate?  Where is the mass uprising in these countries?


    Indeed, that is the true measure. (none / 0) (#27)
    by sarcastic unnamed one on Tue Nov 27, 2007 at 12:50:41 PM EST
    Absence of mass uprising over an issue means that issue is not a problem.

    Plenty of things I've noticed you being pretty hot and bothered about here on TL, where's your uprising? I guess maybe they're not so important after all.

    Personal example, I used to work for a co with a Canadian division. Sales rep in Vancouver blew out her knee playing softball. 18 months later, when I left the co., she still hadn't risen high enough on the wait list to get an MRI done. That'd be 1 and 1/2 years and still waiting.

    She said if she had the dough she'd come to LA to have it done.

    Oh, and she also said she didn't know the right people in order to get bumped to the top of the list. Yes, that's the kind of HC we really need here.


    Things are tough all over..... (none / 0) (#30)
    by kdog on Tue Nov 27, 2007 at 01:57:57 PM EST
    When I was uninsured and hurt my knee, I went to the hospital and was refused an MRI...the doctor said it wasn't necessary.  I'm no doctor, but I do know x-rays are no substitute for mri's when it comes to ligament/cartilage damage. I don't blame the doctor for lying, I betcha he was under pressure to cut down on expensive care for uninsured walk-ins.

    In Canada you have to wait, and the line may be crooked, but at least they don't lie to you.  

    I'm wondering if a NHC system where you have to wait, and can go to a private outfit and pay if you don't want to wait, is better than a system where care never comes.  Yeah, the rich will be better served but that is true under any system.


    Odd story kdog. (none / 0) (#32)
    by sarcastic unnamed one on Tue Nov 27, 2007 at 02:16:55 PM EST
    If you are uninsured, and you want non-critical HC, you typically pay for it out of pocket.

    Did you pay for the ER doc and x-ray yourself, out of pocket?

    They literally said "no, don't want your money for an MRI."?

    fwiw, I went to the ER 6 weeks ago for a fingertip that I splattered with a hammer. I have insurance, and the ER doc said I didn't need stitches, even though there were two big splits in my finger tip that were oozing blood and yellow fatty tissue.

    While I disagreed with his opinion, and still do (with the edges of the splits stitched together the splits surely must heal faster than with the edges apart) I'm not sure I would call him a liar.

    Maybe ER docs are just lame?


    They sent me a bill.... (none / 0) (#34)
    by kdog on Tue Nov 27, 2007 at 02:40:39 PM EST
    for the visit and the x-ray, which I paid over a couple months.

    It was an odd health care experience, the only time I went for care when I was uninsured.  My best guess is they sized me up as someone who couldn't afford an MRI, and tried to shoo me away with a mere x-ray...which of course showed nothing.  I specifically asked "shouldn't I get an mri?", and thats when the doc said it wasn't necessary.  By the look on his face I got a strong feeling he was bullsh*tting me, though I could be wrong and he was just a lousy doctor.  But it sure felt like a lie.

    My self-diagnosis since then is some kind of cartilage damage/loss. I'm fine in my knee brace, but without it my knee will just give out sometimes during athletics.  


    Yep, that is an odd one. (none / 0) (#37)
    by sarcastic unnamed one on Tue Nov 27, 2007 at 09:14:24 PM EST
    If your knee gives out that does sound like cartilage. At least, that's what mine did...

    btw, speaking of athletics, I was home last week over the holiday and thought about you and your Sun AM football game. I was nowhere near you (you're in LI?) but we wrangled the kids and their cousins into a game. Good times.


    Giving thanks for football.... (none / 0) (#39)
    by kdog on Wed Nov 28, 2007 at 08:36:09 AM EST
    I am in LI but the games are in Queens....playoffs started last week, we won by 2 scores...on to the semis!

    Why come to LA? (none / 0) (#31)
    by Molly Bloom on Tue Nov 27, 2007 at 02:09:47 PM EST
    The Canadian system is for the most part publicly funded, but most of the services are provided by private enterprises, private corporations. Doctors do not receive an annual salary, but receive a fee per visit or service. Public funding, privately provided services.

     Canadians can get supplemental insurance. So why come to LA? Are Canadian doctors just bad? If so, how do we account for the fact that Canadians live longer than US citizens?


    Dunno. It's what she said. (none / 0) (#33)
    by sarcastic unnamed one on Tue Nov 27, 2007 at 02:22:10 PM EST
    She said many Canadians with money come the US to get HC. It sounds to me, for whatever reason, some Canadians think US health care/docs/whatever are better than the Canadian ones.

    Also sounds to me like their system, at that time anyway, had a real shortage of MRI machines in Vancouver.


    It would seem that (none / 0) (#49)
    by jondee on Thu Nov 29, 2007 at 09:59:07 AM EST
    indicators such as life expetancy, infant mortality, rates of death from cancer and heart disease would be factored in by most rational people when acessing overall quality of care, particularly if prevention/health education are factored in as relevant aspects of a health care system.

    Also, children in the U.S being four times as likely to be on some sort of psychiatric medication, (last time I looked), is as good an indicator of a system gone awry within a larger system gone awry as any, IMHO.


    Factored in, yes (none / 0) (#50)
    by Deconstructionist on Thu Nov 29, 2007 at 10:08:28 AM EST
      but used to make sweeping conclusions, no.

      Health care systems do not exist in vacuums and do not  serve similar populations under similar conditions.

      We could have nearly identical "health care systems" and widely divergent life expectancy, infant mortality, rates of death from cancer and heart disease  in two different places because of many factors which can influence such statistics other than "health care systems."



    Most rational people (none / 0) (#52)
    by sarcastic unnamed one on Thu Nov 29, 2007 at 12:00:23 PM EST
    would recognize that HC systems are but one of a multitude of causal factors that directly affect the actual health of a given population.

    Unless, of course, there's an agenda to be obsequiously promoted...


    Erm (none / 0) (#36)
    by scarshapedstar on Tue Nov 27, 2007 at 08:29:13 PM EST
    At least today you can sue an insurance company if it incorrectly denies coverage.  

    If the wonderful experience of suing an insurance company is your argument in favor of our unique health care system, I have nothing to add. You've made my argument for me.

    I might note, however, that this will change if the insurance companies have their way. They already won immunity for their pawns, the HMOs, in many places. Strangely, the awesome and affordable coverage that they promised in return for that gift hasn't materialized yet.

    I wonder why?


    I, all my friendsm relatives and (none / 0) (#38)
    by jimakaPPJ on Tue Nov 27, 2007 at 09:42:26 PM EST
    acquaintances must be the luckiest people in the world.... none of us have been denied coverage..

    Thank your lucky stars and (none / 0) (#48)
    by Molly Bloom on Wed Nov 28, 2007 at 08:57:51 PM EST
    Therefore, make peace with your god,
    Whatever you perceive him to be - hairy thunderer, or cosmic muffin.

    Smoking is dangerous for surgery patients (none / 0) (#14)
    by lilybart on Tue Nov 27, 2007 at 09:18:09 AM EST
    Any time you have surgery, you are asked to stop smoking weeks before because of complications.

    Would yould you like to know how it (none / 0) (#16)
    by jimakaPPJ on Tue Nov 27, 2007 at 09:57:11 AM EST

    The elderly person is living at home but becomes unable to take care of themselves, even with maximum effort of the family and the limited assistance of some "Home health agency" care.

    If the failure is some type of catastrophic event, stroke, hip fracture, the person goes to a hospital for treatment. After treatment the person is sent to a skilled nursing facility for recovery. Medicare is paying for part of this. The patient is responsible for the rest. (Advice: Get supplemental insurance.)

    If the person is incapable of going home, the Medicare coverage runs out in about 30 days. At that point the patient pays 100%. Typically Medicaid becomes involved. This is a means tested program and a complete evaluation/investigation is made of the finances of the patient. The result is usually loss of almost all assets to the state for payment unless they have been properly protected within a certain time frame. (Advice: If you or your parents are 50 plus, consult an attorney who specializes in Medicaid, Nursing home care, etc.)

    At some point the patient dies with no advance notice, or becomes too ill to be treated at the nursing home and is transferred back to the hospital. The patient either dies within the "treatment time" within the hospital, recovers and is sent back to the nursing home or is declared terminal and discharged to friends and relatives to die at "home" or is sent to a hospice.

    A Doctor's opinion is required on the discharge irrespective of the destination.

    If the patient's initial problem is not catastrophic, say senile dementia finally advancing to where the patient can not function, the patient may go straight to a nursing home, but this is fairly unusual as most Doctors will want some tests ran in a hospital to back up their recommendations.

    But whether from a nursing home or hospital, a Doctor's opinion must be obtained before a patient can be sent to a hospice.

    Medicare's actions highlighted in NYT article are required by law and have nothing to do anything else, despite all the BDS I see flowering on the thread. The Demos have control of Congress, all they have to do is pass a bill.

    That they can not highlights their ineptness and lack of focus on the people's business in favor of attack politics designed to get them reelected.

    In the end this is the real problem.

    In the early days of the Medicare hospice benefit, which was designed for those with less than six months to live, nearly all patients were cancer victims, who tended to die relatively quickly and predictably once curative efforts were abandoned.

    But in the last five years, hospice use has skyrocketed among patients with less predictable trajectories, like those with Alzheimer's disease and dementia. Those patients now form a majority of hospice consumers, and their average stays are far longer -- 86 days for Alzheimer's patients, for instance, compared with 44 for those with lung cancer, according to the Medicare Payment Advisory Commission.

    I can think of a dozen questions regarding the above. And if it is the tip of an iceberg, this will be happening nationally.

    Spin on "Die faster, please" (none / 0) (#20)
    by diogenes on Tue Nov 27, 2007 at 11:52:40 AM EST
    This headline is like the Daily News headline, "Ford to NYC-Drop Dead".  It never happened.  NYC was mismanaged in the 1970's, as are a few mostly southern for-profit hospices now, and people are making hay at the expense of a republican administration.