The Federal Government is Undermining Hospice

With a government like this, terminally ill people don’t need enemies. Back in the late 1990s, federal bureaucrats began an assault on hospice known ridiculously as “Operation Restore Trust.” The idea was this: If a hospice patient on Medicare didn’t die within 6 months, the government would presume that the hospice referral was wrong and demand a refund.

I was a hospice volunteer at the time and I saw the profound chilling effect that this had on hospices. Indeed, my last hospice patient, a man with ALS, was kicked out of hospice—not because he was no longer dying, which I also witnessed—but because he didn’t die on schedule. It devastated the patient emotionally and I refused to leave him even though he was no longer officially a hospice patient. He died about 3 months later.

Well, apparently the bureaucrats are still at it. From today’s New York Times:

Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.

Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

The charges are assessed retrospectively, so in most cases the money has long since been spent on salaries, medicine and supplies. After absorbing huge assessments for several years, often by borrowing at high rates, a number of hospice providers are bracing for a new round that they fear may shut their doors.

Good Grief! We should be encouraging patients and doctors to prescribe hospice, not make it harder for patients to get quality hospice care! Moreover, one failure of American hospice is that people get into it too late, not the other way around!

Everyone opposes Medicare fraud, but the idea that people die-by-the-numbers or that a terminal diagnosis will follow a certain course and time is ludicrous. I have been hearing a lot of complaints about a seeming rush in what I still assume is a vast minority of hospices, to see the patient off to the great beyond sooner rather than later. If this is happening, the government’s assault on the caregivers for the most vulnerable among us is at least partially to blame.