After all these years of writing about health policy, I finally attended my first MedPAC meeting the other day. (Not sure what it says about me that I found it interesting.) They recommended a significant change in how hospices are paid under Medicare starting in 2013. Instead of one daily per diem, the rates would be higher at the beginning of a hospice stay and after a death, the two points when care is most intensive. (Transcript here, policy brief here, background from June MedPAC report here) First a bit of back story...
About two years ago, I tried to write an article about the growth of for-profit hospices. I spent weeks on it, and it was a frustrating exercise. I couldn't make it, as some editors wished, completely black and white. Not-profit good. For-profit bad. It isn't that simple; tax status doesn't in and of itself determine whether a hospice provides high quality, compassionate care to the dying. Remember too, there are for-profit, publicly traded, investor-owned chains as well as small for-profits owned by a family or individuals who may just prefer the control they have in the for-profit model, without having to deal with a nonprofit board. In the reporting I've done over the last few years on end-of-life care, I've met families who got excellent care from for-profits, and I have met families who didn't get ideal care from nonprofits. In some parts of the country, most hospice care is for-profit.
Kenen also wrote an article for the AARP Bulletin that discusses hospice care and the changes the hospice care industry has undergone over the years.
Hospice generally earns enviable satisfaction rates. Hospices’ own surveys have found that more than 98 percent of bereaved families would recommend hospice to a family member or friend with a terminal illness. Yet, not every case goes smoothly. Those same surveys have also cited problems: lapses in pain control, for instance, or unwanted hospitalizations; such errors are particularly traumatic when a loved one is dying. “It boils down to patient care,” said Claire Tehan, a California-based consultant who founded TrinityCare, a well-regarded Los Angeles hospice. “There is hospice care being delivered that doesn’t meet the high standards that we would hope everyone would achieve.”
So, like other segments of U.S. health care, hospice has embarked on a major drive to improve and evaluate the quality of the medical, psychological and spiritual care it provides. Some of the industry’s increased emphasis on quality comes in response to new regulations issued by Medicare, which pays nearly 84 percent of all hospice fees. The new rules, which took effect in December, require hospices to keep better records and do a better, faster job of providing services such as pain control, home assistance, respite care and social worker assessment.
But even months before the new rules were issued, many hospices had begun exploring ways to improve services. The major trade industry groups held seminars and conferences where hospices could learn from one another. One hospice in Charlotte, N.C., found that it could speed up admissions and cut response time by improving staff training and increasing phone and fax coverage in off-hours. Another, in Illinois, learned how to minimize distress and confusion for families by explaining clearly what to expect when their loved one was in the final phase of dying.
Meanwhile, HealthBeat blog contributed two posts last week about the MedPAC recommendations, taking a more black and white approach to the issue of for profit and non-profit hospice providers.
