Right Voices

Memeorandum has the link to the NYT’s article: In Hospice Care, Longer Lives Mean Money Lost . Before I get into my feelings on the subject, I want to link to Diane, who discloses :

the private contractor doing the audit in California is PRG-Schultz. Among the investors in PRG-Schultz is Blum Capital Partners, headed by Richard Blum of San Francisco. Blum is married to Sen. Dianne Feinstein, D-Calif.

This article certainly paints a horrible picture, but it is the story within the story that has me troubled.

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.

Why are patients with Alzheimer’s and dementia receiving hospice care. Hospice care is designed for the the patients that have been diagnosed with imminent death expected. Alzheimer’s and dementia patients are better suited for an “all purpose” nursing home. I can take you to the homes in my community and show you one bed after the other with these types of patients. People diagnosed with these diseases can live many years beyond the date they are diagnosed. My grandmother had Alzheimer’s. That wasn’t the cause of her death, it was pneumonia. That is usually the cause of death. She lived in a nursing home for almost four years. Her expenses were covered by medicare. Could it be that this is part of the reason for the audits? It may not be that the gov’t wants to kick them out of the system, but wants the patient in the proper facility?

Because fewer than a tenth of all hospice providers have faced repayment, Medicare officials suggest that management might have been an issue. But Lois C. Armstrong, president of the hospice access alliance, said that if the cap on Medicare reimbursements was not lifted, the availability of care would tighten at a time when demand for hospice care was exploding and when new research suggests it saves money for the runaway Medicare program.

The fact that the facility they illustrated is a “for profit” leads me to believe that I may not be too far off the truth. I am not familiar with the area they refer to, but based on how the story reads, this facility has made themselves a one size fits all business, when in fact they are licensed as hospice. Michigan has many different types of elderly care options, with visiting nurses as a major benefit to the elderly. A major problem facing the elderly is the fact that their kids almost abandon them. They need someone overseeing their decision making but are left to care for themselves..

Herb B. Kuhn, the deputy director of the Center for Medicare and Medicaid Services, said that finding was attracting attention at the center, which is eager to keep the hospice care benefit from morphing into a long-term care entitlement. “Well over nine out of 10 hospices seem to be managing well, including the ones in higher-wage areas, so it does raise an issue of management,” Mr. Kuhn said. Mr. Kuhn said it remained a question whether hospice care saved money, but called it “a wonderful benefit” that “probably needs refinement” after nearly 25 years.

Among the matters meriting review, he said, is whether doctors have been premature in certifying patients as terminal. Medicare has issued disease-specific guidelines for the certifications, which must be made by both a personal physician and the hospice medical director.

Hospice care is billed at a higher rate than that of a standard nursing home or visiting nurse. These people that they are caring for qualify for medicare coverage of treatment, but not in the form of hospice care. So it really isn’t that the gov’t is going after the seniors, they are going after the “for profits” that should know better than to put a atient in their care that has no business being there. These patients can be transfered to another facility.

I will leave you with this, as I feel it speaks volumes for that story within the story:

Some providers have survived only by aggressively recruiting new patients, using this year’s Medicare reimbursements to pay off last year’s cap charges, while stalling for Congressional relief. Ms. Youngblood, the 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.’”

On a different note, here is the continuing saga of Brooke Astor. A woman that dedicated her life to giving her money away. Does anyone really believe that a woman that spent 50 years spending over $200 milion to charities, the arts, and various other NYC projects, would all of a sudden cut them off and give it to her son?