December 27, 2013

What to do about those "hospice survivors" who are "draining billions from Medicare"?

They only got in because 2 doctors certified they'd only live 6 months at the most.
[O]ver the past decade, the number of “hospice survivors” in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer.
So... the way we're supposed to see that the greedy corporations aren't bilking us all is for more people in their care to kick off? Noted!

52 comments:

mccullough said...

Make Warren Buffet and Bill Gates pay for hospice. This can be their legacy.

RecChief said...

the IPAB will fix that

Michael K said...

One problem that appeared early was that hospice care lengthened lives of patients who would have died in less than 6 months. Hospice was originally all non-profit. I don't know how it is now. I know it was a godsend for many patients who could stay at home. I'm not sure how it has become such a huge expense item as it is supped to be only supportive care and no therapy for the primary disease. That shouldn't be that expensive.

Michael K said...

"About 78 percent of patients who enrolled at the Mobile, Ala., branch left the hospice’s care alive, according to company figures."

Every good cause eventually becomes a racket.

madAsHell said...

.....more unintended outcomes.

m stone said...

“You see somebody sitting on the front porch in a wheelchair and you hit the brakes.”

In the near future ACA doctors will be required to speed up or run them down.

jacksonjay said...


Seeeeee!!

Waste, Fraud and Abuse!!

Seeeeee!!

Cut Medicare and send that money over to Medicaid!!

MadisonMan said...

My father-in-law got kicked out of hospice twice but eventually died at home, with hospice. My brother lived in a hospice facility for about 30 hours. My Mom had hospice for 12 days -- all at home.

My experience is that terminal illnesses can be a continuous decline (brother/mother) but also a slow up and down decline to the inevitable (father-in-law).

From the article, it seems to me if you can leave the facility for an activity, you don't belong there. That's why my father-in-law got the boot twice. And he left willingly!

Big Business will always find its way into the Govt till. This will happen with aspects of Obamacare as well, of course.

DanTheMan said...

>>Big Business will always find its way into the Govt till. This will happen with aspects of Obamacare as well, of course.

Thieves will always find a way to take advantage of uncontrolled government spending.

Fixed it for you. :)

Deirdre Mundy said...

We know several people who recovered once they went on hospice. They went off the meds and the hospices focused on pain management and comfort and whatnot---- and somehow, that's what was needed!

One woman went on to live 3 years after-- the hospice did want the hospital couldn't.

Maybe we should see what these hospices are doing RIGHT....

Michael K said...

"Maybe we should see what these hospices are doing RIGHT…."

When I was a resident we had a professor who said "In a last desperate effort to save the patient, pull out all the tubes and feed him !"

Sometimes it worked. Chaos theory in action.

Deirdre Mundy said...

I wonder how much of it is that hospitals are profoundly depressing places. When you're stuck in the hospital, death probably looks better than it does when you're surrounded by friends and family at home.

With older people, especially, a lot of it seems to depend on their will to live.

Therefore, Obamacare must sap patients' wills to live in order to save money!

Deirdre Mundy said...

Actually, the food is probably an issue too. A lot of older people are on really restricted diets=-- no fat, no cholesterol, no sugar, no salt...

Then they go on hospice, and suddenly it's "Sure, have a second slice of cheesecake! You're dying anyway!" Suddenly, nutrition is a joy and not a burden....

john said...

Blogger Deirdre Mundy said...
When you're stuck in the hospital, death probably looks better than it does when you're surrounded by friends and family at home.


Norman Rockwell painting, nostalgic, but not very accurate. Many, if not most, elderly are coming from assisted living into emergency care, then into long term rehab, then into hospice. Returning "home" surrounded by friends and family hasn't been an option for years, since the house was sold, the kids are all living in other towns (except for one, who has been stuck with giving care). Hospice for many is the final dumping ground before the dirt nap, a place to go that frees up an expensive hospital bed for the next person, him or herself waiting for a hospice bed to open up somewhere.

gerry said...

You want them to die faster? Send them to Great Britain.

averagejoe said...

Here come the death panels, led by the liberal loons who called it "lie of the year", but now advocate for the necessity of government keeping people from living too long, draining the system, being a burden on society.

MadisonMan said...

When you're stuck in the hospital,

The night my brother was in the hospital -- before being moved to hospice -- he was regularly awakened by beeping machines, blood pressure being taken, phones ringing out in the hall.

Hospice was quiet.

The biggest problem with Hospitals is the noise noise noise noise. Second is all the artificial light.

Henry said...

From the article:

Finally, according to the lawsuit, when the hospices were making too much from patients — and running into the cap on payments imposed by Medicare — Asera­Care would take extraordinary measures to bring their numbers down.

The company “dumped” patients from its rolls, telling them they were no longer eligible, according to the lawsuit. In some cases, hospice recruiters even specifically sought out “last-breath” patients — those who would die quickly — to bring their average down, according to the lawsuit.


Althouse writes: So... the way we're supposed to see that the greedy corporations aren't bilking us all is for more people in their care to kick off?

Don't worry about the greedy corporations. They gain both ways. When people live they make money. When people kick off they make money.

Andy Freeman said...

It's bad when corporations "play by the rules" and profit but imaginary folks who "play by the rules" and don't get skittles and unicorn are justification for whatever policy that Obama is pushing today.

Got it.

Rob said...

I knew somebody whose doctor was treating him for kidney disease. He lived for another 20 years and died of a heart attack. This would never happen with my doctor. If he treats you for kidney disease, you die of kidney disease--and it doesn't take 20 years either. (h/t Don Adams)

jimbino said...

Wow! Moral Hazard.

Sending someone to a hospice does more to prolong his life than all the docs, hospitals and drugs put together.

Much cheaper, too.

Megaera said...

The hospice organization I did volunteer work with was entirely home care. Nurses visited regularly to see that patients were getting needed care, but it was palliative, not designed to prolong life. Several of my patients died within days or weeks; one, a woman with <20% kidney function who had refused dialysis and been told she had 3 months, lasted a year and a half from the time I was assigned to her When her actual death process kicked in, she went in less than a week, quietly, in her daughter's home with her family around. A lot of the funds cut from Medicare to pay for Obamacare are coming from the hospice and home healthcare programs, and it is my sincerest hope that every last person responsible dies the vilest, most prolonged death possible in the loneliest, most wretched of Obamacare facilities.

Inga said...

I worked in a hospice fcility for a few years, most patients did not live 6 months, most far less. The idea was LESS intervention, not to cure them.

traditionalguy said...

I suspect they are lying statistics easily faked. When has any Obama related health care entity ever issued true findings? Zero.

Hospices are all for "transitioning" people around here.

Michael K said...

"The hospice organization I did volunteer work with was entirely home care. Nurses visited regularly to see that patients were getting needed care, but it was palliative, not designed to prolong life."

That is my experience with hospice. I used to take medical students to a hospice that had a few inpatients there for pain med adjustment or acute intake. There were very few patients not at home.

A friend of mine died of ALS and had hospice at home the last six months. It was a godsend for him.

sinz52 said...

Dierdre Mundy: "We know several people who recovered once they went on hospice....the hospices focused on pain management and comfort and whatnot---- and somehow, that's what was needed!"

Maybe those patients were just misdiagnosed to begin with. Some diseases can mimic other diseases.

There was such a case shown on the "Mystery Diagnosis" TV series. This woman had been diagnosed with advanced lymphoma (IIRC). Her test results sure suggested lymphoma. She was getting sicker and sicker, despite all the treatments her doctors prescribed. She was afraid she was going to die soon.

Then a new doctor appeared who correctly diagnosed her with Kikuchi-Fujimoto disease, a rare disease which mimics the symptoms and test results of cancer, but which is actually self-limiting!

http://www.ncbi.nlm.nih.gov/pubmed/22762705

He told her to just take Advil and be patient. Sure enough, in another couple of months, the disease subsided on its own.

Patients don't usually die of Kikuchi-Fujimoto Disease. But they can die of the chemo and radiation treatments that doctors give them when they misdiagnose the patients with cancer.

Archie said...

"Just step on their damned air hoses and be done with it." Obamacare manual, Chapter 3, section 2(a), line 63 et seq.

buck smith said...

My Mother-in-law has been in and out of Hospice of the past two years. My mother was in it for 7 months before she died of cancer. For very sick people hospice offers free access to morphine in return for agreement to not use expensive procedures that extend life for a little bit with very low quality of life. My mother made that decision herself, with a clear mind, even as she needed more morphine to deal with the pain.

buck smith said...

My mother-in-law has Alzheimer's and went into hospice after she broke her hip. The only reason hospice offers value to consumers is because of government regulations and the tort system. If we citizens, as consumers, could limit liability to healthcare providers and make our own decisions about what devices, drugs and services to use, many low cost options would be available.

Scott Anderson said...

I knew a guy who bought a used car. Ten years later, Bam! Heart attack.

ironrailsironweights said...

On a similar note, most of the dying children who get their dreams made true through Make A Wish Foundation don't die, and make full recoveries. Though of course this is actually a good thing.

Peter

The Godfather said...

One of the really scary things that the advocates of universal health care (now, Obamacare) said in 2008, and have repeated since then, is that 80% [or some other large percent] of medical expenses are incurred in the last 6 months of life, the implication being that this is wasteful. Of course, it may be "wasteful" if money is spent in an unsuccessful effort to cure the patient of the disease from which he/she later died. But a lot of the time, when someone gets sick, there's no way to be sure that the disease is inevitably fatal, except to try very hard to cure the patient, and fail. So the promise (or threat) to save the medical costs "wasted" on final illnesses implies Sarah Palin's Death Panels.

The fact that some people survive hospice may not be solely the result of corporate greed. It may actually reflect the fact that medical science is imperfect and that some people who are diagnosed as terminally ill may in fact be curable, and may even be cured by nature or by minimal medical support.

Government medicine threatens to impose one size fits all standards, which will leave no room for such uncertainties.

Edmund said...

For very sick people hospice offers free access to morphine in return for agreement to not use expensive procedures that extend life for a little bit with very low quality of life.

Yep. If you are a doctor outside of a hospice and treat pain aggressively, you get investigated by the DEA for "overprescribing". And it can bankrupt you due to legal fees and time away from the office. Even in the 60s it was a problem. My 80ish grandmother had a bad knee and was not a surgical candidate. My father, a podiatrist, begged her doctor to prescribe narcotic pain meds, with little success. She was in great pain for the last few years of her life because her doctor didn't want her to "get addicted". Like it mattered - she didn't drive or any other hazardous activity.

Even though it is the "fifth vital sign" doctors outside hospitals don't treat pain well, a fact that my wife - an anesthesiologist - hates.

The Godfather said...

One of the really scary things that the advocates of universal health care (now, Obamacare) said in 2008, and have repeated since then, is that 80% [or some other large percent] of medical expenses are incurred in the last 6 months of life, the implication being that this is wasteful. Of course, it may be "wasteful" if money is spent in an unsuccessful effort to cure the patient of the disease from which he/she later died. But a lot of the time, when someone gets sick, there's no way to be sure that the disease is inevitably fatal, except to try very hard to cure the patient, and fail. So the promise (or threat) to save the medical costs "wasted" on final illnesses implies Sarah Palin's Death Panels.

The fact that some people survive hospice may not be solely the result of corporate greed. It may actually reflect the fact that medical science is imperfect and that some people who are diagnosed as terminally ill may in fact be curable, and may even be cured by nature or by minimal medical support.

Government medicine threatens to impose one size fits all standards, which will leave no room for such uncertainties.

Bob Ellison said...

Those who can pay cash for health care will do so. I am one of them. Obamacare has killed my HC plan.

Those who will ride the gravy train of free health care, free cell phones, free food, and free votes will keep voting for more of this.

This is a sad state of affairs.

Edmund said...

... 80% [or some other large percent] of medical expenses are incurred in the last 6 months of life, the implication being that this is wasteful. Of course, it may be "wasteful" if money is spent in an unsuccessful effort to cure the patient of the disease from which he/she later died.

Happened to my father. He was hospitalized twice in his life. In his teens in WWII for appendicitis. And the last six months of his life for an unknown disease that presented as congestive heart failure, and spiraled out of control from there. He was in his early 70s, still a practicing podiatrist (no surgery), and active in the community.

If you get hit by a car and die a few days later you fall into this bin. Until they have godlike powers, they can't know who will and won't die in many cases. (Of course, many surgeons act as if they already have godlike powers.)

wildswan said...

There's just no way to determine when the the "last six months" is happening versus when a miracle of modern medicine is saving someone. But I wonder whether if someone made a study of the different diseases we might find that the last six months aren't the most expensive in many kinds of causes of death in a predictable way. For example, suicide. Auto accidents and other accidents are probably the most expensive only in the last 24 hours of someone's life. Heart disease and stroke might be the most expensive only in certain circumstances. Cancer and diabetes might be very expensive but then some treatments might drop in price because it becomes better understood when these treatments would be effective because they were tried on people when all else failed. In other words research is part of the cost of treating the dying. In short the government bean counters will apply a one size fits all treatment regime and wreck medicine. See the Obamacare rollout where no was in charge and everyone did happy talk and people's insurance was replaced by man-caused disaster. And still the Democrats have no plan but happy talk.

Molly said...

Here's one glimpse of reality. My mom is 95, and only gets out of bed to eat and poop. She has in-home care givers to help her in and out of bed, and keep her company when family is at work.

Three years ago, I asked my mom's doctor if she would qualify for medicare financed hospice care (so that her condition and care would remain unchanged, but the cost would be picked up by Medicare rather than by her (or let's be honest by the inheritance she will leave to me and my siblings). The doctor said, "Hospice is for people who don't have a realistic prospect of living more than a few months." (he was probably more specific than "a few" but I don't remember if it was three or six; but something like that.) And, he went on, "I can't say that is the case for your mom."

He was right. Three years later she is still alive, and though slightly weaker, pretty much unchanged.

In home (or in a facility) daily care is expensive. Think about it: a minimum wage worker with payroll taxes and health care will run you $10/hour -- a way to low estimate of actual costs through a reputable agency -- and that's $240 a day, or $90K a year.

So my mom's three years have run down her estate to the tune of $300-500 K.

Do I want the gov't to pick up this tab so that I can have a more comfortable retirement when she dies? Yes.

Does that mean that it's good public policy? Not necessarily.

But what about all those moms whose wealth isn't enough to cover these high costs? Should they be forced to go without the care because they were too irresponsible to save for this eventuality? Do we want to stop behaving as though Medicare is not welfare for the poor, but some even handed non-need based "insurance" program? And let's not fool ourselves: if we make these benefits "need based" my mom and others are going to figure out a way to distribute their assets so that they qualify. And finally, though half a million a year in expenditures per year sounds pretty ritzy (I'd live pretty high on the hog with that), my mom's life isn't exactly a castle in Spain. The half million a year buys her safety from falling out of bed, keeps her bottom wiped, her medications on schedule, and her stomach filled.

I'm not leading up to some great solution; just laying out a real world case relevant to this WP story.

Molly said...

After posting the above, I realized that I had taken the three year $500K cost and begun talking about it as an annual cost. But the essential points I'm making remain the same even with corrected numbers.

Jeremy said...

The thing is, hospice care is used when insurance companies no longer pay for a nursing home (after being kicked out of a hospiital for that same reason).

What other option do these people have? Leave them to die in the streets?

Pogo said...

Obama thanks Althouse for her 2008 vote.

Obamacare is realty. So quit whining!

Alex said...

Well well, now it's clear that liberals want to exterminate us.

Dantes said...

This is actually a problem. By definition, hospice patients are supposed to be terminally ill. However, a lot of companies have gottten into this business and pressure families and patients to have their doctor certify their need for hospice, or they find some who will.

It is a rip off.

Laura said...

Interesting. I remember a case where the patient on hospice went into organ failure after his nurse wife told him he could go. Nice nursing home, though. Better than the one he fell in.

AReasonableMan said...

When the Repubs finally win the presidency again it is going to be fun watching these same commenters defend what will ultimately be an essentially unchanged policy.

SGT Ted said...

One of the biggest insurance scams ever pulled off was the advocacy demanding that insurance cover end of life palliative care.

Before that happened, Hospice was run on shoe string budgets by volunteers and low paid vocational types, funded on donations and grants. Their entire selling point was that it was going to be cheaper to die under Hospice care than to die in the hospital.

Hospice pimpers were salivating at the thought of being able to tap into big pots of insurance pay outs to fund their desires for the fancy lifestyles they thought they all deserved for their "compassionate work with the dying". Hospices immediately larded up their salaries and expenses to reflect their newfound source of wealth. I watched this happen in my own communities Hospice industry.

We see what they were really going for after all: To be able to endlessly tap insurance companies to fund their operations that would never be able to survive in a normal market.

The rent-seeking from the medical industry using Government to tap into ever increasing amounts of medical insurance money has destroyed the patients/consumers ability to pay for it and is now destroying the industry as we know it.

Tom Perkins said...

@Molly

At $166,000 per year, I suspect there's a lot of administrative types freeloading on your mom's dime. I can't really see the cost of a low-skilled person being there for 11 hours a day for 5 days a week, even with admin costs doubling it, being more than $60,000 / year, especially now that the fed gov will be providing care to all comers as Obamacare collapses utterly.

@ AReasonableMan

Would you care to make a wager on that? I expect the Republicans will not be in a position to change Oabamacre until they run a tea party type for the Oval Office, and then I think they will take the Oval Office and Congress and obliterate the nonsense. The tea partiers do not want to be the party that runs the welfare state better.

SGT Ted said...

Michael K,

Hospice is still "non-profit". They just tapped into the insurance gravy train to lard up staff. Most people that run Hospices hold Graduate Degrees in some sort of Sociology field, including 'Hospice Director' Masters degrees, which pretty much guarantees a rent-seeking entitlement attitude towards other peoples money. Like most of the social science "non-profits", they really know how to spend money, but not much about how to gemerate it.

geokstr said...

“You see somebody sitting on the front porch in a wheelchair and you hit the brakes.”
Not me.

Here in Georgia, if I see somebody on the front porch, first I check to see if they have a banjo, then determine if they appear to be a special needs kid. If both are true, I stomp on the gas, not the brakes.

MB said...

"Hospice survivors" who are "draining billions from Medicare" They only got in because 2 doctors certified they'd only live 6 months at the most.

Well obviously the problem is those two doctors!

Curious, that on the tail of Reagan using an extreme example was bad politics, extremes are used again as an argument to cut back care. A major problem here is the distribution is not given, that is the mean survival and standard deviation. Also is this a normal (Bell-shaped) curve or a different type curve. Basically, are these examples “in the acceptable range” within the 95%, or stricter standard, 99% range? The cases are cherry-picked without proper context.

jr565 said...

Maybe we should institute a Logan's Run type policy at the hospises. If you outstay your survivor period we send you into the woods and then sent hunters out to kill you.

jr565 said...

"A lot of older people are on really restricted diets=-- no fat, no cholesterol, no sugar, no salt..."


This is probably why a bunch of them wind up in the hospice in the first place. In particular not eating fats is CRAZY!