How Hospice Became a For-Profit Hustle

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

It’s never fun to share a negative article about healthcare providers but it’s important for the industry to be aware of what’s “out there” in the media.  Such an article was published on November 28, 2022 for the December 5, 2022 edition of The New Yorker; ProPublica published the article with the headline of Endgame.  This article is a collaboration between The New Yorker and ProPublica.

In addition to the title (same as this blog), the byline reads It began as a visionary notion—that patients could die with dignity at home. Now it’s a twenty-two-billion-dollar industry plagued by exploitation.

You can read the piece of listen to the audio recording – 1:13:29 in length via the length in The New Yorker posting.

“Forty years on, half of all Americans die in hospice care. Most of these deaths take place at home. When done right, the program allows people to experience as little pain as possible and to spend meaningful time with their loved ones. Nurses stop by to manage symptoms. Aides assist with bathing, medications, and housekeeping. Social workers help families over bureaucratic hurdles. Clergy offer what comfort they can, and bereavement counsellors provide support in the aftermath. This year, I spoke about hospice with more than a hundred and fifty patients, families, hospice employees, regulators, attorneys, fraud investigators, and end-of-life researchers, and all of them praised its vital mission. But many were concerned about how easy money and a lack of regulation had given rise to an industry rife with exploitation. In the decades since Saunders and her followers spread her radical concept across the country, hospice has evolved from a constellation of charities, mostly reliant on volunteers, into a twenty-two-billion-dollar juggernaut funded almost entirely by taxpayers.”

“For-profit providers made up thirty per cent of the field at the start of this century. Today, they represent more than seventy per cent, and between 2011 and 2019, research shows, the number of hospices owned by private-equity firms tripled. The aggregate Medicare margins of for-profit providers are three times that of their nonprofit counterparts. Under the daily-payment structure, a small hospice that bills for just twenty patients at the basic rate can take in more than a million dollars a year. A large hospice billing for thousands of patients can take in hundreds of millions. Those federal payments are distributed in what is essentially an honor system. Although the government occasionally requests more information from billers, it generally trusts that providers will submit accurate claims for payment—a model that critics deride as “pay and chase.”

I encourage you to review the article, so you know what’s “out there” in the event you’re faced with a question from a client/family/patient who has read it.