Nathan Gray, a Professor at Johns Hopkins School of Medicine, authored a powerful comic strip illustrating the challenges facing doctors transitioning patients to hospice care - one of healthcare’s most critical end-of-life care options. Gray’s comic starts with an excellent perspective on why hospice is misunderstood: Hospice does not mean giving up. It means the current treatments may be doing more harm than good, and it means honoring the patient's wish to be at home.
He goes on to explain why healthcare has historically struggled with the hospice care option.
“Doctors...struggle to acknowledge that it’s time for a change in strategy, and entrusting
their patients in their final months to a new team can be difficult.”
Overcoming these barriers has been a challenge for decades, but recently, a new set of challenges are being faced by hospice. Confidence in the credibility of hospice care is being challenged by a series of powerful articles exposing fraud in the hospice sector.
What caused fraud to surface in the hospice sector? Changes to the payment model for hospice. Medicare decided to apply “coding” to hospice services. Medicare created “bundled payments” to make this service ‘more efficient.’ Bundled payments depend on the use of a complex coding system. Coding is not only complex, but it distracts caregivers from time with their patients. Miscoding can be fraud, so providers go through elaborate processes to document the codes being used. Manipulating these payment codes is very lucrative.
For profit healthcare focuses on coding to maximize revenues. For-profit healthcare has become increasingly interested in hospice because “bundled payment” and coding make hospice a new profit opportunity for those providers focused on coding and patient selection. Coding invites fraud because of its complexity. Coding makes no sense for a simple labor-intensive and low-technology service like hospice. Bundled payments have increased cost, not decreased costs.
The growth of fraud in hospice is another challenge that this important care option doesn't need. Fraud could be virtually eliminated in hospice by removing coding from their payment formula.
We need to simplify how Medicare pays for Hospice. We also need to simplify access to the benefit for patients. My book The Journey’s End offers pragmatic and comprehensive solutions to these concerns.
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