Over the last few months, the national media have taken notice of hospice care and on one aspect in particular – those patients who remain enrolled in end of life care longer than the norm. Two separate but related articles discuss the systematic targeting by for profit hospices of long length of stay patients as a way to make money (Washington Post) and the increasing number of patients who are discharged alive from hospice services because their health has stabilized (New York Times).
In the latter piece, our own Clinical Director, Reggie Bodnar, is quoted discussing the reason for the increase in live discharges – increased regulatory pressure combined with the obvious difficulty of predicting when death will occur. To quote Reggie in the Times: “I get the need to right the ship and make sure only eligible patients receive benefits…My fear is that we’re at risk of discharging patients who aren’t dying fast enough.”
With that set-up, I’d like to offer my two cents. For one, the Washington Post article is an investigation of for profit hospices elsewhere in the country, although the behavior discussed is generalized to be a nationwide problem. In Maryland, this posture simply doesn’t hold. Because of the state’s strict requirement to prove there is an unmet need for services before opening a new hospice program, the number of for profit hospices is low here and the non-profits like Gilchrist serve the majority of the patients. (Gilchrist is, in fact, the largest hospice provider in the state.) In addition, the Post article talks about hospices having “incentive” programs for enrolling long length of stay patients. Certainly, we have no such incentive structure and, in fact, our lengths of stay are decreasing, as evidenced by the fact that the number of patients we care for daily is decreasing even as our admissions are increasing.
Gilchrist has a highly controlled admissions process. No patient is admitted unless one of our physicians approves the patients. Once enrolled, patients who outlast their initial prognosis and are likely to require care for more than six months undergo a review process, led by Gilchrist’s Medical Director Dr. Tony Riley, to determine their continued eligibility. We also employ a compliance officer to make sure we are meeting all regulation requirements. In addition, because we are acutely aware that prognoses may change and some of our patients will be discharged if they stabilize, our parent organization, Gilchrist Services, has created Gilchrist Transitions to ensure that these patients are not left suddenly without support after months of coordinated and diligent hospice care.
As always, Gilchrist is committed to providing the finest in end of life care for any terminally ill patient in need of our specialized, compassionate hospice services, as well as care and support for the loved ones they will leave behind. And we are both committed to providing that care within the limits of the existing regulations and to ensuring that no patient or family ever feels “abandoned” should those regulations require discharge from our care.