A number of hospices have found an interesting new way to juice their business: bringing in patients who aren’t actually dying. The Washington Post reports:
Medicare pays a hospice about $150 a day per patient for routine care, regardless of whether the company sends a nurse or any other worker out on that day. That means healthier patients, who generally need less help and live longer, yield more profits.The trend toward longer stays on hospice care may be costing Medicare billions of dollars a year.In 2011, nearly 60 percent of Medicare’s hospice expenditure of $13.8 billion went toward patients who stay on hospice care longer than six months, MedPAC, the Medicare watchdog group created by Congress, has reported.
As a result, some for-profit hospices now encourage employees to sign up as many patients as possible, regardless of whether or not they are terminally ill. This has escalated to the point where hospice workers have begun to lodge complaints against their employers, many of which are now facing a wave of lawsuits. The government has also been pressured to revise the rules governing Medicare’s hospice payment system, particularly since these payments account for nearly 90 percent of these companies’ revenues. The hospice industry is lobbying hard against these proposed changes.Ah, the wonders of top-down controls.Medicare costs aren’t just ballooning because of fraud. They are ballooning because in a top down, bureaucratic system, there are huge incentives to game the rules. Inevitably the bureaucrats policing the system move more slowly than the lynx-eyed lawyers and accountants gaming it. Worse, because the lawmakers that writes these laws are indebted to the corporate interests who fund their campaigns, the rules are often written in ways that make it easier for the system to be gamed.The federal government was doing a poor job of organizing and managing the medical responsibilities it already had under programs like Medicare, Medicaid and the VA. Now under Obamacare it is taking on vast and complex new ones.