A Revealing Look at Hospice Care

Most people think of hospice care as a nonprofit program offered to help the terminally ill through their last days. In fact, it’s a big business filled with all sorts of aggressive sales tactics, bonuses, referrals fees, potential conflicts of interest, and regular targets or goals for employees. Bloomberg has a revealing report on this small but rapidly-growing sector of the medical world.

Hospice care, once chiefly a charitable cause, has become a growth industry, with $14 billion in revenues, 1,800 for-profit providers and a base of Medicare-covered patients that doubled to 1.1 million from 2000 to 2009.

Compensation based on enrollment numbers, pay to nursing- home doctors who double as hospice medical directors, and gifts to the nursing facilities have helped fuel the boom, according to an examination of 1,000 pages of court documents and interviews with more than 45 current and former hospice employees, patients and family members.

The business changed quite a bit after Medicare began reimbursements for it and publicly-traded companies entered the market. The piece on Bloomberg gives you a lot of information to digest if a loved one is being referred to hospice and ideas for questions to ask before choosing a hospice.

Vitas paid salespeople bonuses based on patients’ length of stay, according to White, who worked for the company in Cathedral City, California, from 1998 to 2004. Medicare, which foots 90 percent of the national hospice bill, compensates providers on a per-diem basis, and lengthier stays increase profitability, federal data show.