Home Health & Hospice Week

A silver lining may be attention on the problem of hospitals pressuring hospices for last-minute admissions.

There’s more bad press about hospices, at least indirectly.

In a 20-page report, the SEIU union accuses HCA Healthcare Inc. of pushing patients into hospice. “Our review of lawsuits, Medicare fee-for-service claims data, Statements of Deficiency citations issued by the Centers of Medicare and Medicaid Services (CMS), and other public data suggests that some patients encountering the HCA system of care may be transferred to hospice inappropriately,” the Masking Mortality report says.

Why would HCA do such a thing? “HCA’s executive compensation structure rewards low in-hospital mortality rates, and transferring patients to hospice can help reduce those mortality rates,” SEIU says. “Analysis of Medicare claims data reveals a recent trend of increasing rates of HCA patients being transferred to hospice.”

HCA, the largest hospital system in the U.S., also “has been expanding its footprint within the hospice and home health space in the last couple of years,” the report adds. “In July 2021, for example, HCA acquired an 80 percent stake in Brookdale Health’s home health, hospice and outpatient therapy business for $400 million.”

NBC News also issued a critical story on the topic titled “‘You’re not God’: Doctors and patient families say HCA hospitals push hospice care.” NBC says it interviewed “six nurses and 27 doctors who currently practice at 16 HCA hospitals in seven states or did so previously.”

“Sometimes it is reasonable to talk about comfort care, but usually it is done prematurely,” physician Ghasan Tabel told NBC. Tabel sued HCA’s Riverside Community Hospital and settled.

This, of course, is the opposite of what many hospices report in general — very late referrals to hospice that give agencies little time to help the patient before their death.

The National Hospice and Palliative Care Organization notes that it “is not in a position to comment on HCA specif­ically,” according to a release. But “on behalf of our member hospices NHPCO has raised concerns about hospitals pressuring hospices to admit patients in the last hours of life,” the trade group points out.

In its comments on the 2024 proposed hospice rule, NHPCO tells the Centers for Medicare & Medicaid Services that “hospices are getting increasing pressure to admit the hospital’s patients who are very near death in order to avoid the death being included in the hospital’s mortality statistics. If the hospice does not agree to admit these patients, many of whom may have only hours to live, at the [General Inpatient] level of care, they risk not receiving referrals from the hospital in the future.”

NHPCO urges CMS or its contractors to issue “specific guidance about this metric … specifically for hospitals and hospices."

“The NBC report works against the goal of public understanding of healthcare options by perpetuating myths about hospice,” NHPCO protests. “One of the main comments hospices receive from patients’ families is, ‘We only wish we had chosen hospice earlier.’ Though the NBC News article never says directly that medical professionals should avoid talking with patients about end-of-life care options, it certainly risks putting a damper on those already very limited conversations, when in fact patients would benefit from the opposite,” the trade group says.  

Note: The SEIU report is at https://hcavsamerica.org/wp-content/uploads/2023/06/SEIU_MaskingMortality-R4V7.pdf. The NBC News story is at www.nbcnews.com/health/health-care/doctors-say-hca-hospitals-push-patients-hospice-care-rcna81599.