WASHINGTON -- Hospice marketers, exploring possibilities for new revenue to help continue the industry's remarkable growth, are looking to exploit a provision in the 2010 health care law by persuading hospitals to send Medicare patients into end-of-life hospice care instead of readmitting them to the hospital.
Such a move, the hospice marketers say, will enable hospitals to avoid paying the Medicare penalties required by the new law when hospitals discharge patients and then have to readmit them within 30 days: Instead of readmitting the patients, hospitals should send them to hospice care, which also is covered by Medicare, according to a USA TODAY analysis of marketing materials.
Patients with severe heart problems and pneumonia tend to decline quickly and often move in and out of hospitals, said hospice marketing specialist Rich Chesney, who proposed the idea.
It might be better, Chesney said, if a hospital CEO hired people to talk to family members about hospice, instead of a doctor, who is more focused on not losing a patient. Chesney made his proposal recently at a conference sponsored by the National Hospice and Palliative Care Organization, an industry trade group.
"If (hospices) make that part of their business and their revenue stream, that's sound business," said Stan Massey, chief marketing officer for Transcend Hospice Marketing in Holland, Ohio. Massey recently wrote a blog recommending hospice marketers talk to hospital CEOs instead of the doctors who usually decide who is eligible for hospice care. Those conversations, he wrote, "must be framed heavily in terms of financial benefit."
Health care analysts and ethicists, however, say such proposals are contrary to the intent of the health care law, which is to provide better care, not to put more patients into hospice care for which they are not ready.
The proposals warp the "whole idea behind hospice," said Josh Perry, a business and ethics professor at Indiana University.
Jon Radulovic, spokesman for the National Hospice and Palliative Care Organization, said that members of his organization have heard about the proposal, but that in the past working with hospitals has been about reducing readmissions because it's better for care, rather than because it's better for the bottom line.
Good hospices have been working with hospital CEOs for years, said Carolyn Cassin, president of the National Hospice Work Group, a coalition of the 25 largest not-for-profit hospice organizations. But the goal, she said, was to make sure patients received the care they needed. She said she was surprised to hear it characterized as a marketing approach to cut costs.
While hospice care costs less than hospital care, at $151 a day for Medicare patients, it's meant for people who are going to die. In hospice care, patients agree not to seek care to improve their health, such as more surgeries, hospitalizations or chemotherapy. After a doctor certifies that he expects a person to die within six months, Medicare covers hospice care.
Experts say they fear patients will be sent to hospice before their time and miss the proper care that could restore their health. Penalties, Perry said, are a "good thing" to hold hospitals accountable. "This isn't about extending hospice."
The health care law will penalize hospitals that readmit patients within 30 days for specific problems, including heart failure, heart attack and pneumonia beginning Oct. 1, 2013. Those penalties could rise to 3% of a hospital's annual revenues by 2015.
The rule is designed to encourage health providers to work together to make sure all of a patient's medical needs are met so the person does not end up back in the hospital.
Penalties for excessive hospital readmissions were meant to encourage hospitals to provide better care, not farm out patients elsewhere for care, Center for Medicare Services spokesman Brian Cook said. The law's incentives, Cook said, are meant to "ensure that savings come from better care, not cutting care."
"I think that's an unfortunate approach," Cassin added. "It's about doing the right thing, not keeping costs down."
Hospice care is the fastest-growing area of Medicare, according to a March report by the Medicare Payment Advisory Commission (MedPAC). The number of hospices grew 53% between 2000 and 2010, and for-profit hospices accounted for most of the increase. As of 2009, 18% of patients who left hospice care left alive, MedPAC documents show.