美国国家公共电台 NPR Nearly 1 In 5 Hospice Patients Discharged While Still Alive

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AILSA CHANG, HOST:

Hospice care is for the dying. It helps patients manage pain, comforts them, perhaps even allows them to focus on spending a last bit of quality time with their loved ones. But in recent years, nearly 1 in 5 patients have been discharged from hospice before death. And a new study finds that hospices with the highest rates of these so-called live discharges also make more money. NPR's Ina Jaffe reports.

INA JAFFE, BYLINE¹: To qualify for hospice care, two doctors must certify² that a patient is expected to live no more than six months. But patient James B. Nelson said he defied the expectations.

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JAMES B. NELSON: It was decided³ that I was not dying fast enough. And to put it most succinctly⁴, I flunked⁵ the hospice program.

JAFFE: This is from an Arizona Public Media documentary "Passing On," which notes that Nelson died several months after this 2015 interview. But his situation is not that unusual. Government reports show that the median rate of hospice patients discharged before death has increased, peaking in 2012 and 2013 at about one patient in five. Now there's a new study in the journal Health Affairs that finds that hospices with the highest live discharge rates also have higher profits. The lead author is Rachel Dolin, a Winston health policy fellow.

RACHEL DOLIN: It's important to continue to study this area to get a better sense as to whether profits are driving the decision to discharge patients from hospice, rather than patient preferences and needs.

JAFFE: When a patient is discharged from hospice, they don't necessarily go anywhere. Hospice services are usually delivered where the patient lives. And those services cost Medicare more than $15 billion a year. Federal regulators have questioned whether high rates of live discharge mean that hospices are admitting patients who aren't actually dying. But those decisions aren't that clear cut, says Dr. Joe Rotella, chief medical officer for the American Academy of Hospice and Palliative Medicine.

JOE ROTELLA: We see more and more patients that have conditions, like Alzheimer's disease or Parkinson's disease, that don't always follow a predictable course.

JAFFE: But some experts who study aging think that hospices may be trying to avoid costs that should be their responsibility. Susan Enguidanos, an associate professor of gerontology at the University of Southern California, gives the example of hospices temporarily discharging patients who need a trip to the hospital.

SUSAN ENGUIDANOS: Individuals that are going in for these very brief health issues are coming out, and then they're being readmitted to those hospices.

JAFFE: Which could be a bad thing, says Jon Keyserling, senior vice⁶ president for communications and policy at the National Hospice and Palliative Care Organization, the trade association for hospice providers.

JON KEYSERLING: Any association between profit margins⁷ and clinical decision-making is inappropriate and not something that the hospice community supports.

JAFFE: That hospice community has nearly doubled in size since 2000. And Susan Enguidanos says it's changed a lot.

ENGUIDANOS: Hospice organizations started as grass-root efforts and were largely nonprofit for a long time. And now we've had a huge increase in for-profit hospices.

JAFFE: James Keyserling says his biggest worry is that people who could be helped by hospice aren't taking advantage of it in time so that instead of comfort care...

KEYSERLING: Much of hospice is crisis care.

JAFFE: ...With about half of patients dying within just 17 days of entering hospice.

Ina Jaffe, NPR News.

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