Guest Editorial Week Of 2/20/2023

Rick Russell President / CEO Hospice of Northwest Ohio

Is hospice care at a crossroads in the U.S.?

A recent investigation jointly published by The New Yorker and ProPublica highlighted fraud and abuse by a select group of publicly traded and private equity-owned hospice agencies. The article implies that hospice has lost its way and presents an inaccurate view of the Medicare Hospice Benefit.
I have been a nurse for more than 30 years and have dedicated the last 19 years of my life to end-of-life care. I have been part of exceptional interdisciplinary teams of nurses, doctors, social workers, chaplains, and others all focused on caring for patients during their end-of-life journey. I believe in hospice and the benefits this model of care provides to patients and families. I fully support changes to
improve the oversight and legal accountability of hospice programs.
Hospice began in the United States in the mid-1960s as a social movement to improve care for dying people, and gradually became a vital component in the health care continuum. Today most hospice programs across the country are known for their compassion, excellence and caring. Sadly, there are some programs that put profits over patient care, and this was the emphasis of the ProPublica article. Publicly traded and private equity-owned hospice companies have competing priorities: delivering a financial return on their shareholders’ investments versus the difficult road of meeting all the needs of patients and families at the most difficult times of their lives.
The National Hospice and Palliative Care Organization reports that in 2020 more than 72 percent of the hospices in America were for-profit corporations, many of which are owned by large corporations. This is a significant change from 2000 where 53 percent of hospices were community-based non-profits serving their communities. Historically, non-profit hospices provide considerably more physician and nursing care per patient than for-profit hospices. While Medicare requires every hospice program to be able to deliver four levels of care: routine home care, respite care, continuous care, and general inpatient care, non-profits typically deliver higher levels of care two and a half times more often than for-profits. In addition, non-profit hospices traditionally provide more grief services for families.
Hospice of Northwest Ohio is the area’s only independent, non-profit hospice agency solely focused on hospice and palliative care and education. Since 1981, we have continuously created programs and services to meet the changing needs of our community. We were the first hospice to be Medicare certified in the state of Ohio. We care for patients wherever they call home.
Our resources are dedicated to this and only this; we do not pay stockholders or generate income for other parent organizations. We are committed to bringing the highest level of knowledge and skills in hospice and palliative care to our community, and we take seriously the trust our patients and families place in us. As the Community’s Hospice, we are guided by our Mission to provide specialized medical, emotional, and spiritual care to anyone who seeks our help, regardless of their ability to pay or the complexity of their care. Our bereavement services are also available at no cost to anyone in the community.
I recognize that not all hospices maintain this same level commitment to patients and quality, and this deeply upsets me. One positive outcome of the The New Yorker/ProPublica article is that it shed light on the importance of updating the Medicare Hospice conditions of participation to improve quality
and eliminate abuse. All hospice providers must be held to the same high level of accountability and quality standards. I am optimistic that the Hospice Act of 2020, a series of proposed hospice survey reforms currently being implemented, is a step in the right direction. These should provide additional quality of care safeguards in the hospice benefit with significant enforcement actions up to removal
from the Medicare program.
I am also encouraged that many national organizations are expressing concern about the disproportionate growth in the number of hospices in some states. We need to take a step back and ask if these new hospices are really needed. What services will they provide that aren’t currently being
offered? Will they increase or delay access to high quality hospice care?
I can assure you that our focus at Hospice of Northwest Ohio will remain on our patients and families; to positively transform the way members of our community view and experience serious illness and the end of life.
To quote Dame Cicely Saunders, the founder of modern hospice “How people die remains in the memory of those who live.”


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