Has treatment improved, or do hospice agencies profit more by discharging prior to dying ?
"Individuals that are going in for these very brief health issues are coming out and then, they're being readmitted to those [same] hospices," says Enguidanos.
That's not a good reason to discharge someone, says John Keyserling, senior vice president for communications and policy at the National Hospice and Palliative Care Organization, the trade association for hospice providers.
"Any association between profit margins and clinical decision making is inappropriate and not something that the hospice community supports," Keyserling says.
That hospice community has nearly doubled in size since 2000. Susan Enguidanos says it's also changed a lot.
"Hospice organizations started as grass root efforts and were largely non-profit for a long time," she says. "Now we've had a huge increase in for-profit hospices." There's a concern, says Enguidanos, that by discharging patients early, some hospices may be "trying to avoid costs that they should be responsible for.
Whatever the short-comings of some hospices may be, Keyserling says that his biggest worry is that people who could be helped by hospice aren't taking advantage of it in time. He says about half of patients die within 17 days of being admitted. And that turns hospice into "crisis care" instead of the comfort care it's intended to be.
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