Discharge trends suggest hospices are ditching patients in their last days to preserve profits, Washington Post reports

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Hospices may increasingly be discharging dying patients to hospitals in an effort to protect their bottom lines, according to an article published Thursday in The Washington Post.

Hospice patients are supposed to have a life expectancy of six months or less, per Medicare rules, so it should be rare for a person to be discharged. Historically, about 15% of patients have been discharged, but this number has skyrocketed in recent years, according to research findings cited by the Post. In Mississippi, 41% of hospice patients were discharged alive in 2010.

“One part of the reason is some of the new hospice providers may … be more concerned with profit margins than compassionate care,” Brown University's Joan Teno, M.D., Ph.D., told the newspaper. Teno was the lead researcher on the team that compiled the discharge findings, which are forthcoming in The Journal of Palliative Care.

To avoid paying for expensive tests and treatments that may become more common as a patient approaches death, hospices might be essentially dumping these people by discharging them to hospitals, W.T. Geary Jr., medical director at the Alabama Department of Public Health, said in an email to the Post.

Hospitalizing a hospice patient likely goes against his or her wishes and often results in a further deterioration of health, the Post noted.

Another reason for the increasing discharge rate could be that hospices are admitting people who are not likely to die within six months, who go on to recover. More than a third of patients who left hospice were still alive six months later, according to the research findings, the Post reported.

Statistics indicate that this trend is being driven by newer, for-profit hospices, according to the article. The live discharge rate at small, for-profit hospices open five years or less was 32%, compared with 14% for older nonprofit hospices. The National Hospice and Palliative Care Organization declined to comment to the newspaper before having seen the actual research paper.

Government authorities have gone after hospices for billing Medicare for patients who do not fit the criteria for hospice care.  In one high-profile case brought this year, an Illinois hospice owner was charged with inappropriately designating nursing home residents as hospice patients and billing Medicare for years.

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