Ethicists question for-profit hospices

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As the for-profit hospice industry booms, some ethicists are questioning whether their success impacts the quality of end-of-life care.

Fifty-two percent of hospices are now in the for-profit sector. An article published in the summer issue of the Journal of Law, Medicine and Ethics reports that the for-profit hospice industry grew 128% between 2001 and 2008, while nonprofits expanded 1%.

For-profit hospices generate higher revenue than their nonprofit competitors. Investigators question whether it's ethical to pay for referrals, give gifts to nursing home employees or accept patients only with certain conditions.

Studies have shown for-profit hospices tend to select longer-term patients. Medicare pays for hospice patients on a per diem rate, rather than basing payments on services received.

“Hospice patients' use of services are greatest on the first day of hospice care, when services are being set up, and in the last few days of life, when round-the-clock nursing care may be required,” study author Robert C. Stone, M.D., said.

Stone and co-author Joshua E. Perry, J.D., cautioned regulators to watch for ethical breaches in the field.

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