NPHI Condemns ‘Appalling Picture of Hospice Care’ in Recent Report

Tom Koutsoumpas, President and CEO of the National Partnership for Hospice Innovation (NPHI), responded to recent negative media coverage about hospice care in a letter to the editor below. NPHI is a partnership of community-based, non-profit hospice, palliative and advanced illness care providers across the country which is made up of like-minded leaders with expertise and passion for the highest quality, person and family centered, mission oriented end-of-life care. Hosparus Health is an active member of NPHI, and we fully support Tom’s response.

Dear Editor:

The October 25th article, “No One is Coming: Hospice Patients Abandoned at Death’s Door,” paints an appalling picture of hospice care in which care is withheld and no accountability structure is in place to oversee or punish these offending providers.

The National Partnership for Hospice Innovation (NPHI) strongly condemns this type of behavior and agrees that there is absolutely no excuse for patients and families not to receive the care they expect and deserve. However, here is the irony: there will likely be no consequences for these providers because Medicare is too busy looking for fraud in all the wrong places.

Unlike what is implied in this article, CMS does have the tools to combat this intolerable behavior. Rather than holding hospices accountable for providing substandard care, CMS contractors are fixated on proving a hospice should have known a patient wouldn’t die “on time” (within six months).

As our non-profit, community-based members have reported, there are too many examples of the outrageous behavior described in the article. Some hospices do not answer the phone after five o’clock, will not allow patients to have a hospital bed until they are bedbound, or tell families to “just let them know when the patient dies and they will call the funeral home.”

We are devastated when we hear stories of patients and families at their most vulnerable falling victim to bad hospice care. Such malfeasance deeply hurts hospice professionals and volunteers who work tirelessly every day to assure comfort and support at the end of life.

Non-profit hospices rely on philanthropy and volunteers to achieve their mission as they have since the inception of the hospice movement. They stretch to provide “ICU-level” care in freestanding hospice facilities by physicians and nurses who are board certified in palliative medicine and have proven quality outcomes. This is an example of the “crisis care” that this article refers to as necessary and underutilized – we strongly agree and strive to provide it.

Today, our nation’s best hospice programs are in immediate jeopardy while other providers are making high profit margins on providing poor care to patients. CMS can hold up payment while charts are under a lengthy review process. Non-profit, community-based programs with thin margins cannot survive while a contractor across the country is reviewing paperwork and making a decision that will take years to appeal.

If CMS continues to put financial pressure on community-based, non-profit hospices, this will have the unintended consequence of harming these programs and consolidation will only continue in an industry where more than 70% of hospices are for-profit.

We do not believe this is CMS’s intent and we urge it to seriously reevaluate what factors it considers to be indicative of aberrant and fraudulent behavior. We actively advocate to Congress and CMS that hospices should be surveyed more frequently.

Additionally, NPHI has provided several easy-to-apply metrics to identify those who may be perpetrating fraud. But even more importantly, hospices need to be evaluated on real-time quality measures. Unwarranted variability in care must stop now. We stand ready to help.

Sincerely,
Tom Koutsoumpas
President and CEO