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NHPCO Comment on Post Article

August 6, 2014

Comment from NHPCO on a Washington Post Article

The Washington Post article, “Rising rates of hospice discharge in U.S. raise questions about quality of care” (08/06/14, online) looks at the issue of live discharges and once again tends to paint a one-side picture of the field.

 Live discharges are not an uncommon occurrence in hospice nor is the effort to understand them.

The Post article cites information that is soon to be published but not publicly available at print time. However, the journalist acknowledges that the as yet unpublished research cites 2010 data as the basis for the study.  Utilizing live discharge data earlier than 2012 is misleading.  Prior to that time, discharge rate data did not distinguish between patient initiated revocations (evidencing patient choice) and hospice discharges (for a variety of reasons, all noted in the hospice Conditions of Participation).  NHPCO’s National Data Set indicates that more than 40 percent of live discharges are the result of patient choice and the CMS contractor for hospice payment reform, Abt Associates finds similar rates for patient –initiated revocation.

The focus on those with higher than average live discharge percentages fails to recognize the complexities that patients face at the end of life.  Patients may change hospice service areas, decide to enroll in a clinical trial, or their family may not be ready to accept the termination of curative care.  And yes, sometimes a patient may revoke because of a disagreement on quality of care or the patient could be discharged by the hospice for just as many legitimate reasons.

At the same time the hospice community has repeatedly called for more consistent and timely oversight of providers. It is hoped that the legislation introduced August 1 by Congressmen Reed and Thompson mandating CMS surveys of hospice programs at least as frequently as every three years will serve hospice patients and their families, as well as hospice providers, in a positive way.

Every sector of healthcare is going to have a small fraction that tries to game the system.  The difference is that NHPCO and the overwhelming majority of providers in the field want to see bad providers closed down – and, more timely oversight should make that happen. Any hospice provider who fails to be fully compliant with all regulations and standards of practice and is unable or unwilling to provide the highest level of quality care should not be in the business of caring for the dying and their loved ones.

It is NHPCO’s belief that the overwhelming majority of U.S. hospices are committed to a shared vision to bring the best that humankind can offer to all those individuals facing serious illness, death and grief.  And the bottom line is that that they also have to ensure that every single patient day of care is delivered within all regulatory and statutory limits.