Last updated on January 13, 2025
Researchers at the University of Pennsylvania Leonard Davis Institute of Health Economics explain that “hospice’s eligibility and payment systems do not support consistent, high-quality care.” This had dire consequences for my family. Unfortunately, my grandpa was admitted to a facility two years ago and passed away after corporate negligence resulted in substandard care during his final days. However, the industry wasn’t always administered in this fashion. Hospice began in the United States as a volunteer-based operation, subsidized by donations and charities. The care was described as comforting as patients passed away in their homes instead of dreary hospitals.
This promising solution was halted after the government passed the Tax Equity and Fiscal Responsibility Act 1982. This legislation permitted Medicare, a fee-for-service health insurance program, to cover patient stays and treatment through taxation. This payment restructure operates a “pay-and-chase system” where owners of medical centers must track the capital spent on medication. Later, they’ll submit an audit to the government, which will reimburse their claim and cover patient services. This inherently leads to problems as Medicare trusts that billers will present accurate statements, although this is untrue. Institutions rush to take advantage of this statute, which prioritizes financial incentives over the solace of dying patients.
This prioritization of profits over patient comfort often results in lower-quality care, as facilities focus on maximizing reimbursements rather than ensuring compassionate end-of-life support. Researchers at the RAND Corporation found this trend after conducting a study involving 653,208 caregiver respondents from 3,107 hospice facilities. 31.1% of for-profit centers scored 3 or more points below the national hospice average of overall performance, which exceeded the number of facilities that performed above the national average. On the other hand, 12.5% of non-profit centers scored below the national average. Unsurprisingly, they mimic the original state of hospice care before its inevitable commercialization in 1982.
Policymakers must reform hospice payment structures to prioritize patient care. Implementing stricter audits and oversight can ensure that facilities focus on comfort over profits by shifting away from our “pay-and-chase system.” Addressing these systemic flaws is vital to ensure that no family has to experience subpar care during their loved one’s final days as mine did two years ago.
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