Odyssey Hospice, which is one of the biggest hospice chains in the nation, has paid the federal government millions of dollars to settle claims of overbilling. The story his here and the Department of Justice release is here.
I have written quite a bit about my dislike for the large chain hospice, and give my reasoning in the How To Choose A Hospice posts (especially this one). I don't want to get into that here because I don't think Odyssey's problem is exclusive to the large corporate hospice. Actually, I know it's not. The claims are that Odyssey was admitting and recertifying patients who didn't meet criteria. It happens all over the nation in all sizes of hospices, and, in my mind, is one of the true problems of the hospice industry.
Let me be clear, I do not think this is something that happens in every hospice. That's actually the problem. Many hospices follow the admission/recertification guidelines to the letter. They are as honest as the day is long. Those hospices have trouble competing with those who bend the admission rules.
The example:
I meet with a family about hospice care. They think it sounds great and want to proceed. The next step is for the hospice nurse to evaluate the patient and their medical history to ensure they qualify. Here's the difference between the Odyssey types and the others. When the patient doesn't qualify, we tell the family that they don't and move on down the road. When Odyssey, as told in this news article, found those patients they often signed them up anyway.
Many believe it's the unethical hospice's problem because Medicare is going to catch them, but that's not really true. Medicare may have never caught Odyssey if one of their nurses wouldn't have blown the whistle.
I have seen multiple examples of people who go hospice fishing after being told they don't meet the Medicare admission criteria. Basically, I have explained to the family how much hospice could help them. They are desperate for the help and usually they find it. That's how it is a problem for honest hospices.
If a person wants hospice, they can usually find someone to provide it. Your options are to bend the rules yourself or watch the competition sign the patient up. That patient won't switch to the honest hospice once they actually do qualify, so this is the moment of truth. Bend the rules and take a patient that doesn't qualify or watch the competition get another foothold in the community. It is made worse because it trains the doctors to call the other hospice first. All they care about is getting the patient help, so when they refer to a hospice, the hospice says no, and another hospice "steps up to the plate", who do you think the doctor will refer to next time.
Until this practice stops, the honest hospices will always have to fight to remain alive. Odyssey's current pain is only the tip of a huge iceberg. Unfortunately, I don't see the smaller players getting caught any time soon.
Many people question the ethical standards of any hospice that employs a marketing staff. Many say that hospice shouldn't be marketed. I agree. If left to stand alone, I believe that the quality of care my hospice provides could stand up to anyone. Unfortunately, that's not how the industry works right now. We have a marketing staff because we need someone constantly reminding the medical community that we are different. Busy doctors tend to remember the pain of a referral not working out much more than reports of great care and symptom control. We pay good money to remind them of the happy patients because my competition can make the doctor happy by taking every patient that comes their way.
I'm happy to see Odyssey was caught. I hope it will start a whistle blower revolution (Odyssey's whistle blower got over $2,000,000 for her trouble). Until then, we keep on fighting.
Thursday, August 03, 2006
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11 comments:
Hi, hospice guy. I am a hospice admissions nurse (12 yrs experience) with Odyssey HC, but I am not here to defend my company. I actually didn't know about all this until I read it in your blog. What I would like to say is, deciding if a person is eligible for hospice is not such a cut and dried thing after all. Yes, we have the guidelines, but there is a human factor here too. I find it particularly difficult with patients with dementia. I look at the FAST scale, and, hey, this person is still talking pretty well, and can smile, but he has lost 40 lbs in the last 6 months. This little lady is bedbound, and not talking, but she has been like this for 2 years. I have admitted a 60 year old dementia patient who was still walking, talking, and eating, because I was told he was in a rapid decline. He was dead in three months. And, yes, sometimes I guess wrong. But not very often. And then there is the fact that some people get better because they are getting quality attention. It is certainly wrong to deliberately admit people who do not qualify. I used to work for a privately owned hospice whose owner directed, "If you have any doubt, admit them and we will evaluate them later." I did not agree with that philosophy and refused to follow it. The fear of this is one thing that discourages MD's from referring because they can't guess if a person has a six month prognosis. So they wait until the prognosis is two days. Sigh. We will all continue to do the best we can. Thanks for y our post. Willa
Hi hopice guy,
I am a former spiritual care coordinator for Odyssey and now am with a small non-profit hospice. I have to say that in my time with the big chain, I found those RN's in admissions to be trying their best to determine hospice appropriateness. Sometimes you admit someone who is questionable and "see what happens" during that first recert period. Obviousy, there has been abuse of the system. And you are right in that it's not just the big hospices. Hospice has become quite the competitive business. There was a ton of pressure on our admissions staff from corporate and I watched a GM, a bunch of marketers and some great clinical staff get fired because of the numbers game.
It's not always easy, but I truly pray that we (hospice workers) may never forget why we are doing what we are doing and not lose the Hospice heart.
And what do you think of a large hospice chain that is planning on accepting patients to service with TPN and Dopamine IV drips?
I have worked for several hospices and 4 out of 5 of them required that admission occur with any M.D. order, regardless of the admitting RN's assessment evaluation. I have dealt with the same demand when it is time for recertification for ongoing care--do the recert or find another job. I'm tired of changing jobs!
Funny really. I've worked now with 4 hospice companies from the biggest to the smallest and I have yet to see one who did not try real hard to evaluate the Medicare certification criteria very closely for every patient on their services. Almost every major hospice in the USA got nailed a few years ago by the department of justice. Do your homework and you will see that it was not just Odyssey, but also VITAS and others. One of the biggest problems that I see is a lack of updated criteria for what qualifies and what does not especially from a non cancer diagnosis standpoint. I am not critical of the original article at all. I think we all need to watch what we do very carefully. Clearly there are those who are going to be discharged for extended prognosis.
Hospice Guy...
I have worked for 2 large hospice companies for the last 8 years (not at the same time!), neither of which is Odyssey. What I find to be more disturbing than admitting them when they don't qualify, is keeping them on the program FOREVER. I have had patients for 2 and 3 years that never really change. The ADC is the most important thing to them. It always interests me that someone sitting in the office behind a desk seems to think they have more knowledge about a patient that the RN Case Managers who see them 2-3 times a week. They ask us to recert these patients time and time again when they simply do not qualify for hospice. I have been told many times "well, that seems like a decline to me". Ok, great. But, not for hospice appropriateness. It got so bad, I got out of the case management part of it. I don't want to be the signature on the bottom. The team doctors are so pressured by the companies to recert them. For the egos that most MD's have, I have seen very few in hospice that will stand up and say "No, they do not qualify". Ok, that is all I have!
You won't have the cahones to leave this post up, but I'll write it anyway. Your blog is the most sanctimonious garbage I have EVER read. It ain't about you or your so-called ethics. Hospice is about the patients and giving them the help they need. You are one of those "hospice dilatantes" who love your little business and don't want the pressure of competition so you have your little self-rightous rants.
The problem with your intellectually dishonest blog is this. If hospice were run according to your desires, it would be just like the '80's...NO doctor referrals to hospice...HUGE areas of the country with no hospice availibility. If it weren't for the Odyssey's, the Vitas's, the Southern Care's etc. coming along in the 90's we would still be in the hospice dark ages when 90% of physicians didn't have a clue how to perform palliative care (most still don't), and had never heard of the Medicare hospice benefit. Those "evil marketers" from the chains are the main reason most doctors know what hospice is and does. I hope those that cheat pay the price but thank God the chains came along. They weren't formed to help YOU. They were formed to help patients.
I am currently an RN case manager with one of the 'big' companies, and while we are under pressure from corporate because we are publicly traded, I experienced as much pressure to 'produce' when I was in acute care for a 'non-profit' local health system. In my short tenure (3 months so far) I have had two patients "graduate" from hospice for extended prognosis. When I presented the reasons for them to be discharged at IDT, our PCMs and Medical Director accepted this and signed the discharge paperwork.
Yes, some of our patients have been on service for a year or more, but often patients 'improve' for a period of time and may actually live longer because they are getting more comprehensive care under hospice, but so sadly, we often get referrals when the patient is so close to death (days or even less) that hospice doesn't have an opportunity to help patient and family -- a good deal of this is because despite our 'marketing' people, a lot of times physicians don't want to tell the family that the person is hospice appropriate -- in other words, don't want to approach the subject of likely death.
By the way, I also have heard of several occurrences when our admissions coordinator or admit nurse have determined that a referral is not hospice appropriate and has not admitted them.
Fortunately, I do not feel I have to choose between my job and my license. The job is inherently very stressful and demanding, but it has its moments and I am dedicated to the hospice philosophy.
Hello, Hospice guy.
It's good to see that this type of action is getting attention. I am currently working for one of the "big" companies and it is common to see other companies in the workplace. I've come to realize that everyone does it. Willa said it great..."deciding if a person is eligible for hospice is not such a cut and dried thing." The big companies will have more of these cases simply because they handle more cases. I would love to see numbers on percentages of illegitimate cases. The size of the company should have nothing to do with the %. Small companies may be under pressure to grow and large companies may have too many to manage. There is no excuse for either of these, but I have seen both. There is never a good medium. Large or small, as you said earlier, it is their intent and actions that make the difference.
I don't agree with everything you write, but I am happy you are doing it. Keep up the good work.
As a family member of a patient who has received hospice care from Odyssey, I am grateful for their existence. My father died a little over a year ago, and the hospice staff made it so much easier on him, and on us. My mother has recently qualified as AFTT, and has Alzheimer's. She is ambulatory, but has had 12 falls in two months. Since hospice involvement, the siruation has improved, with only two falls, and that was because the aids at the nursing home did not want to use the geriwalker prescribed by the Odyssey MD. I just wanted a patient/family view to be included. Thank you.
Having been an experienced Hospice and Palliative Care Nurse for 12 years, we have found in oour Research Facility that patients referred to us in End Stage Disease Process for Non-Cancer Diagnosis usually die without the Care provided them by comprehensive Hospice Care. It is usually left up to the evaluation of the Nurse Case Manager and the Primary Physiacian in Consult with the Hospice Home Care Physician. No one can predict when Death will occur even when a patient meets end stage disease process criteria.
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