It doesn’t seem right: We blame Congress for argument, empty rhetoric, and gridlock–and then when it passes a bill, we ignore it.
Last week, the House and Senate passed legislation requiring tougher scrutiny of hospice facilities to guard against mistreatment of patients and selective admission of those likely to be most profitable. President Obama is expected to sign it.
“Hospice agencies must subject themselves to government inspections at least once every three years under new legislation approved by Congress, part of a measure that addresses concerns about substandard operators in the booming industry,” wrote Peter Whoriskey of The Washington Post. And he continued:
Several Medicare statistics analyzed by The Post indicate that some hospices may be stinting on patient care in order to pad profits…For example, about 18 percent did not provide a single patient with “crisis care” during 2012, according to Medicare billings analyzed by The Post, meaning the hospice did not provide either continuous nursing care or inpatient treatments. Hospices are required to provide such services to patients whose symptoms are difficult to control.
It’s an important bill. Hospice care, once a largely non-profit enterprise, has been taken over by for-profit outfits whose main concern is: profit. No surprise there, but if they’re earning it at the expense of people near death and their families, we need to keep a careful eye on that.
Did you miss this one? If so, don’t be surprised. Whoriskey is one of only a handful of reporters who wrote the story. A search of Google news for the past week produced only a few results. Modern Healthcare covered the story. The Corning Leader wrote two grafs on the story, because a local congressman introduced the bill. The Pittsburgh Post-Gazette covered it, too, I thought, until I looked and saw that it had reprinted Whoriskey’s story.
Are all the healthcare reporters covering ISIS? Or the National Football League? What’s going on? Who’s covering healthcare? Admittedly, not all healthcare coverage has disappeared–see, for example, Elisabeth Rosenthal‘s story last Sunday on the patient who received a $117,000 bill from a doctor he didn’t recall meeting.
But where was everybody on the hospice bill?
Whoriskey didn’t just cover the hospice story; he explained why the bill was important:
Approved by the House earlier this week and by the Senate late Thursday night, the bill also requires closer scrutiny of hospices at which a large percentage of patients live longer than six months — a sign to regulators that a hospice may be intentionally enrolling people who are more profitable than patients closer to death.
As the hospice industry has grown in recent decades, evolving from a movement of nonprofit organizations into a significant piece of the healthcare industry, critics have noted that some of the new hospices may not be living up to the original ideals.
Whoriskey has written a series of stories about hospice that are shocking, and sometimes even stomach-turning. People in hospice are in desperate straits–they are near death. They and their families are being forced into emotionally wrenching decisions, and they should be able to expect appropriate, compassionate care. Whoriskey’s stories show how wrong they are to expect it.
Last December, Whoriskey and colleague Dan Keating wrote:
Hospice patients are expected to die: The treatment focuses on providing comfort to the terminally ill, not finding a cure. To enroll a patient, two doctors certify a life expectancy of six months or less.
But over the past decade, the number of “hospice survivors” in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer.
In May, Whoriskey and Keating wrote about an 85-year-old woman in hospice care at home who “heaved for breath sometimes and panted at others. Sounds of gurgling and congestion came from her throat.” The nurse taking care of her said, “she is leaving soon,” but it was the nurse who left. When her replacement failed to show up, she “left the house and drove away,” Whoriskey reported. The woman “died within an hour,” he and Keating wrote.
The bill that Congress passed last week isn’t likely to solve all of the problems Whoriskey and Keating have uncovered, but it will help. Why it didn’t receive more coverage is a mystery. I doubt that healthcare reporters were pulled off of their beats; where would they go? Congressional correspondents who might have covered the bill were perhaps distracted by the prospect of a new war in the Middle East. But even many of the medical trade publications failed to cover the hospital bill, and they should not have been distracted by geopolitical instability.
We are engaged in a battle to improve healthcare in this country, and we cannot win that battle without unfailing attention from the press. We’ve barred insurers from refusing coverage for pre-existing conditions, partly because of horrific stories in the press about insurance-company rejections of ailing patients. We’ve made insurance available to more people, partly because the press has highlighted the tragedy of people in desperate circumstances who could not get health insurance.
Without attention from the press, for-profit hospice facilities will do what they are set up to do: earn profits. There are ethical ways to do that, and unethical ways. The new legislation will help push those facilities to earn profits ethically, but the government can’t do this alone. And it certainly can’t do it without attention from the press.
Am I forfeiting objectivity in arguing for more aggressive coverage of health industry failings? I’m saying that the press should take a position against negligence, and against practices that harm patients and families and cost lives. Call that advocacy journalism if you like, but I can’t imagine who would take the other side.
-Paul Raeburn
Laura Newman says
I think that your view about the lack of news coverage is harsh. Clearly, hospice care is worth covering. But it’s a huge, complicated topic and that’s why Whoriskey goes for the big story.
Once-every-three-year inspections are not going to achieve much reform. Inspections happen all the time throughout healthcare and providers know how to play them. If they are cited for problem(s), they can fix them and restore their approval rating. The inspections are scheduled, not unannounced.
The long stay/lower case mix is a dicey topic. People in palliative care are pushing people to enroll in hospice earlier because frankly, once people are going downhill, there is nowhere else for them to go and get any kind of care. I support that. So you can’t just question long lengths of stay.
There are other issues not addressed in the new law. Hospices have very little end-of-life training for staff, an area unaddressed by this new law.
Finally, the hospice industry endorsed the IMPACT law, which is telling. If the law had much teeth in it, the industry wouldn’t be applauding.
praeburn says
Laura,
Good points; you know more about this than I do. But if the bill lacks teeth, that might be even more reason to report it. I can’t think of anything that would give reporters reason to pass on this–whether it will change the industry or not. I, for one, would like to known that Congress passed an industry-supported bill. Thanks to Whoriskey–and now to you–I do.
Best,
Paul