Hospice providers are continuing to play a critical role at the end stages of a patient’s life. More and more families are aware of this and push relatives to make the election knowing that the alternatives are more intrusive, less compassionate, and likely do not extend the inevitable.
With this growth, the hospice market has started to come under new pressures from the government, large public companies, and insurance companies. The OIG continues to work on new programs which seem to be aimed at targeted aspects of hospice providers. This isn’t because of the practices of the local provider like you, it’s due to the large, national providers who force staff to focus on earnings and meeting objectives that satisfy Wall Street rather than grandparents.
These continued pushes for growth and increased profit, all while reimbursement rates continue to rise, has caused greed to morph into fraud. No longer are the big hospices in the business of providing patient care, they are in the business of satisfying analyst opinions and ratings. Many times, hospice fraud is perpetuated at the local branches of a national corporation who sets targets to meet the investor’s needs. This then turns to improper billing, upcoding, and placing patients on service too early.
Who gets to clean up the mess? You. Your hospice agency. You are left to deal with the new, onerous regulations and all the added expenses and losses that come with complying to them. You are left feeling that you must constantly be looking over your shoulder as if your hospice was the one that committed fraud when it wasn’t.
A long time ago, I had a conversation with a very well-connected healthcare executive and we discussed how the large companies were like banks – too big to fail. The government liked having the larger providers around because they were an easy target for uncovering large ticket fraud and abuse, giving the various investigative bodies a chance to shine and make themselves look good whenever they needed a public relations’ boost. Together, it was a win-win situation.
When the dust finally settled, the local providers were always left holding it together and making due. While the national companies got to pay a few million and move on, a smaller hospice would likely be shut down and forced to relinquish its provider number if they were discovered to have committed even a fraction of those millions in billing fraud.
Will things change? Maybe…but your hospice has to lead the way. Together, the locally managed and operated hospices, for-profit and non-profit, have to come together with one common goal: patient care. From there a plan needs to be devised on working together to root out its own bad apples and focus on what is good. You have the ability to do so and will do so by focusing on what you do best – providing personalized, unique, patient centered care that earns a good reputation for compassion and understanding. You aren’t worried so much about star ratings as you are about comfort and peace of mind for your patients and their loved ones.
Please let us know if you have any questions or comments. We love to get feedback on our newsletters and to hear from providers across the country to get their opinions and outlook.