Hospice profits raise questions about Medicare volunteer rule

Updated: 10:51 p.m. Saturday, April 14, 2012

Posted: 10:38 p.m. Saturday, April 14, 2012



Hospice profits raise questions about Medicare volunteer rule


Vote (0)By Charles Elmore



Palm Beach Post Staff Writer



Quick: Name the only industry in which Medicare requires volunteers to provide free labor - in some cases helping for-profit executives become millionaires.



It is hospice, which cares for terminally ill patients, according to a new congressional advisory report that questions the arrangement.



"I just don't think that's right," said volunteer Carolyn Millard of West Palm Beach. "I think it's terrible."



She said she was a volunteer for Vitas Healthcare until she read a report in The Palm Beach Post in January. She had no idea Vitas was a for-profit company in the first place - let alone one under federal investigation of its billing practices. Company officials have denied wrongdoing.



At least five officers at Vitas' parent company made more than $1 million in total annual compensation, The Post found. Vitas is the larger of two businesses controlled by $1.4 billion Chemed Corp. of Cincinnati. The other is Roto -Rooter plumbing.



For-profit companies have been a driving force behind the quadrupling of annual hospice costs to $13 billion since 2000, making it the fastest­-growing part of Medicare, government reports show.



Volunteers sometimes help for-profit hospitals and other businesses, but hospice is unique. It is the only service that requires volunteers to provide at least 5 percent of the hours spent caring for patients in order to qualify for Medicare payments.



The Medicare Payment Advisory Commission report released in March raises renewed concerns about blending for-profit business models with government rules written when most hospice providers were nonprofit. Medicare began paying for hospice care in 1983.



"When the requirement was established, virtually all hospice providers were 'voluntary' or charitable organizations," the report said. "Today, more than half are for-profit providers."



The situation "raises questions about the role the volunteer requirement plays in hospice care," the report said.



There are no plans to drop the volunteer requirement, a spokeswoman for the Center for Medicare and Medicaid Services said. "Eliminating volunteer services would require a change to the law itself," said spokeswoman Carolina Fortin-Garcia. That's up to Congress.



In 2006, Florida made it easier for for-profit hospice providers to operate in the state under a bill sponsored by then-Sen. Jeff Atwater, R-North Palm Beach. Atwater said at the time the bill would put nonprofits "on notice that the best in the business" are coming to Florida. State law also requires 5 percent volunteer hours.



Vitas, founded in Miami and now the nation's largest hospice company, gave more than $185,000 in campaign contributions to Florida officials including Atwater since 2000, records reviewed with the help of followthemoney.org show.



Atwater, now the state's chief financial officer, was traveling and unable to respond to a request for comment, a spokeswoman said.



The volunteer requirement should stand, maintains the National Hospice and Palliative Care Organization, a group that represents both nonprofit and for-profit providers.



"NHPCO strongly believes that volunteers play an essential role in the provision of care and are valuable members of the hospice interdisciplinary team," said Jon Radulovic, vice president of communications for the organization.



Volunteers "root an organization to the community it serves" and bring "immeasurable" benefits to the bedside of patients, he said.



An estimated 458,000 trained hospice volunteers provided 21 million hours of service in 2010, his group says.



In a statement, Vitas defended the volunteer role.



"Volunteerism has long been recognized as a vital component of hospice care," the company's statement said. "Volunteers provide support, engagement and companionship for hospice patients and their families. Moreover, beyond uniquely benefiting patients, volunteers find their service to be a personally rewarding experience. Many hospice volunteers are family members, friends or acquaintances of hospice patients."



Thirty years ago, hospice was promoted as a way to show compassion to dying people and save money, too. Organizations with community roots, including many with religious ties, led the way.



The idea was to allow a patient diagnosed with six months or less to live to choose to give up expensive last-ditch efforts to cure a terminal disease. Instead, the patient would accept "palliative" care such as pain and anxiety medicine, along with other support, in an atmosphere designed to be as dignified and peaceful as possible. For the vast majority, hospice is not a place to which they go but a service they get where they are - at their homes or in assisted-living facilities.



The cost-saving benefits seemed clear enough with, for example, late-stage cancer, but a growing number of patients on hospice care have such conditions as dementia or Alzheimer's. It can be less clear what "curative" treatment a dementia patient is giving up in exchange for palliative care.



Dementia patients tend to live longer on hospice care than cancer patients, making them more profitable to the hospice provider, government reports show. For-profit hospices do a better job of finding more profitable patients, studies have found.



Patients spent 40 percent longer on average in for-profit hospice care compared with nonprofits among providers serving Palm Beach County, a Post analysis found. Nonprofits Hospice of Palm Beach County and Hospice by the Sea are also licensed to serve the area.



The bottom line has been an increased cost to taxpayers.



Selene Fishkin of Palm Beach Gardens said her late husband was in an assisted-living facility for Alzheimer's.



She said she was astounded to see Vitas billed the government more than $20,000 in a month last year. She remembered the service largely as 15-minute visits from a hospice worker.



"I think they're robbing Medicare," she said.



Rebecca Cohen said she did not know Vitas was a for-profit hospice when her mother was in a Delray Beach health care facility last year.



"Looking at Vitas' website you will not see they are for-profit," Cohen said. She believed her mother's facility was pushing the family to choose Vitas for hospice care, though she selected a nonprofit after doing her own research.



Cohen said she suspected "perks in it for them to shove residents toward the for-profit choice."



Assisted-living providers and hospice firms have denied such perks.



Millard, for one, has seen enough. She stopped volunteering at a for-profit hospice.



"I thought we were being taken," she said.





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Hospice volunteers



•Required by federal and state law to provide 5 percent of hospice hours.

•There were an estimated 458,000 hospice volunteers nationally in 2010.

•They provided 21 million hours of service.

Source: National Hospice and Palliative Care Organization





http://www.palmbeachpost.com/news/lifestyles/health/hospice-profits-raise-questions-about-medicare-vol/nN29k/