The Commercial Appeal
‘Alarming’ number of patients discharged from hospice alive
Over the past decade, the number of patients who outlived hospice care in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying.
The number of “hospice survivors” was especially high in two states: in Mississippi, where 41 percent of hospice patients were discharged alive, and Alabama, where 35 percent were, a Washington Post investigation shows.
It is normal for a hospice to release a small portion of patients before death — about 15 percent has been typical, often because a patient’s health unexpectedly improves. But research showed that at some hospices, and particularly at new, for-profit companies, the rate of patients leaving hospice care alive is double that level or more.
Patients who are not near death are more profitable because they typically require fewer services. Hospices are paid a flat daily rate for hospice patients.
About 1 in 3 hospice patients were not given key information about what the choice of hospice entails at the time they enrolled, reports the Office of Inspector General of the U.S. Department of Health and Human Services.
Medicare, the government insurer, pays for the vast majority of hospice care in the United States. In 2013, it paid $15.1 billion for hospice services covering 1.3 million people. The federal government in recent years has sought to recover more than $1 billion from hospices that, according to attorneys, illegally billed Medicare for patients who were not near death.
OIG inspectors reviewed a random sample of the documentation that patients sign to indicate they want hospice care. In many cases, the patient was not informed that electing hospice meant that they intended to forgo a cure for their terminal illness, which investigators noted is a critical distinction between other health care. Hospices instead provide “palliative care” — that is, care focused on the prevention and alleviation of suffering of people nearing death.
“When people elect hospice care, they are forgoing curative care — and it’s important for them to know that,” Nancy Harrison, one of the investigators, said in an interview.
Moreover, in about 14 percent of cases reviewed, the physician who is supposed to approve the enrollment of a patient in hospice care paid only cursory attention to matter. They provided scant information about the patient’s prognosis and “appeared to have limited involvement in determining that the [patient] was appropriate for hospice care,” according to the report.
The trend is “alarming,” said Jodi Nudelman, who also worked on the report. people who work in front and behind the scenes at places visitors frequent.
A week ago, she spoke at the Embassy Suites on Shady Grove in East Memphis. More than 60 staff members from the kitchen, housekeeping, sales, night audit and other departments filled the room. Each received a pass allowing them guest admission at 30 attractions in the city.
Schmitz hit the high points of Downtown Memphis with a 20-minute video that featured Tad Pierson, who operates American Dream Safari. Along his tour, he picked up and dropped off experts who know something about every nook, cranny and cobblestone.
The city began to place the cobblestones in 1852 to accommodate the steamboat industry. Today, Memphis has the largest original cobblestone wharf remaining in America with over one million cobbles.
A few blocks away, Pierson drove past the mansions in Victoria Village. President Teddy Roosevelt spent the night in one house before he went on a bear-hunting trip in Mississippi, Schmitz chimed in. There’s a story behind Teddy and the bear.
Those are details tourists can read about in magazines or listen to as part of a pitch for Memphis to host a convention, but it means more when a local person says it, she said.
“It doesn’t feel like a sales pitch,” Schmitz said. “It’s someone who lives here, who is proud of their city and wants visitors to enjoy it, too.”
Embassy Suites general manager Ken Mendoza said there are many more things to do here than he realized. He plans to take his family on expeditions soon.
“So much history, so many museums,” Mendoza said. “I want to go to Stax. I love that music. That fire museum looks fun.”
“There’s so much bad press about crime and other things in Memphis,” Mendoza said. “Gosh, we’ve got to fall in love with our city and everything it has to offer. People will see our enthusiasm, and it will spread. I’m excited about this.”
The training session included emphasis on three foundation principles of the service culture: Smile. Welcome. Thank you.
Visitors hate indifference when they ask a question or voice a concern, Schmitz said.
“If you don’t know, you can find out,” Schmitz said. “It’s something that makes a big impression. You are going to any length that you can to help them. It makes them feel like you care. And you should care.”
An Embassy Suites room attendant received a $9 tip and praise from a guest who asked about things to do in the city. The recommendation: See the Fire Museum of Memphis and the Memphis Zoo.
Collin Stephenson, 23, moved to Memphis six months ago. He started working for Sprock n’ Roll, a pedal tavern that makes its way around the city using energy provided by patrons who sit at the bar atop a bike and pedal. Stephenson recently took the Memphis Insider course so he would have more to tell his visitors.
“I deal with oohs and ahhs and inquisitive faces all the time,” Stephenson said. “WDIA! The first black radio station in the country. There’s the (National) Civil Rights Museum, Graceland, Gibson Guitar, Stax. There’s just so much to talk about. I’ve lived a lot of places, but I’ve never felt more at home in a city anywhere in the U.S. I feel the soul of this city. The heart of this city is so transparent.”