Please Die Faster

Over the past few months I have had several interesting conversations with family members of patients who are on hospice services. The jest of the conversations have been twofold.

1) The patients are on hospice services and why aren’t they dying faster? (Asked by family members)

2) Why is it so expensive for hospice services and I’m not going to pay that much money for hospice!!! (Said in one long run-on sentence)

I always address the first question with the family prior to signing them onto hospice services. We are human and as such we are not the arbiters of life or death. When I sit down with a family and discuss end-of-life issues I make it clear that the time of appointed death is between the patient and God, not me. If you don’t believe in God, then it’s up to the fates or whatever you do believe as to when your loved one is going to die. I tell families that their loved one could live another two, three, or ten years, (depending on diagnosis) or they could drop dead while we sit and talk. I just don’t know exactly how long someone is going to live.

I try and make educated guesses as to how long a patient is expected to live based on data for a set of patients with the same diagnosis. The expectation for hospice services used to be that the patient would be dead in six months. That has changed and a more flexible system of recertifying a patient for hospice services has evolved. Often patients who looked as if they might die get better with the increased care they receive by hospice. Sometimes they get so much better hospice services have to be discontinued.

Certain diagnoses such as failure to thrive or general debility make it difficult to predict a patient’s rate of decline. Hospice providers have to be very careful not to sign on too many patients who later get better and are signed off of hospice services. If a provider has too many of these then their screening process for providing services may be carefully scrutinized by Medicare, something no provider wants.

Why does it cost so much for hospice services?

This question can be a valid concern especially if you are paying cash for the service. I checked into how one of my patients is being cared for and who was paying the bills. It turned out that the hospice is receiving about $3800 dollars to provide hospice care. The spouse of this patient yelled at me on the phone that he was not going to pay for such expensive care. He went on to rant about number of nurse visits per week and how it was all a scam.

He refused to listen to a thing I had to say but here is how it broke down. Prior to her enrolling onto the hospice service her room and board was paid for by Medicaid. That’s 100% paid for and comes to $4250 dollars per month. All her medications, doctor/NP visits, treatments, therapy etc… were paid for by Medicare as additional expenses. When she was enrolled onto the hospice service the hospice and the facility agreed on a different pricing structure. So now hospice bills Medicare $3800 dollars for the month and pays for everything except doctor visits. My visits are not billed and the doctor bills his own visits. So what was costing the taxpayers $4250 plus per month is now costing the taxpayers $3800 inclusive per month. Medications, therapies, room and board are all paid out of the $3800 dollars. Yes, our company does not make as much when we enroll a patient to hospice but we do save the taxpayers money.

The spouse of the above patient complained that he was not going to pay for these unnecessary services. Who cares if the hospice nurses come and see her two to three times a week, he said. In reality the spouse of this patient has not paid one thin dime for any of her hospital care. She never worked so she never paid into Medicare. He has been retired for almost thirty years and could not have paid into Medicare more than $1300 dollars in his lifetime. So a couple who really never paid anything into socialized medicine have been sucking $4250 dollars a month out of the system for the past seven years. That is just the room and board cost. Folks, that’s $357,000 dollars just for room and board and the family has paid $1300 into the cost of this care.

And who says Medicare/Medicaid and social insecurity aren’t in any crisis?

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