Hospice Profit Status is Not a Reflection of Quality

Hospice Profit Status is Not a Reflection of Quality

(Alexandria, Va) – The February 2 issue of the Journal of the American Medical Association includes an article, “Association of Hospice Agency Profit Status, With Patient Diagnosis, Location of Care, and Length of Stay.” The National Hospice and Palliative Care Organization wants to stress that this JAMA article doesn’t provide any correlation between the profit status of a hospice program and the quality of care provided.

NHPCO is concerned that people looking at this study may overlook the critical importance of quality measures when discussing the provision of hospice care in the US.

“Ultimately, the most important measure or consideration is the quality of care provided to patients at the bedside,” said J. Donald Schumacher, president and CEO of NHPCO. “Detailed analysis of data submitted by hospices as part of NHPCO’s comprehensive survey, the Family Evaluation of Hospice Care, shows no difference in family caregivers’ evaluation of the quality of care based on a hospice program’s profit status.“

For many years NHPCO has been encouraging hospices to care for a full range of patients in the last months of life including non-cancer patients, such as those with dementia. Many hospices, including newer hospices that are for-profit, have worked to address the needs of such populations, including those who reside in nursing homes.

“Hospice organizations providing care to dementia patients and those living in nursing homes are meeting a very important need in this country and to infer that the primary motivation is financial does a disservice to the dedicated hospice staff caring for these people,” Schumacher remarked.

“The study authors seem to conclude that such patients are ‘lower skill’ – the implication being that their care needs are minimal. This reflects a fundamental misunderstanding of the important unmet needs for persons dying from dementia. A person dying from dementia may still experience pain,” remarked noted researcher Joan Teno, MD, MS, of Brown University and a member of the NHPCO board.

“Furthermore, pain is a huge public health problem in nursing homes where one in four Americans will die,” Teno added.

A 2009 article published in the New England Journal of Medicine provides evidence of some of the burdensome interventions that persons dying from dementia receive.
Hospice care brings skilled expertise to patients and families in all care settings to address their unmet needs.

“Availability of good care at the end of life is the right of all Americans,” Schumacher added. “The JAMA article also reminds us that for-profit providers are making more inroads in caring for African-Americans and Latinos, communities that have been underserved in the past.”

It is NHPCO’s position that research should move the entire industry forward by analyzing which hospice interventions enhance the quality of care provided and which demonstrate the efficacy of hospice care in all settings and for all hospice patient populations.

Furthermore, NHPCO calls for all providers, regardless of profit status, to meet and exceed NHPCO’s Standards of Practice for Hospice Programs, participate in its Quality Partners initiative, and fully comply with all hospice regulations.

Hospice began as a volunteer-driven, grassroots movement which has evolved to become a vital component of the healthcare system. The industry now includes a mix of nonprofit, for-profit and governmental entities similar to other healthcare sectors in the US. Together, the diverse hospice provider community is committed to caring for all individuals facing the challenging journey at life’s end.

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Note: NHPCO offers some more detailed key message points to members.