Rise of the For-Profit Hospice

(1:03) Guests: Karen Wyatt, family physician and author of “What Really Matters: 7 Lessons for Living from the Stories of Dying”  Arla Jaramillo, registered nurse and the Utah County Hospice Director for Envision Home Health & Hospice  Decades ago, Americans with terminal disease had pretty minimal options when it came to choosing how they’d like to die. It was either in a hospital hooked up to tubes or IVs, or at home, likely uncomfortable and in pain.  Today, hospice has become so prevalent that nearly half of Medicare beneficiaries use it in some form as they die. Initially, hospice was the purview of church and community organizations—generally nonprofits, funded by donations. But then insurance started covering hospice care and Medicare got on board. It wasn’t long before private companies figured out there was money to be made in helping people die “well.” The Washington Post reports hospice is now a $17 billion dollar industry dominated by for-profit companies.  Patient advocates and government regulators have raised concerns that profits might take precedent over quality of care in hospices. Dozens of hospice providers have been by investigated for fraudulent billing practices. We look at the rise of the for-profit hospice industry and ask what it means for patients and providers.  “The criteria for hospice care is care for a patient who is expected to have 6 months or less to live,” says Wyatt.  “Our primary focus is quality of life. Comfort is a big piece of that because obviously if you’re uncomfortable your quality of life is diminished,” says Jaramillo.