In a study published in JAMA, The Journal of American Medical Association, the study authors concluded that for-profit hospice agencies had a higher percentage of patients with diagnoses associated with lower-skilled needs and longer lengths of stay, when compared with nonprofit hospice agencies. This has led other writers in publications such as the Los Angeles Times and Modern Healthcare to suggest that the for-profit hospices may be selecting patients who are less expensive to treat — leaving patients who are more costly to care for to nonprofit agencies.
The results of the study suggest that Medicare’s per diem payment structure may create financial incentives to select patients who require less resource-intensive care and have longer hospice stays. We have been concerned for some time that Medicare’s policies have effects like this. There can be a similar risk of “cherry picking” of patients by physicians and medical groups for the same reason. Medicare’s “OASIS” rating system that publishes outcomes for healthcare providers may similarly encourage providers to shun patients who are so sick that they may produce bad OASIS scores for the providers.
The JAMA extract for the study can be found at this location:
Association of Hospice Agency Profit Status With Patient Diagnosis, Location of Care, and Length of Stay