Cognizant of the penalty, not to mention the public reporting and notoriety, hospitals across the country are taking steps to beef up their hospice and palliative care programs.
"There's no doubt that hospitals are aggressively pursuing palliative care and hospice strategies for their patients," Kupfer says. "And there's no doubt they're aggressively hiring physicians to be able to provide much more rapid evaluation for palliative and hospital care… and have made it part of their strategies for reducing readmissions and also, therefore, mortality."
Overall, Kupfer is "questioning the morality" of using financial incentives to make doctors and hospitals do what they should be doing anyway, giving the right care at the right time.
So what should we do instead? Do we throw out all of our incentive programs and not require quality measurement in how we deliver care? Kupfer thinks peer review should come into play.
But for me, that's not going to cut it. We've had peer review for a very long time. It hasn't worked.
Maybe, just maybe, the recognition that hospice care is more important should prompt these conversations earlier, before that moment of confusion and crisis when the patient is back in the hospital, and no one knows what to do.