Hospitals' Fear of 30-Day Penalties May Speed Hospice Admissions

Cheryl Clark, June 6, 2013

An exception to federal 30-day mortality measures may incent hospitals to prematurely push patients into hospice care, says one critic, who calls it an unintended consequence of healthcare reform.

To avoid 30-day mortality penalties, hospital clinicians are aggressively steering newly admitted patients into hospice rather than usual inpatient services if they are at high risk of dying soon.

That's the rather caustic view of Joel M. Kupfer, MD, director of interventional cardiology at 336-bed Methodist Medical Center in Peoria, IL, who describes what he believes is another chapter in the healthcare reform book of unintended consequences.

Kupfer expressed his thoughts in a Viewpoint published in this week's Journal of the American Medical Association.

"The policies that hospitals and clinicians will implement to avoid being saddled with a mortality they are not in a position to predict or prevent should not be underestimated," Kupfer writes.

His words sound harsh. After all, wasn't part of the whole idea behind healthcare reform to give patients at the end of life a choice about how to spend their last days, and avoid futile, often painful, expensive care in surgical suites and intensive care units if that's not what they'd want?

Does he really think physicians will prematurely push patients into hospice care? That, I would think, would be tantamount to malpractice.

So I asked Kupfer to explain what he thinks is going on, and why he believes federal payment rules are steering us off the tracks and into the dreaded swampland of—yes, he dared say the word—"rationed" care.


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