As I point out in The Medical Profession Is Dead and the Doctor Is “Critically Ill!“, more factions are able to charge for and be reimbursed for healthcare delivery than ever before. This has come about through creating boutique health care niches. The demand for boutique care is being driven by entrepreneurial interests, and, once brought to fruition, then being managed with corporation business tactics — i.e., for profit.

One of the most incredible niches of them all has been hospice’s success at making care of the dying a specialty niche.  In days of yore, the dying patient’s family physician accepted the responsibility of pain management, comfort and dignity for their dying patients — and took that responsibility quite seriously. Has Medicare bothered to check recently the amount of money they are paying out to hospice for assurance that dying is being managed correctly? The work horses being remunerated for staffing most of these niches are RNs and ARNPs, with a physician, usually somewhere in the distant background, getting a cut of the action, for his supervisory service.

Could a professionally run, altruistic hospice service, for bonafide patients still residing in their own homes, be valuable to the system?

Absolutely. But permitting hospices to enterprisingly ply their trade in nursing homes, where Medicare is already being charged by that facility’s attending physicians — and where nursing salaries are implicitly paid by Medicare as well — is ludicrous.  The nursing homes where end-of-life care is being mismanaged should revoke the privileges of the offending physicians, and nursing homes, whose own administrative policies are resulting in self-serving case management decisions, should lose their Medicare certification.  We must demand quality of care from those being paid to provide it.

It may already be too late for Medicare, but if any hope still remains for its survival, Medicare must begin paring down the numbers of  “providers,” and para-medical consultant services that are currently able to submit charges to them — particularly those submitting charges for poor services, no services, etc. — and physician and facility self-serving services.  Should the current trend continue, soon Medicare will be paying individual nursing homes for only providing an administration and a physical plant for housing the patients.  All other patient care services will be subcontracted out to providers who also will then bill Medicare for their own particular boutique service.

In the nursing homes, hospice care should be the responsibility of the attending physicians and nurses already being remunerated by Medicare for caring for their patients.  Anything else constitutes double dipping.

Alan Cato is the author of The Medical Profession Is Dead and the Doctor Is “Critically Ill!”

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