HCA hospitals push for hospice care for patients in a bid to improve performance metrics and pay

Approximately 180 hospitals across the U.S. and the UK are part of the Hospitals Corporation of America Healthcare (HCA) facility. Now, this chain of hospitals is being accused by patients of pushing hospice care on patients so that hospitals can improve their score on performance metrics by improving in-house mortality rates and by freeing up beds faster for new patients, which will generate more insurance reimbursements.

Hospice care can be used as a means to reduce mortality rates for hospitals because when a patient transfers to hospice care, the patient is technically discharged from the hospital. So, even when they might physically be on the same hospital premises, their death is no longer counted towards the inpatient mortality figures. Reducing mortality rates for hospitals is important because high mortality rates reflect negatively on the hospital.

Another reason why low mortality rates and subsequently hospice care are encouraged in the HCA is that the board uses mortality rates to calculate incentive pay. In a way, lower mortality rates mean better executive pay. For example, of the $35.3 million HCA chief executive Samuel N. Hazen received in compensation, around $305,400 was incentive pay raised through decreasing mortality rates.

By suggesting end-of-life care to patients, hospitals also reduce lengthy patient stays as patients in these programs do not tend to live for too long. The patients transferred from hospital care essentially make room for more patients that can generate more revenue for the hospital, while the other patients may be costing the facility money because their insurance has run out.

Marisol Perez and her mother Alma Salas are one such example of attempts made by hospitals to push families of sick patients into hospice care. When Perez was first brought to St. David’s North Austin Medical Center in 2021, she was so severely sick with Covid and pneumonia that doctors suggested putting her in a coma to save her life.

Within a month of entering the HCA facility, Salas was being visited by palliative care nurses regularly who urged her to put her daughter on end-of-life care. At one point, a group of around 7 doctors gathered around her daughter’s bed and informed her that it is in the best interest of her daughter if she lets go.

Salas, however, held hope, and within a month of being discharged from the institute, her daughter made a full recovery.

Although there is a difference in the treatment received by patients in palliative and hospice care, an HCA spokesperson has confirmed that at their institute these two treatments work in tandem, and palliative care even at times acts as a gateway into hospice care.

 

Concerns and Ethical Issues Surrounding HCA’s Approach to Hospice and Palliative Care:

Dr. Ghasan Tabel, who works at an HCA facility called Riverside Community Hospital, has expressed his concerns over HCA’s hospice and palliative care by saying, “Sometimes it is reasonable to talk about comfort care, but usually it is done prematurely. What is very alarming to me is if they mislead the patient’s family about the prognosis, paint the worst-case scenario, sometimes graphically, to convince the family to go to palliative care and withdrawal of care.”