Thursday, November 11, 2021

Opposing The Palliative Care and Hospice Education and Training Act (2021)

House RCP 117–17 (10-28-2021) of H.R. 5376, BUILD BACK BETTER ACT, §§ 31007-31011

Position Statement

The EPC - USA opposes assisted suicide and euthanasia. This bill would  federally fund training in how to assist a suicide (an option within palliative care) and promote it. We support hospice and palliative care that mitigates distressing symptoms, relieves pain and maintains function. We support helping patients live well without placing them at risk of abuse, serious harm and hastened deaths. Until dangerous and unsafe palliative and hospice care can be identified in time to protect patients, the federal government should not be promoting it.

Talking Points

The bill would federally fund medical training in how to assist a suicide (an option within palliative care(1)) and the promotion of assisted suicide as palliative care. The Assisted Suicide Funding Restriction Act only forbids federal funding of providing or obtaining assisted suicide.

The bill would extend palliative care provided by hospice (69% of hospices own palliative care programs(2)) and by health insurers to non-dying patients, federally fund medical education and direct HHS how to “sell” palliative care to the public. The bill has no enforcement mechanisms.

    1. Hospice, a palliative care program, is plagued by fraud and poor quality care leading to serious harm and deaths, while wasting hundreds of millions of federal dollars.

Federal juries found the medical directors and a nurse from Novus Health Services guilty of Medicare fraud close to $40 million along with the director who told nurses to make patients “go bye-bye” with overdoses of drugs like morphine.(3) All of them are facing lengthy prison sentences.

Federal investigators found hospices enrolling patients who are not terminally ill, without their knowledge or under false pretenses, providing poor quality care, and inappropriately billing Medicare hundreds of millions of dollars.(4)

Eighty percent of hospices had deficiencies that pose risks to beneficiaries; 20% had deficiencies jeopardizing patients’ health and safety or substantially limiting their ability to provide adequate care.(5) The bill does not address this.

    2. Palliative care programs are used to enroll more patients in hospices earlier,(6) even if clinically inappropriate,(7) to make more money.

“Palliative care is for all individuals with serious illness who face heightened risks of crisis hospitalization and preventable spending” per the Center to Advance Palliative Care.(8)

Health insurers (e.g. Anthem and Humana) are running palliative care programs. Anthem owns the Aspire palliative care company which uses a Google funded algorithm to target people for palliative care.(9) Humana is running a palliative program where people who sign up are enrolling in hospice with curative care that automatically ends after 31 days.(10)

The Senate Finance Committee says 16% of hospice enrollees got care from either a private equity owned or publicly traded hospice company in 2019; care quality in for-profits is concerning.(11)

Research of care in private equity owned nursing homes found a 10% increase in mortality and a 11% increase in taxpayer spending, while Medicare compliance declined.(12)

    3. Enactment of the PCHETA bill could erase federal fraud recoveries, rewarding those who game the system.

The HHS Office of Inspector General says hospices are defrauding Medicare of hundreds of millions of dollars by enrolling people who are not terminal and then billing at the highest rates.(13)

Most hospice settlements listed on the Fraud in Healthcare site are for enrolling ineligible people.(14)

    4. Palliative care is often a dangerous pathway to death for people not otherwise dying who could have years to live.

Palliative care leads to the deaths of people who were not otherwise dying; typically by indifferently assessing people as terminal and providing them “comfort care” where they are heavily sedated, overdosed on pain killers and denied food and water so the prognosis becomes self-fulfilling.

Clinical practices in palliative medicine regularly result in shortening lives.(15) In one study, 39% of physicians and nurses said they intended to shorten lives with drugs and treatment withdrawals.(16) A survey of over 800 hospice and palliative care physicians revealed 45% would sedate patients who were not actively dying to unconsciousness and then withhold food and fluids until they died, as a “best practice.”(17) One-fourth of them said it did not matter how long the patient had to live. Id.

These practices are so prevalent that they were described by the Washington Post in a 2014 series,(18) identified as a serious problem by Duke University professor Farr Curlin, 2015,(19) and identified as a patient safety problem by the Agency for Healthcare Research and Quality in 2017.(20)

  1. Delaware HB 140 says medical aid in dying (a euphemism for assisted suicide) is a palliative care option. (Link) see also (Link). 
  2. (Link). 
  3. (Link); (Link). 
  4. (Link to the complete report)
  5.  (Link to the complete report). 
  6. (Link to the article) calling palliative care a loss leader for hospice providers. A loss leader is a service sold below cost to attract customers who will then buy more profitable services. 
  7. See notes 3and 5. 
  8. (Link) 
  9. (Link to the Anthem companies) (Article about Aspire Health). 
  10. (Link to article); (Link to document) 
  11. (Link to document) 
  12. (Link to article) 
  13. See note 4. 
  14. (Link). 
  15.  Rietjens JA et al., Physician reports of terminal sedation… Ann Intern Med 2004;141:178-185.
  16. Cohen L, et al., Accusations of Murder and Euthanasia in End of Life Care, J Pall Med 2005.8.1096 at 1102. See note 15 at 1099. 
  17. Plots created by Sahr N, Ph.D from data reported on in Maiser S et al., A Survey of Hospice and Palliative Care Clinicians' Experiences and Attitudes Regarding the Use of Palliative Sedation, J Pall Med 2017 Sep;20(9):915-92. 
  18. Peter Whoriskey, As More Hospices Enroll Patients Who Aren’t Dying, Questions about Lethal Doses Arise, Washington Post, August 21, 2014 (Link).
  19. Farr A. Curlin, M.D., Hospice and Palliative Medicine’s Attempt at an Art of Dying, chapter 4 in Dying in the Twenty-First Century, edited by Lydia Dugdale, MD, MIT Press 2015 at pages 47-8. 
  20. Palliative-Care-Comfort-vs-Harm (Link) published November 2017.

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