On June 5, the Wall Street Journal
carried a front-page story by Lucette Lagnado about how some
elderly, terminally-ill patients were targeted as part of a drive by
Medicare to cut back on supposed fraud among hospice care providers.
The reason, according to the Journal report, was some
patients in upstate New York had lived longer than the six months
anticipated by Medicare rules governing hospice care — so the
government wanted its money back.
broadcast networks — whose news programs frequently feature stories
of how patients of Health Maintenance Organizations (HMOs) have
suffered as a consequence of cost-cutting rules — failed to tell
viewers about the Journal story or to provide their own
follow-up report. But the lengthy (3,500-word) story offered an easy
roadmap for any news network to follow — if, that is, it had any
interest in documenting the human costs that can result from the
mindless application of government rules.
Medicare pays $88 a day for dying patients to receive hospice
care in their own homes or in home-like facilities. It’s almost
always cheaper than either hospital care or nursing home care, and
patients at the very end of their lives typically prefer the more
comfortable, less institutional surroundings. Most of those who
receive hospice care live only a short time. Dr. Nicholas
Christakis, an expert from the University of Chicago quoted by the
Journal, found that the average patient received hospice care
for just the last 36 days of their lives; one out of seven patients
(15.6%) died within one week.
But a small percentage of patients beat the odds: Dr. Christakis
found that just under 15 percent of hospice patients survived for
more than six months, usually patients with chronic lung disease,
dementia or breast cancer. But Medicare’s rules allow only six
months for hospice care, and in late 1997 the Clinton administration
ordered a crackdown. A memo from the Department of Health and Human
Services’ inspector general instructed the government’s Health Care
Financing Administration (which runs the Medicare program) to start
getting tough. "There has been less rigorous enforcement of the
six-month prognosis requirement by the hospice industry, especially
for noncancer-diagnosed patients," said the memo.
Rigorous enforcement meant that terminally-ill patients received
letters from telling them they were no longer eligible for
Medicare’s hospice benefits. The Journal described the plight
of several patients who were caught up in the hunt for hospice
One, Rosie DesParois, was a retired nurse diagnosed with cancer
who began receiving hospice care when she was 87 years old.
According to the Journal’s account, Mrs. DesParois "loved the
idea of spending her final days in her old house that she adored,
tinkering in her flower garden" and the hospice nurses visited her
regularly, bringing coffee and doughnuts and ensuring that she took
Four years later, however, Mrs. DesParois was still alive and
receiving care, and her hospice was being investigated by United
Government Services (UGS), a subsidiary of Blue Cross-Blue Shield
that is contracted by the government to administer portions of the
"As the inquiry closed in, the hospice decided it had to force
out Mrs. DesParois," related the Journal’s Lagnado. "She was
91, but was lucid — and devastated."
Although one of her nurses continued to visit Mrs. DesParois,
"without the resources the hospice provided, the sick woman couldn’t
remain at home, and she slid downhill," wrote Lagnado. "Her house
was sold, and....she was sent to a hospital, then a nursing home
where she became almost unrecognizable. She had long been a small
eater. But at the [nursing] home she stopped eating almost
completely....Cancer spread to her pancreas and stomach. She
developed gaping bedsores and was in agony. And on Sept. 16, 1998,
Mrs. DesParois died, away from her home and the hospice staff."
"As it turns out, the government’s move backfired," reported the
Journal. "Mrs. DesParois’s nursing home charged Medicare
about $150 a day, nearly twice the hospice’s fee."
Ultimately, the hospice which cared for Mrs. DesParois filed for
an administrative court hearing to fight UGS. The judge ruled
against the government and ordered that the hospice be returned
$85,000 that had seized from it as restitution. The judge said that
the fact that a few patients lived beyond six months "represents an
achievement; it is not indicia of fraud."
Often, network news departments rely on the front pages of major
newspapers such as the New York Times, the Wall Street
Journal and the Washington Post for story ideas. The same
morning that the Journal ran its story on hospices, for
example, ABC’s Good Morning America interviewed two high
school girls who thought they were being awarded full college
scholarships, only to discover that it was a mistake and there
wasn’t any scholarship money. That story appeared in the
Washington Post the previous Friday.
Since no network saw fit to dispatch cameras to help bring the
facts uncovered by the Journal’s investigation to a wider
audience, most Americans probably remain unaware of how the federal
government’s unthinking efforts at cost savings hurt real people in
the real world. Contrast the networks’ lack of interest in
government’s mistakes with their longstanding practice of
highlighting how privately-run HMOs sometimes jeopardize patients
when they try to cut costs.
On February 22, for example, on CBS’s 60 Minutes II
newsmagazine, Dan Rather profiled a patient, Cynthia Herdrich, who
in 1991 went to her doctor complaining of pain. Her doctor suspected
an ovarian cyst and, believing that no emergency existed,
recommended that Herdrich receive an ultrasound test at another
hospital 50 miles away the following week.
The doctor was wrong. When Herdrich was finally tested, she found
out that she really had a burst appendix and a life-threatening
infection. She survived, and won a malpractice suit against the
doctor who misdiagnosed her. But her lawyer, Jim Gintzkey, also
wanted to sue the HMO. Gintzkey argued that the incentives doctors
received from the HMO to cut costs contributed to the chain of
events that imperiled his client.
On 60 Minutes II, Herdrich, her lawyer and Dr. Harvey
Wachsman, an anti-HMO activist, all railed against HMO cost-cutting
procedures. Gintzkey told Rather that he believed "every decision
that the HMO made in [Herdrich’s] case can be explained on the basis
of their profit motive." Dr. Wachsman said, "There’s no question in
my mind, this is not health care. This is, to me, managed fraud.
It’s not managed care. There is no such thing."
On June 12, the Supreme Court ruled that Herdrich couldn’t sue
the HMO under federal law. On the CBS Evening News,
correspondent Jim Stewart painted the ruling as purely a procedural
win for HMOs. "By granting them immunity from federal lawsuits,"
Stewart reported, "the justices just as clearly threw blood in the
water at the state level, where juries have rarely been kind to
health care systems."
In other words, HMOs will remain on the defensive — in the media
as well as in the courts. But even as the networks continue to push
the notion of the little guy getting trampled by big business,
fairness would dictate that the networks also tell audiences about
when the little guy gets run over by big government, and where
government’s approach to cost-cutting harms both patients and