美国国家公共电台 NPR Nearly 1 In 5 Hospice Patients Discharged While Still Alive

 

AILSA CHANG, HOST:

Hospice care is for the dying. It helps patients manage pain, comforts them, perhaps even allows them to focus on spending a last bit of quality time with their loved ones. But in recent years, nearly 1 in 5 patients have been discharged from hospice before death. And a new study finds that hospices with the highest rates of these so-called live discharges also make more money. NPR's Ina Jaffe reports.

INA JAFFE, BYLINE¹: To qualify for hospice care, two doctors must certify² that a patient is expected to live no more than six months. But patient James B. Nelson said he defied the expectations.

(SOUNDBITE OF DOCUMENTARY, "PASSING ON")

JAMES B. NELSON: It was decided³ that I was not dying fast enough. And to put it most succinctly⁴, I flunked⁵ the hospice program.

JAFFE: This is from an Arizona Public Media documentary "Passing On," which notes that Nelson died several months after this 2015 interview. But his situation is not that unusual. Government reports show that the median rate of hospice patients discharged before death has increased, peaking in 2012 and 2013 at about one patient in five. Now there's a new study in the journal Health Affairs that finds that hospices with the highest live discharge rates also have higher profits. The lead author is Rachel Dolin, a Winston health policy fellow.

RACHEL DOLIN: It's important to continue to study this area to get a better sense as to whether profits are driving the decision to discharge patients from hospice, rather than patient preferences and needs.

JAFFE: When a patient is discharged from hospice, they don't necessarily go anywhere. Hospice services are usually delivered where the patient lives. And those services cost Medicare more than $15 billion a year. Federal regulators have questioned whether high rates of live discharge mean that hospices are admitting patients who aren't actually dying. But those decisions aren't that clear cut, says Dr. Joe Rotella, chief medical officer for the American Academy of Hospice and Palliative Medicine.

JOE ROTELLA: We see more and more patients that have conditions, like Alzheimer's disease or Parkinson's disease, that don't always follow a predictable course.

JAFFE: But some experts who study aging think that hospices may be trying to avoid costs that should be their responsibility. Susan Enguidanos, an associate professor of gerontology at the University of Southern California, gives the example of hospices temporarily discharging patients who need a trip to the hospital.

SUSAN ENGUIDANOS: Individuals that are going in for these very brief health issues are coming out, and then they're being readmitted to those hospices.

JAFFE: Which could be a bad thing, says Jon Keyserling, senior vice⁶ president for communications and policy at the National Hospice and Palliative Care Organization, the trade association for hospice providers.

JON KEYSERLING: Any association between profit margins⁷ and clinical decision-making is inappropriate and not something that the hospice community supports.

JAFFE: That hospice community has nearly doubled in size since 2000. And Susan Enguidanos says it's changed a lot.

ENGUIDANOS: Hospice organizations started as grass-root efforts and were largely nonprofit for a long time. And now we've had a huge increase in for-profit hospices.

JAFFE: James Keyserling says his biggest worry is that people who could be helped by hospice aren't taking advantage of it in time so that instead of comfort care...

KEYSERLING: Much of hospice is crisis care.

JAFFE: ...With about half of patients dying within just 17 days of entering hospice.

Ina Jaffe, NPR News.

(SOUNDBITE OF OLAFUR ARNALDS & NILS FRAHM'S "01:41")

1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 certify   

vt.证明，证实；发证书(或执照)给

参考例句：

• I can certify to his good character.我可以证明他品德好。
• This swimming certificate is to certify that I can swim one hundred meters.这张游泳证是用以证明我可以游100米远。

3 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

4 succinctly   

adv.简洁地；简洁地，简便地

参考例句：

• He writes simply and succinctly, rarely adding too much adornment. 他的写作风格朴实简练，很少添加饰词。 来自互联网
• No matter what question you are asked, answer it honestly and succinctly. 总之，不管你在面试中被问到什么问题，回答都要诚实而简明。 来自互联网

5 flunked   

v.( flunk的过去式和过去分词 )；（使）（考试、某学科的成绩等）不及格；评定（某人）不及格；（因不及格而） 退学

参考例句：

• I flunked math in second grade. 我二年级时数学不及格。
• He flunked out (of college) last year. 他去年（从大学）退学了。 来自《简明英汉词典》

6 vice   

n.坏事；恶习；[pl.]台钳，老虎钳；adj.副的

参考例句：

• He guarded himself against vice.他避免染上坏习惯。
• They are sunk in the depth of vice.他们堕入了罪恶的深渊。

7 margins   

边( margin的名词复数 )； 利润； 页边空白； 差数

参考例句：

• They have always had to make do with relatively small profit margins. 他们不得不经常设法应付较少的利润额。
• To create more space between the navigation items, add left and right margins to the links. 在每个项目间留更多的空隙，加左或者右的margins来定义链接。