I applaud Jay Greene for reporting on hospice care, Federal report: For-profit hospices drive up health care costs, but several key points may have been missing or misleading.
The Medicare hospice benefit extended to nursing home residents in 1986, because this is “home” to many people at the end of their lives. Today, one-in-four Americans are likely to die in a nursing home, and that number is growing.
While hospice care began with a majority of cancer patients, other eligible non-cancer terminal diagnoses were being underserved, chronic conditions that include: heart, liver, pulmonary, and kidney diseases; Alzheimer’s; ALS/neurological disease; debility; and stroke. Today, over 20% of people who die, do so in nursing homes from one or more of these non-cancer diagnoses, which have a longer decline time frame than cancer.
Currently, all hospice care – non-profit or for-profit – is paid the same daily rate no matter where the patient resides. By 2013, this will change; the longer a patient is on hospice care, the less the provider will be paid.
Hospice is in addition to care provided in a skilled nursing facility; hospice is not a replacement. Hospice is a Part A benefit that is chosen in lieu of Part A hospitalization. It is a cost effective, dignified way of providing pain and symptom management at the end of life instead of aggressively treating the inevitable in a hospital. According to a recent Dartmouth study, keeping a patient on a hospice program actually saved Medicare on average $2,309 per patient.
Choosing a provider to entrust end-of-life care should not be based on tax status, rather the quality and service of care to the patient. We all get paid the same rate, whether it’s for profit or non profit. It’s the number of services, length of stay and quality of care that differs. Competition among all hospice providers, regardless of tax status, has an important and significant series of benefits to Medicare, primarily reducing cost of care while improving quality of end of life. That quintessential benefit is to the terminally ill individual and their family. Medicare requires that patients be given a choice of hospice provider. Excellence will command those who are most successful, not tax status. We provide access to ALL the services to everyone no matter where they live or wherever they call home. They deserve the expertise and care that hospice teams provide.
Submitted by: Laura Wagner, Great Lakes Caring Hospice Chief Operating Officer (Aug. 3, 2011)
