Skip to main content

The Price of Hospice Rate Cuts


It goes without saying one can’t put a price on the last months, weeks and days of a life shared with a loved one. But in addition to improving the quality of the lives of millions of terminally ill individuals and their families each year, hospice care has also been proven to save the government money. Sounds like a win-win situation, right? Well, not judging by Congress’ proposed rate cuts.

The high-quality, compassionate end-of-life care Americans depend upon is threatened by not one but two devastating rate cuts. Already bracing for a 3 percent regulatory rate cut starting this month (the Budget Neutrality Adjustment Factor or BNAF), hospice, along with most other Medicare providers, is also facing additional cuts through a “productivity adjustment” to help finance health care reform.

These new reductions would slash rates by a damaging 11.8 percent throughout the next 10 years to fund new health care initiatives written into the bill. Combined, the impact of these two cuts would mean an astounding 14.3 percent loss to hospice. Considering hospice, as sited by MedPac, already operates on a very small profit margin of 3.4 percent, this means programs will go broke, doors will close, and Americans will be left without or with limited options of having hospice at home. In response to the proposed cuts, The Alliance for the End of Life Care and the National Hospice and Palliative Care Organization (NHPCO) have launched “Two Cuts Are Too Much,” a grassroots campaign.

As part of this effort, I traveled throughout central Iowa videotaping touching testimonials, putting faces on the cuts Congress is about to pass. As is the case of many hospice employees, I learned about hospice care when my loved one needed it. I cannot imagine what my family would have done without the compassionate care we received, which allowed Grandma and Bessie to live the end of their lives in comfort and with dignity, according to their wishes. In my position as community relations coordinator for Hospice of Central Iowa, the largest non-profit hospice organization in the state, I see the benefits hospice brings to our communities each day. My colleagues and I are very concerned the proposed cuts would limit both our ability and that of other hospices likes ours to provide this needed service. Because care is most expensive to provide in rural areas like much of Iowa, many hospices here would have no choice but to close their doors or severely limit service areas.


But together, we can help. Contact your members of Congress TODAY to tell them that “Two Cuts are Too Much for Hospice!” Visit NHPCO’s Legislative Action Center for steps to educate your Congressional representatives about how additional rate cuts would impact patient care in your local hospice community. Also encourage your friends and family to join the effort. Less than five minutes of your time can make a difference to fight for those who cannot fight for themselves and ensure that hospice is available now and for generations to come.

Thank you,

Katie McIntyre
Community Relations Coordinator
Hospice of Central Iowa

Comments

Eric Widera said…
Thank you Katie for spreading the word about hospice rate cuts. The 'My Representatives' tool is a terrific resource at the NHPCO website. I just spent the last 1/2 hour playing around with it!
Anonymous said…
Well said.
Katie McIntyre said…
Here a full legislative update on hospice cuts from NHPCO:

On October 13, with a vote of 14-9, the Senate Finance Committee completed its health care reform deliberations. The 14 votes in favor of moving the bill forward represented unanimous support from the Committee Democrats and Republican Senator Olympia Snowe (ME). The draft legislation, entitled America’s Healthy Future Act, includes drastic rate cuts to hospice, yet closing statements from both sides of the aisle made clear that this is just one step in a complex process. Here’s a recap of the provisions of interest to the hospice community contained in the Finance Committee proposal:
• Hospice Annual Market Basket increase reduced by Productivity Factor Adjustment,
FY 2013-2019
• Allows for concurrent, curative and hospice care for children in Medicaid
• Establishes a 26-site Hospice Concurrent Care Demonstration Project in Medicare
• Requires HHS Secretary to establish Medicare Hospice Quality Reporting
• Physician assistants would be recognized as attending physicians to serve hospice patients
• Requires improved data collection to inform payment reform for hospice
• Requires physician or APN visit at recertification
Really good article related to the each type of patient in the hospice, for medicare facility this blog was good.Thanks for the supportive article.

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Opening the Black Box of LTACs: Podcast with Anil Makam

What happens in Long Term Acute Care Hospitals, or LTACs (pronounced L-tacs)?  I've never been in one.  I've sent patients to them - usually patients with long ICU stays, chronically critically ill, with a gastric feeding tube and a trach for ventilator support.  For those patients, the goals (usually as articulated by the family) are based on a hope for recovery of function and a return home.

And yet we learn some surprising things from Anil Makam, Assistant Professor of Medicine at UCSF.  In his JAGS study of about 14,000 patients admitted to LTACHs, the average patient spent two thirds of his or her remaining life in an institutional settings (including hospitals, LTACs and skilled nursing facilities).  One third died in an LTAC, never returning home.

So you would think with this population of older people with serious illness and a shorter prognosis than many cancers, we would have robust geriatrics and palliative care in LTACs?  Right? Wrong.

3% were seen by a geriatrici…

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…