Volume 16, No. 2, Spring 2008
Your Good Health Forum |
By David W. Rehm
I grew up in a small rural town in northern Illinois, where my family ran a small funeral business. It was unusual in that my family took an expansive interpretation of their role. I have often told my mother that she ran the first bereavement program because we would go to families’ houses and keep in touch with them long after the funeral.
I never thought I would stay in the family business, but, when looking for new opportunities in the mental health field, I discovered Hospice and I knew I’d found my place.
That was in 1987 and back then there were just a few flagship programs, including Hospice & Palliative Care of Cape Cod. Hospice was a new idea then, almost a counter-cultural movement as an alternative to the standard medical care system, focused on a fairly narrowly-defined group of patients. Many were run by volunteers.
Change, however, was on the way. In 1984 Medicare had created its Hospice reimbursement, which allowed this new movement to grow nationally and to expand its range of services in a way that saves substantial taxpayer dollars.
Today, there are 4,500 hospice programs in the United States with services covered by virtually all health plans.
The biggest challenge Hospice faces today is the fact that nationally we only serve about one-third of the patients eligible for our help. We need to find ways to make sure that everyone in the community who may need us has access to these services. We must reach out to underserved populations.
Awareness of Hospice as an option has risen dramatically over the years, but there remains considerable misunderstanding about what we can do and how to access it.
If a diagnosis of a life-threatening disease is made, call Hospice right away!
And it isn’t just for the last days. The “guideline” is a life expectancy of six months, but the key word is “expectancy.” It is not a limitation.
Also it’s a patient-elected, not physician-ordered service, meaning anyone can call anytime to inquire about eligibility. It’s one of the few services in the medical system under Medicare where everything is paid for, including medications, equipment, hospital beds, and there is no financial cut-off point.
Many patients come into our care, stabilize, do better, and can be discharged; returning later if there is a need again. In fact, national research shows that patients in Hospice care live an average of 30 days longer than those with similar diagnoses who are not in Hospice care.
The decision to contact Hospice is the most personal choice anyone can make. But the earlier you begin family conversations on the subject the better. Families should talk about their wishes even before there is any sign of illness. That helps avoid a potentially difficult situation. One helpful tool for doing so is a workbook called The Five Wishes, available for free from our Website www.hospicecapecod.org.
One-half of all Americans die in hospitals, which never were designed to provide terminal care. At the same time, 80 percent of all Americans say they would prefer to die at home. Here in Massachusetts, we are well below the national average in the number of those who can really benefit from it actually receiving Hospice care. We need to partner with hospitals, physicians and other health care providers to become a fully integrated part of the system.
Hospice is committed to helping people experience the third act of life. Our plan of care is the patient’s and family’s plan of care, which we support and carry out wherever they choose to be. That’s how this most challenging time can become one of life’s most important opportunities for growth and understanding.
(Mr. Rehm recently became President and CEO of Hospice & Palliative Care of Cape Cod, 508-957-0200.)
With one recent hire, Hospice & Palliative Care of Cape Cod has created the opportunity to fill two top management positions.
In February, David W. Rehm was named the organization’s President and CEO.
Well, it turns out that Mr. Rehm’s wife, Lise M. Lambert, also is an experienced health care executive. And last month she was named H&PCCC’s Vice President of Business Development and Philanthropy.
The two met as colleagues and recently married and they had been seeking a new professional opportunity to work together.
“We work very effectively as collaborators and this emerged as an exciting way to do that and be on Cape Cod, where we both have roots,” Ms. Lambert explained.
Board Chair Robert Keeling added, “We are fortunate to have the extensive skills and experience of two talented leaders used to working together as a synergy providing far more than the sum of the parts.”
Ms. Lambert brings a wide range of experience in both the health and business sectors, mostly in business development, sales and marketing.
She previously directed a project developing outreach and educational partnerships with national corporations and organizations on behalf of The National Hospice and Palliative Care Organization. Most recently, she founded a successful Home Physicians company in Maryland designed to provide primary care to homebound seniors.
By Gary Sheehan
Recently colleague Rob Fessler and I attended the American Association for Homecare’s annual legislative conference in Washington. Included was a day of lobbying for our home healthcare industry on Capitol Hill with our Congressional and Senate representatives. We discussed homecare and the vital role it plays in the United States healthcare continuum.
Our concerns focused on two priorities: end of a “competitive bidding” program for Medicare services and a repeal of the 36-month cap on oxygen reimbursement.
The competitive bidding program essentially auctions off the right for businesses to provide Medicare beneficiaries equipment and services in the home, with the low bidders winning exclusive rights to do so. This legislation actually is anti-competitive as it will drive many smaller firms out of business and also will limit consumer access to homecare.
The second issue concerns oxygen reimbursement. Many patients survive on home oxygen far longer than 36 months. The home services that firms like ours provide allows patients to receive treatment in a lower cost environment and we all know that staying at home is the preferred arrangement for most seniors. [After 36 months, patients are required to actually buy rather then lease their equipment.]
Elected officials are understandably desperate to find savings within the Medicare program. But focusing their energies on durable medical equipment and respiratory care is foolhardy and misguided since these services represent a scant 4 percent of the overall Medicare budget. Actually they should instead be focusing additional funding on this area since it provides a net savings for the overall system and delivers the care where it is preferred by beneficiaries.
We do find ourselves in competition for Medicarereimbursement from representatives of physicians, hospital groups and insurance companies, who collectively comprise over 70 percent of the Medicare budget.
Still, I am confident our voice was heard and many of our representatives expressed themselves as open to our suggestions.
(Mr. Sheehan is President/CEO of Cape Medical Supply, Inc., 1-800-339-3322 or gsheehan@capemedical.net,)