Volume 17, No. 2, Spring 2009
By David W. Rehm,
CEO, Hospice & Palliative Care of Cape Cod
The established medical field of end of life care is still a relative newcomer here in the United States. Hospice & Palliative Care of Cape Cod is one of the pioneering programs in the country, founded in 1981 by a group of concerned Cape Codders brought together by Mary McCarthy, a local nurse known for her compassionate concern for patients diagnosed with life-limiting illnesses.
In 1983, two years later, the Medicare Hospice benefit was enacted, providing financial coverage for the full range of hospice services.
Today, after many years as the only Hospice provider, we are one of eight currently operating on the Cape, albeit the only independent non-profit. This mirrors the growth of the field nationally, with more than 1,000 new Hospice providers springing up over the past decade, almost all being for-profit entities.
As a result of this growth, overall Medicare Hospice spending has more than tripled, exceeding $10 billion annually.
The most recent and comprehensive study, conducted by Duke University, shows Hospice has reduced Medicare costs by an average of $2,300 per patient, amounting to a $2 billion annual savings. Most importantly, Medicare has enabled more and more patients and families to receive the specialized care and support that Hospice uniquely provides.
A component of the growth in Medicare expenditures, however, has been a trend towards increased lengths of stay for some patients. The positive outcome of longer stays is that patients and families are able to receive the full value of what hospice provides. On the flip side, the concern raised by The Medicare Payment Advisory Commission (MedPAC) indicates these long-stay patients may erode the financial benefit to the Medicare system. MedPAC’s recently published Report to the Congress: Medicare Payment Policy, makes preliminary recommendations for changes to the Medicare payment system, including the Hospice benefit. It recommends that the Secretary of Health and Human Services review length of stay, create a different payment structure, investigate the prevalence of financial relationships between hospices and long-term care facilities, and collect additional data to facilitate the management of the hospice benefit.
As CEO of Hospice & Palliative Care of Cape Cod and the sole New England member of the National Hospice Work Group, I share my colleagues’ appreciation that the growth of the field merits regular review. But I also share a concern that changes are enacted within a comprehensive analysis so there are no unintended negative consequences. Based upon MedPAC’s preliminary recommendations, our initial analysis suggests that the impact to our organization alone could mean a reduction in Medicare of $2 million or more. This certainly runs contrary to MedPAC’s broadly stated goal of encouraging greater utilization of Hospice services.
By our organization’s best estimates, more than 1,000 eligible Cape Codders are not receiving Hospice care. MedPAC recommendations should serve to enhance, not decrease, our ability to meet this need, especially in light of the significant growth of our aging population.