Hospice care; increasing providers and saving costs

SOUTHERN UTAH – Hospice care provides services to those persons deemed “terminal” or who are in “decline,” meaning they are “losing weight, have loss of appetite, are confused, sleeping more, or have weakness.” Pauline Bale, Director of Nursing at Dixie Hospice Care, said it’s an expanding service in Southern Utah and nationally.

Since 1993, hospice care has been a guaranteed Medicare benefit. Unlike many federally funded programs, “hospice care actually saves Medicare and Medicaid money,” said David Isom, hospice director for Southern Utah Home Care Hospice.

Dixie Hospice Care’s website describes hospice as “a compassionate, specialized healthcare directed by a team of professionals to provide services for comfort and relief to patients preparing for end-of-life stages. Hospice provides support by caring for the physical, emotional, spiritual, and practical needs of patients and families without performing life-saving procedures.”

Dixie Hospice began providing hospice services only last year, and received approval in October, 2011, for federal Medicare payments. It is one of several providers in Southern Utah.

The Medicare approval process is arduous, and expensive; “It cost us $10,000 just to have the accreditation agency visit and assess us,” Bale said. Applicant companies must have patients before Medicare will assess them, and they can’t get paid for these patients unless the companies are first approved by Medicare; it is a bit of a catch-22.

“The biggest challenge starting our company was getting the approval of an accrediting agency, to qualify for Medicare reimbursement,” said Derek Sorensen, administrator of Dixie Hospice Care. “Many times I would try to contact Medicare in general and it would take many, many phone transfers to get in contact with the person I really needed.”

But “the elderly and those who would qualify for hospice care often do not know about hospice,” said Bale.  “So they continue accessing far more expensive options like the emergency room, or hospital care, often (intensive care unit) care, all of which are very expensive,” Isom said. Bale said that one of their patients said they wished they could have had hospice sooner.

Public education about hospice care, included services, and Medicare and Medicaid coverage, would allow patients to make better-informed decisions.

About 85 to 90 percent of hospice care patients are covered by Medicare, with private insurance covering the rest. Occasionally a patient will “private pay” for hospice care, but that is rare.

The hospice team is comprised of physicians, nurses, social workers, therapists, nursing assistants, chaplains, equipment suppliers, pharmacies, and volunteers.

Available hospice services include:

• Physician Visits

• Nursing Visits.

• Pain Management.

• Medications.

• Medical Social Services.

• Aide/Homemaker Services.

• Spiritual Counseling.

• Bereavement Support.

• Family/Caregiver Counseling.

• Holistic Therapies (massage, music therapy, aromatherapy, therapeutic touch).

Typically, hospice care starts as soon as a patient’s doctor makes a formal request, or “referral.” Hospice focuses on caring not curing, and in most cases care is provided in the patient’s home. Hospice care is also provided in freestanding hospice centers, hospitals, nursing homes and other long-term care facilities. Hospice services are available to patients of any age, religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations.

Hospice is not the first choice of everyone. Doctors can be somewhat conflicted by it because they pledged to heal and to extend life; while referring a patient to hospice is an admission the patient is not going to live, they are in decline, weakening, and in a condition the doctor cannot reverse. It’s difficult for doctors to let go of the patient, but Medicare will pay only if the doctor refers the patient to a hospice care provider.

History of Hospice Care

The “hospice” name was first applied to specialized care for dying patients in 1967 by physician Dame Cicely Saunders, who founded the first modern hospice – St. Christopher’s Hospice – in a residential suburb of London.

Sens. Frank Church and Frank E. Moss introduced the first hospice legislation in the U.S. in 1974 to provide federal funds for hospice programs.  The legislation was not enacted.

Congress included a provision to create a Medicare hospice benefit in the Tax Equity and Fiscal Responsibility Act of 1982. Congress then made the Medicare Hospice Benefit permanent in 1986 and hospices were given a 10 percent increase in reimbursement rates.  States are given the option of including hospice in their Medicaid programs. Hospice care is now available to terminally ill nursing home residents. Veterans and American Indians were added in 1991 and 1992 respectively.

By the year 2004, over one million patients in the United States had hospice services provided. Findings of a major study out of Duke University published in “The Journal of Pain and Symptom Management” shows that hospice services save money for Medicare and bring quality care to patients and families.

Federal hospice directives require hospice providers to include volunteers. Five percent of services provided must be by volunteers. Nationally, well over half a million volunteers assist in providing hospice care.

Future of Hospice Care

The great unknown is how President Obama’s Health Care Plan will impact hospice care. Isom said he is concerned about “death panels” and possible reduced payments as federal deficits continue to skyrocket: “Unfortunately, we haven’t had time to adequately assess and determine how Obamacare will affect the hospice industry.”


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Copyright 2012 St. George News.


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