Ailing Hospice industry may not get care it needs

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From Florida: Jacksonville.com

Northeast Florida hospice industry leaders say they are considering cutting some patient services to plug financial holes created by nationwide cuts in Medicare payments that go into effect today.

The two organizations that provide virtually all of the First Coast's end-of-life care estimate the changes in the reimbursement system could cost them more than $4.6 million combined over the next three years.

The Centers for Medicare and Medicaid Services, which manages the health insurance program for those 65 and older, estimates that the proposed reduction in reimbursements to hospices will save the program nearly $2.2 billion over five years.

The policy is going into effect over the objections of a national hospice trade organization and dozens of lawmakers who have signed onto House and Senate bills seeking to delay the move for a year.

The National Hospice and Palliative Care Organization filed a lawsuit last month to prevent the cuts from going forward. The organization estimates that the cuts will reduce hospice reimbursements by 4.1 percent.
"The [Bush] administration's back-door rate cuts warranted the strongest response," said Jon Keyserling, an NHPCO spokesman.

Earlier this year, Congress delayed until at least 2010 a proposed 10 percent cut in Medicare payments to physicians. Although 32 senators and more than 70 House members have sponsored a similar postponement for the hospice cuts, the legislation has been pushed to the back burner amid the bailout talks.

Locally, the cuts are so deep that Community Hospice of Northeast Florida is delaying a decision on its annual October-through-September budget for the first time in its 29-year history, said Phillip Ward, chief of business operations. The nonprofit's board will wait 90 days to get a clearer picture of the change's impact.

Community Hospice serves more than 6,000 patients a year, about 85 percent of hospice patients on the First Coast. The Medicare cuts will sap about $2.6 million from its bottom line over the next three years, Ward said.

And those financial wounds will sink deeper, Ward added, because they come at a time when hospices are facing increased reporting requirements and skyrocketing fuel prices.

Haven Hospice, a Gainesville-based hospice organization, estimates its losses will total more than $2 million. The organization operates one facility on the First Coast, the River Garden Hebrew Home/Wolfson Health and Aging Center in Mandarin.

"I think it has a real effect, maybe not Thursday morning but a year from Thursday morning," said Tim Bowen, Haven Hospice's executive director. "It is a substantial rate cut that could impact patient care in the future."

Both hospice organizations said the first programs to go would be those considered less critical to end-of-life care. Neither provided details on which programs those may be.

Ward said he is puzzled that the Bush administration would target hospices for budget savings, citing a 2007 Duke University study that found Medicare beneficiaries who used hospice cost the program $2,300 less than those who did not.

Over the last 12 years, Lynn Weatherford has had four family members enter Community Hospice. Her father and grandmother each have walkway pavers dedicated to them at the organization's inpatient facility in Mandarin.

The 50-year-old Orange Park woman worries how the Medicare cuts will affect future patients.

"This needs to stay the way it is," she said.

Also, see this link: Lawsuit challenges Medicare cuts for Hospice and this: Senators fight Home Health, Hospice cuts