hospice cap madness

Monday, November 12, 2007

Hospice Cap Madness

I finally got a chance to check out the web site of the group that is producing all of this press about the Medicare Hospice Cap. They call themselves the National Alliance for Hospice Access, and their web site does a good job of making it seem like fighting against the Hospice Cap is a no brain decision. As usual, I think only half the story is being told, but they do a very good job of telling their half of the story. I might talk more about that later; this post is written to address an article that slipped past me until now.

There is a link to this article in the Daily Oklahoman on the NAHA website. The article really makes me mad. (Thus the title of this post.) I mean really, really, really makes me MAD! The article makes me more sure than ever in my thought that the television news story about the cap was done in bad faith. In my post on the TV news story, I said “it seems that the hospice is using, guilting, and upsetting patients to further its own political agenda. ” At that point I gave them the benefit of the doubt.

Here are some excerpts from this article with my thoughts:

It wasn’t until close to the end when I learned that the payment for our hospice care was capped, and independently owned hospices, like our extended family AutumnBridge, were suffering because of it.

How exactly did she find out that her father’s cancer was causing a hardship for the hospice? Seriously, can you think of an appropriate way that this comes up in conversation? Why would any hospice share its financial problems with the family of its patients?

When Congress created the hospice benefit to cover end-of-life services, it also created two caps: a lifetime cap that limits each beneficiary to a maximum of 210 days of hospice care and a cap that limits the amount each hospice could bill Medicare in a single year.

The cap is about $20,000 per patient, and any payment in excess of that must be refunded to Medicare by the provider.

Dad was on hospice 290 days — 129 days past the number Medicare will cover for patients in Oklahoma County.

There are many factual problems with these paragraphs. The biggest being that the cap is not a per patient thing. If the average patient goes over the cap, then the provider must pay the money back. One patient going over the cap does not – I repeat – does not put the hospice over the cap. The hospice does not owe Medicare for the 129 days for this specific patient.

I assume, but do not know for sure, that either this hospice or NAHA saw/proofed/or approved this article before it was submitted to the newspaper. If that assumption is true, then they allowed flawed information to be published. At the very least, it seems they didn’t do a very good job of explaining the cap to this family.

Now our hospice likely will owe close to $1 million to Medicare next year, partially because of my dad, and I can’t help but feel some guilt.

The last line is the one that put me over the edge. We, as the hospice industry, have many different thoughts and feelings on the cap. I do not know how many members NAHA has. It could be a very large group; I don’t know. I do know that not everyone agrees with NAHA. I know NHPCO has not come out supporting NAHA or publicly made any indication that they are planning to work with NAHA to help them achieve their goals. We, as the industry are divided over the cap.

I hope that we, as an industry, are not divided on the belief that making patients and their family feel guilty is a bad thing. This family has enough to deal with without being told that their father has caused the hospice, which the family loves and respects, has been damaged by their loved one living longer than medically expected. Even if there were a national consensus that the cap is a devastating issue, I would hope and pray that there would be a way to try to correct the problem without making patients and families feel guilty.



Wow. I. mean. wow. The people at Autumnbridge Hospice and the group that is doing this PR campaign apparently have no shame! And no understanding of the cap!