Received an alert from NHPCO today indicating that part of President Bush’s proposed budget is a 0.65% cut in the Medicare Hospice reimbursement rate starting next year and continuing every year thereafter. Let me be clear on what this means. If this passes, next year when it is time for Medicare to figure out how much of a raise I should get (usually it is around 3%), they will subtract 0.65 from whatever number they decide upon. Thus, I will get a 2.35% raise next year instead of 3%. Don’t buy into the hype that we are getting our payment rates cut. We are not getting as big of a raise as we expected. That is never good news, but it is far from them actually cutting payment rates. This is an effort to slow the growth of Medicare.
I have posted my thoughts on rate cuts before (here also). I’ll cut and paste one of my favorites here (I was in quite a mood the day I wrote this):
I’ve posted a few times that I know that Medicare cuts or changes are coming and that I welcome them. I’m a good Republican, and spend some time behind my desk conflicted at the waste of government money. The conflict comes because some of that money ends up in my bank account. So, here we go again, time to purify my soul.
Medicare needs to cut the payment rate for hospice patients that live in nursing homes. I’m talking about significant cuts, but only for those patients that live in nursing homes. Yes, the cuts will put some hospices out of business. Yes, they will mainly be the companies whose business practices make me throw up a little in the back of my mouth. Yes, since you asked, I have spent some time practicing my evil laugh for the day when the companies who have gotten into the hospice business to take care of nursing home patients because you can make a killing on them crawl back into whatever vile soulless hole they crawled out of.
Unfortunately for me, the same companies that I hope to see ruined are the ones who have the money (money=power) to make sure that this kind of intelligent decision is not made in Washington. Instead something like freezing the Market Basket is going to happen which will allow inflation to reduce the massive profit on nursing home patients and make it even harder to break even on home patients. That decision will force people like me to focus my energy on the nursing home market in hopes of having enough big profit nursing home patients to finance my admirable but financially unsustainable home patient habit. The problem there is that most of the nursing home patients are taken by the nursing home owned hospices. Thus, people like me will go out of business and companies who don’t have to practice evil laughs because that is the way they laugh naturally will survive.
The person hurt the most? The home patient. When those of us who have no fear of daylight are gone and the nursing home owned hospices are all that are left, it will become very hard for a patient to die at home.
I was on quite a role that day and would probably say things a bit differently if I were writing that today, but the underlying thoughts are still very true. Reducing our “cost of living” pay raise each year from now until Jesus returns, will, over time, make it very financially tenuous to run a hospice that focuses on providing hospice in a person’s private residence. Those patients require more care, more equipment, and more handholding than patients in nursing homes. It remains silly to pay the same amount for nursing home and home patients. Yes, we offer the exact same services to both, but nursing home patients don’t actually take us up on the full extent of that offer. They already have many of the things hospice offers, thus the hospice doesn’t have to provide it.
Hospice remains on the hot list for a Medicare Rate cut, and I remain worried that they will not make smart cuts. When the rate cuts come, they will probably put half of the hospices in the nation out of business. Which half is left standing will determine how Americans face death for the next half century. I hope the good guys win, and you should to!