hospice sky is falling

Tuesday, April 01, 2008

The Hospice Sky is Falling!

I can’t believe I haven’t written anything in a month! To make it even worse, it has probably been the busiest month in the industry since I started writing this a few years ago. While it seemed everything hit hyperdrive within the industry it also hit hyperdrive in my life. Wow.

It is almost midnight as I write this, so I’m not even going to attempt to give any type of detail to the things that have been going on. Thanks to all of you who have sent e-mails recently asking my opinion on subjects or making sure that I hadn’t missed any of the big news. I’ve been keeping up with the news, but haven’t been able to keep up with the writing.

The quick run-down of things that are happening in the hospice world:

  • As I blogged recently, President Bush’s budget calls for what will amount to a 15% reduction in hospice rates. I would love to know how many hospices turn a 15% profit. My guess would be that less than 5% of hospices in the nation turn that kind of profit, which means that almost every hospice in the nation would have to tighten their belts if not cut services. (If you have read this blog long enough, you’ll know that I’m not a big fan of government spending, but a 15% rate cut will be very hard to swallow.)
  • A congressman and senator from Oklahoma have introduced legislation to keep Medicare from collecting the hospice cap money. Currently some hospices owe Medicare quite a bit of money because they exceeded the “hospice cap” law. If they have to pay it back, it will put some of them out of business. How many? Nobody seems to know. Why do they owe money while the majority of hospices don’t have any cap trouble at all? Good question. How in the world did these Oklahoma Congressmen become so convinced that Medicare shouldn’t take their money back? I’d guess that hospices that owe money probably decided it was cheaper to get congress to bail them out than it would have been to pay the money back, but that’s just a guess. (I’d love to write more about this one. Some other day I hope.)
  • A lawsuit has been filed in Oklahoma dealing with the hospice cap issue. (I guess they thought it would be cheaper to hire a lobbyist and a lawyer than to pay the money back.) I really don’t know much more than that. Both the congressional movement and the lawsuit can, I’m sure, be traced back to the National Alliance for Hospice Access.
  • It is becoming more evident by the day that Medicare will release new hospice regulations (“Conditions of Participation”) this summer. We won’t know until then exactly what these new regulations are.
  • Last but not least, two months from today hospices will be required to submit bills with much more information than we have ever submitted before. While some of the details have been ironed out, there are still some questions that have not been answered. The biggest question is how in the world Medicare expects us to track how many times the hospital nurse visited a hospice patient when the patient is in the hospital. Hospitals do not track each time an employee walks in and out of a room, but somehow Medicare expects hospices to magically be able to track and report that number. Hospices have tried to explain this to Medicare, but they don’t really seem to care that we are expected to report something that we can’t really know.

All of these subjects deserve their own post. Actually, may of them deserve many many posts. I write when I can. That brings me to yet another plea for others to join me in writing this blog. I am not the smartest guy in the hospice world. My opinions come from my perspective, but I know there are other valid opinions and perspectives. If you would like to write on any kind of regular basis (weekly or monthly), e-mail me and we’ll talk more. Your identity will be kept anonymous just as mine has for all these years. There is a lot going on in the hospice world, why not help get the word out?



I am reading into your blog that you do not agree with the cap problem. We are an agency which has a payback to medicare from years past. We are still paying them off. In recent years we have managed our hospice cap. We do appropriate admissions and take great care of our patients. Our patients do qualify. Maybe you should look a little more into this issue instead of judging us that have had a problem.

Christian Sinclair, MD

Glad to see a new post. I was hoping you would jump on this issue.

I think for longevity of a blog, a team blog is the way to go. Of course I am biased. But what if a new writer wanted to come on non-anonymously. Would that be okay?

I am hoping to put up a post on this on Pallimed in a few days, but I got a LONG to-do list in front of me right now.

Have you seen the HFA blog, it has some good info too, but they are not posting about this much yet.


Is there a place to understand the specifics surrounding hospice cap?
Thanks Bridget