if you think price of gas is hurting

Saturday, May 03, 2008

If you think the price of gas is hurting you…

The price of gas has been making headlines for a while now, and has become a political football. There are all kinds of ideas being put out there by the President and those who want his job. We could have a gas tax holiday, drill for our own oil, punish the oil and gas companies, ride our bikes more… In the end I expect that our “leaders” in Washington will probably point their fingers at the other party and do absolutely nothing.

I’ll stay out of the political side of the issue, and just say that if gas is going to cost $3.75 a gallon, Medicare needs to seriously consider giving rural hospices a little extra money. Every delivery you get these days has a “fuel surcharge”, and hospices need to get into that game also. Rural hospices cover a lot of ground, and that is becoming very hard on their employees. Rural hospice nurses can easily drive 100 miles a day to visit four patients. Sure, the federal mileage reimbursement rate has gone up, but my gut says that the number of hospices that actually reimburse their employees at the full federal rate has not kept up.

The basic math here is that a $.10/mile increase to a hospice worker who averages 100 miles a day would cost the hospice $2,400 a year. Multiply that by the number of nurses, home health aides, chaplains, and social workers the hospice employs, and you’ve got a nice chunk of change.

The problem here is that every rural hospice administrator in the country has a huge battle going on in their head right now. We are in the middle of the most serious threat of a rate decrease in years, so this is not the time to spend more money. We need to be finding ways to decrease spending, so logic tells you that you can’t increase the mileage reimbursement rate. On the other hand, if you don’t help offset the massive increase in gas prices, then you risk losing good employees to jobs that don’t require them to drive. Thus, logic tells you that you must increase the mileage reimbursement rate. Can you say “stuck between a rock and a hard place”?

Years ago Medicare gave Home Health a 5% rural modifier to offset these types of issues. It is time for hospice to see a rural modifier to help us keep our best employees in the field where they can do what they are so good at doing.


Christian Sinclair, MD

Thanks for posting about this issue. I had been holding it as a topic for Pallimed, but have not gotten around for it. Now I can just link to yours!