The most interesting speaker was Tom Scully, former CMS Administrator. Mr. Scully is no longer at the Medicare helm, his former deputy now has the helm, so he seemed to have the freedom to speak that most government employees do not have.
He equated his job to the old game “whack-a-mole”. Basically, with the number of different programs in Medicare and the amount of money the system handles each year, Mr. Scully saw his job as being in charge of whacking moles who stuck their head up to far. Each program is expected to use a certain amount of money each year and they have growth projections for those programs into the future. If a program grows to fast, it gets whacked. (He did clarify that this wasn’t getting whacked like the Sopranos, so that made me feel better.)
He made it very clear that hospice is the current mole with its head sticking up and that it will get whacked. The CMS Administrator has no choice other than to whack moles that stick their heads up too far. His words were that the current CMS Administrator is “completely focused” on hospice.
The fact that hospice is well loved by the nation and the congress will not protect us from the whacking that is to come, but it does give us a chance to get hit with less force than others have experienced in the past.
All of this was presented very much like it was fact. He went to the realm of opinion to say:
- He doesn’t think we will get whacked until after the 2008 election. (When he gave this opinion he seemed to be indicating that the election would be the only reason the whacking would not happen sooner.)
- The odds of the hospice cap being changed are between 0 and .0001%.
- Hospice was created as a terminal benefit and did not address the gap in coverage for those who are chronically ill for a reason. Any attempt by the hospice industry to close that so called chronic care gap with the hospice benefit will be shot down. The gap exists because Medicare can’t afford to close it.
- There is a chance that we could get a concurrent care (more info here and here) cancer benefit so cancer patients can try second and third line treatments that have low side effects while getting the support they need from hospice.
There were other speakers who added to these points, and, in my mind, the end message of the forum was:
Since we no longer can debate that the whacking is coming, we need to refocus on what we were created to do. We need to fight for a payment system that will reimburse us appropriately for very short term patients and be willing to accept a payment system that does not reimburse us very well for long term patients. Basically, it seems that a payment system that in some way pays less as a patient stays on service longer is in our future. Our best hope is to make sure that system pays us well for those that we only have on service for a short time.
We need to become very active in funding studies that prove cost savings to Medicare. Currently there is little data out there about hospice care. Medicare is going to be looking for data to make their decisions, and, if we can be the ones handing them the data, we can control many things. To do this we need to raise money, which leads to what is probably NHPCO’s biggest announcement of the week. They are creating a c(4) political organization that will have fewer fundraising rules. This group and its efforts are in direct response to our current whack-a-mole situation. Hopefully, I’ll dig up more information on this in the future.
That’s day one of the conference (actually it was a preconference, but who’s being technical here.) I’ll try to get around to what I learned on the real day one soon.
If you were at the Public Policy Forum, I’d love to hear what you learned and how your understanding of what was presented differs from mine.