what is main thing

Thursday, August 21, 2008

What is the main thing?

I have no clue who first said, “The main thing is keeping the main thing the main thing”, but I owe them a debt of gratitude. That odd little line has helped keep me focused through the years, and it is very timely advice for the hospice industry. My last couple of posts have dealt with the necessity of hospices moving from the relaxed business practices of the past to the world of having very serious best practices in place to ensure operational efficiency. I’m sure it isn’t the most popular stuff I’ve ever written, but I am also sure that it is something hospices must face.

Today I want to deal with what, exactly, the main thing is. Hospice, as defined by the Hospice Medicare Benefit, is the main thing.

Hospices today often do so much more than what they did twenty five years ago. Just because a hospice does something doesn’t mean that it is hospice. Your hospice may provide community wide grief support, but that isn’t hospice. You may do Palliative Care, but that isn’t hospice. You may do parental hospice care, but Medicare wouldn’t call that hospice. You may have a beautiful Zen garden, but that’s not hospice. Children’s grief camps are not hospice. All of these things are great; they are needed and important, but they are not hospice.

I am not saying that hospices should not be doing these things! I’m just saying that these things are not the main thing. If your hospice does things that are not part of what Medicare considers hospice care, then you need to make sure these “extras” don’t become a financial drag that puts your company at risk. Every hospice needs to give serious thought to the expenses associated with these non-hospice activities and what activities may have to be cut if the hospice payment rates are significantly changed. We have all gotten comfortable with the idea that hospice does all of these wonderful things. We’ve adopted the attitude that a hospice that doesn’t do all the things we do isn’t a good hospice. Hospices that only do hospice are soooo yesterday.

I believe hospices that only do hospice may be the wave of the future. We get paid to do hospice, and that may be all we can afford to do in the future.

We don’t have to close down the counseling center today, but it is time for us all to start to remember what the main thing really is. Hospice is an awesome sacred thing. Let’s all, as an industry, take a step back and remember to keep the main thing the main thing. I would hate to see good hospices going out of business because they had lost sight of how awesome and meaningful their core task really is.

1 comment:


You are certainly correct in keeping the main thing the main thing, at least where CMS is concerned.

Having just gone through the million and one hoops the IRS just required to get 501(c)(3) approval is a completely different story. For new non-profits and those who are having their non-profit status examined, the IRS is requiring LOTS of extras now – it’s no longer good enough to be doing the main thing well, you’ve got to do the community-wide bereavement, the kids camps, etc etc etc or they consider you no different than the for-profits and will treat your tax status as such.

Walking that tightrope between CMS requirements/payments and IRS requirements/tax authority is an increasingly difficult task for non-profits to pull off. Another :woot: for efficiency and productivity analysis/improvement.