what is open access and why do i care

Thursday, February 15, 2007

What is Open Access and Why do I Care?

As I have pointed out before, there is a lot of talk in the hospice community about “open access” or the need for hospices to be more open about the types of people and treatments they accept. A paragraph from the New York Times article I linked to earlier sums the problem up well.

Only comfort care is covered through the hospice benefit, and patients sometimes have to fight for therapies to control distressing symptoms, like blood or platelet transfusions, that may coincidentally prolong their lives.

Why do patients have to fight for therapies that control distressing symptoms? Don’t we exist to control distressing symptoms? Yes, blood or platelet transfusions will prolong their lives, but they will also do a very good job of controlling symptoms and add significantly to the patient’s quality of life.

Open access means providing these types of therapies. Medicare has, in many ways, backed hospice into an uncomfortable corner. First, a hospice does not get paid any differently when they pay for a treatment like a blood transfusion, so open access means spending more money on a patient’s care without hope of actually collecting more money for giving the care. Second, if Medicare decides that this treatment is aggressive or “not hospice appropriate” you run the risk of not getting paid at all for the patient. Thus, a decision to be an “open access” hospice means that you increase your costs and risk of losing funding with no hope for a gain in income. Not a good business decision.

“Open access” hospices are on a mission to care for dying people. I believe that is a principle that connects us to our roots and should remind us of why they call hospice a “movement”. Hospice started as a movement to care for the dying. Then it became a business. Open Access is the decision by a hospice to pay more attention to caring for the dying than business. There are hospices across the nation who didn’t have to decide if they were going to be “open access” because they always were; for other, financially focused hospices, it requires a decision to make a fundamental shift in purpose. For me, that is why this debate is important and confusing at the same time. Open Access hospices function on a different set of values and goals than a financially focused hospice. In many ways the two types of hospice don’t even speak the same language.

This has set up quite a battle in the hospice community. Financially focused hospices believe they will put open access hospices out of business by beefing up their marketing department with their excess profits. Open Access hospices believe they will put financially focused hospices out of business because the community will see the difference in care between them and their competitors. Who will win? Only time will tell, but every person who plans on dying in the United States in the next 80 years has a dog in the fight.

This is a debate within the hospice community, but it effects an entire nation.

1 comment:


I think this is a fabulous idea. In my hospice we have to struggle with this all the time. But really, how do you pay for it? Do not for profit hospices just write off the cost? I don’t get it.