OPINION: Hospice Reimbursement Rate Cuts Hurt End-of-Life Care

The Centers for Medicaid and Medicare Services (CMS) announced on the first of August that it will cut Medicare reimbursement for hospice, putting a strain on hospice providers across the country who work hard to provide quality end-of-life care regardless of a patient’s ability to pay. The final rule, published in The Federal Register, is effective October 1, 2008.

These cuts will amount to more than the total we will spend this year on bereavement services for the entire community. These programs are free to the entire community, whether the loved one who has died was a hospice patient or not. But we are committed to continue to provide these services at no charge and to make hospice care available to anyone, regardless of their ability to pay.

Jonathan Keyserling of the National Hospice and Palliative Care Organization says the government's reason for its decision that would effectively cut rates – the need to save money – simply isn't true.

"Research has shown that hospice saves Medicare money, is highly rated by family members of hospice patients, and enables the patient to die at home in most cases," notes Keyserling. "This rule defies logic, and will have a direct, negative impact on care at the bedside."

According to an independent 2007 Duke University study, hospice saves Medicare an average of $2,300 per patient, amounting to a total savings of about $2 billion a year.

The rate cut is scheduled to be spaced out over three years. In the first year, the rate cut will mean the equivalent of one Master’s-prepared social worker on the hospice team. By the time the rate cut is fully implemented it will represent three Master’s-prepared social workers.

At the same time, CMS has issued new Conditions of Participation for hospice. Our preliminary analysis of these new rules indicates that we will have to increase our staff by at least 1.5 full-time employees to meet the requirements. In addition, CMS has imposed new reporting requirements on data processing. These new rules meant that we had to hire a part-time bookkeeper to keep up.

The cost of drugs, medical equipment and supplies is rising at a rate far faster than the new reimbursement rate will cover. Now, the cost of these critical items of care, let alone everything else required to operate a small agency, is increased by a ‘fuel surcharge’ that we have no choice but to absorb. This cut could not have come at a worse time, in my opinion.

Congress has historically rejected Administration requests to reduce the level of hospice reimbursement, realizing the harmful impact such cuts would have on care at the bedside. Sentiment on Capitol Hill largely remains the same — a bicameral and bipartisan group of more than 90 members of Congress has sent a letter to Health and Human Services Secretary Mike Leavitt in opposition to the proposed rule.

Keyserling sums it up best saying, "It is in our nation's fiscal and moral interest that high-quality hospice care remains an option for all who need these unique services and support."

Lynn Bonde, Executive Director of Calvert Hospice

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