Treatment Concerns - Definitions / Living Wills / Palliative Care / Terminal or Excessive Sedation / Organ Donation / DCD or NHBD / Hospice / POLST / DNR

How Will Hospice Care Change?

[Note: Read the comment at end. I think that comment is more likely than the answer from the NYT.

Left out of all the discussion is how assisted suicide will “work” in hospice. The Obamacare bills I read used the same disclaimer terminology about not condoning assisted suicide that Oregon’s assisted suicide law uses.
While the end comment is “only” a comment, it is a comment worth repeating, if simply to stimulate reflection.]

Q.
I am a medical social worker in the hospice arena. Would this bill include cuts to the hospice Medicare program? What would this bill mean to hospice programs in general? — Mary Z

A.
Hospice benefits won’t change under the new law, said Vicki Gottlich, a senior policy lawyer at the Center for Medicare Advocacy. The House provision that would have required plans to offer voluntary end-of-life counseling — which led to the infamous “death panel” claims that government bureaucrats would be empowered to give the thumbs up or thumbs down to care for the critically ill — was dropped. Nothing similar was included in the Senate bill, which ultimately became law, Ms. Gottlich said.

Comment:
Douglaston, NY
May 12th, 2010
The buildings will still be there, the admission standards for hospice care will still be there, but there are lots of changes this law will make to hospices, and they’re not good.

Hospice care is often provided by non-profits, and church or religious affiliated agencies.

Should they not undertake the paperwork required by the secretary, the states, the countless bureaucracies this law creates, hospices will see their reimbursement cut 2% for each report they fail to produce. So, is our trillion dollars being well spent on paperwork instead of patients – apparently the democrats thought so.

Other cuts that hospices will face won’t be known till 2013, when (according to the text in the law) “not earlier than October 20 1, 2013, the Secretary shall, by regulation, implement revisions to the methodology for determining the payment rates for routine home care and other 23 services included in hospice care”

Who can take care of you in the hospice?

Well, don’t ask your own personal doctor, the law empowers mid-level practitioners such as nurse practitioners and physician assistants to run hospices.

Reimbursement is mandated to be “budget neutral” so if the hospice uses a physician, who generally gets more money (after all, they went to school for 4-8 years and many graduate with hundreds of thousands of dollars in debt) that will require the hospice to cut somewhere else.

When ‘the secretary’ decides how much to pay professionals for a hospice visit, it’ll be based at a nurse pay scale, not a doctor’s.

So, we can expect lots of changes, as the secretary has all kinds of discretion to set up demonstration programs, define what services are and are not covered, and decide who’ll be allowed to start and run new hospice programs. The secretary has 3 years, so let’s ask this question again later.

For now, facilities are worried they may not meet the requirements that will come in 2013, and they’re concerned the doctors and other professionals providing care may be replaced by entitlement-school graduates with much less experience and training.

[11May2010, By MICHELLE ANDREWS, http://prescriptions.blogs.nytimes.com/2010/05/11/how-will-hospice-care-change/ ; 12May10, N. Valko RN]