Local hospice administrators brace for budget cuts

Vicky Eckenrode

Jul. 31, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- When Joanne Tennille's mother was diagnosed, the brain cancer already was spreading aggressively.

For the next month, Tennille and other family members stayed at her mother's Wilmington home, keeping close watch and spending time together before she died.

"We had a very precious window of opportunity with her, and we never left her side," said Tennille, who now lives in Currie.

They were helped through the process with home hospice care, which also had helped a few years earlier when Tennille's 92-year-old grandmother became terminally ill.

The assistance, largely paid for through Medicare, provided for a hospital bed, wheelchair, visits from home health care workers and nurses -- all things that Tennille said made it possible for her mother and grandmother to remain at home and without pain in their final days.

Tennille, who has volunteered with hospices ever since the experience with her grandmother in 1993, said she is concerned that proposed cuts in Medicare funding could reduce those types of services for other families.

"I don't know how hospice can continue to pay for a lot of this stuff," she said. "It's going to be a tremendous loss. I hope the government listens to those of us who really care and feel so passionate about this."

Lawmakers already are getting deluged with messages from hospice facilities and organizations across the country about a proposed change in the Medicare reimbursements for hospice care they estimate will reduce payments $2.3 billion nationally over the next three years.

Local hospice administrators estimate the new rule, which could be finalized Friday, would cost them $1 million next year.

Many advocates have been asking their local congressional delegations to visit their hospice facilities during the upcoming August recess, said Judy Brunger, president and CEO of the Carolinas Center for Hospice and End of Life Care, which represents 76 hospice providers in the state.

"This will impact almost every one of our hospice programs in North Carolina in every county," she said.

Brunger and other industry representatives are hoping Congress will intervene to block the new rule, which was proposed as a federal agency policy and not in the form of a legislative bill.

The rule changes the amounts many hospice programs receive for labor costs. If implemented, it will effectively decrease the daily reimbursement rate for patients who covered by Medicare.

The Centers for Medicare and Medicaid Services have been factoring in adjustment to wages, depending on whether workers live in high-cost areas. The projected cuts come from that adjustment being phased out.

Medicare pays about a $100 to $150 per day for a qualifying person with Lower Cape Fear Hospice, said president and CEO Laurie Myles.

She estimated the change will result in an average drop of 4.5 percent in reimbursement for each patient at a time when other operational costs from medicines to mileage rates for workers are increasing.

"Some of our staff drive close to 1,000 miles a week," Myles said.

Lower Cape Fear typically has 340 people in hospice care each day. A dozen of them stay at an inpatient facility in Wilmington, while the rest are cared for at homes throughout New Hanover, Brunswick, Pender, Columbus and Bladen counties.

Though hospice care is an option for terminally people of all ages, the majority are older and covered through Medicare.

Myles said hospice care involves a team approach made up of physicians, nurses, certified nurse assistants, social workers, chaplains, counselors and volunteers for medical as well as emotional treatment for the families.

She said if the changes go through, Lower Cape Fear likely would have to think about expanding community programs, such as bereavement classes not covered by Medicare, and find ways to become more efficient.

Administrators still would move forward with plans to open a new inpatient facility in Whiteville and Brunswick County because those buildings are paid for through fundraising efforts, Myles said, adding that it will cost to operate the centers under the new rule.

She said Lower Cape Fear's operation is large enough to avoid shutting down if the reimbursement levels change, but other smaller ones in the state will find it difficult to remain open.

"I think there are going to be some hospices who aren't going to be able to weather this," Myles said.

Newstex ID: KRTB-0217-27110591