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Investing in Hospice Care Is the Right Choice for Everyone

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The Centers for Medicare and Medicaid Services announced April 29 that the 2014 hospice reimbursement rate would include an “increase of 1.1 percent.” The CMS announced the proposed “increase” because it cited the fact that spending on hospice services has increased 500 percent since 2000.

That sounds like great news and is fiscally sound, but a closer examination of the numbers reveals the real truth. The current sequester has already mandated a 2 percent decrease in all Medicare reimbursement across the board. That means that the actual reimbursement for hospice would decrease by almost 1 percent year over year, well below the actual increase in the direct cost of doing business next year. It is that kind of “fuzzy math” that has plagued the CMS, and has put providers in a vulnerable position and ultimately put the care at risk.

Cutting the reimbursement rate for hospice does not reduce the overall costs for healthcare. CMS has been promoting Hospice for terminally ill patients for well over a decade.  There should be no surprise that this strategy has resulted in more hospice care being provided throughout the country and it has also significantly improved outcomes and cost savings overall to Medicare.

New research published in March by Mount Sinai found that hospice enrollment saves money for Medicare and reduces emergency room stays and hospital readmissions. In that research, providers saved Medicare between $2,500 and $6,000 per patient depending on when the patient begins hospice care. That can more than offset any increase in the hospice reimbursement rate.

Patients need hospice care, because of the positive impact it has for end-of-life care as well as its impact for caregivers. Quality of life is improved, patients actually live longer than those who don’t receive hospice care, and caregivers have also seen tangible benefits. Our patients and their caregivers have given testimonials about how much hospice care has helped them.

This is not the time to manipulate numbers, and in turn, manipulate the end results for patients. Hospice care needs a stronger investment from the CMS, because that investment will pay the most dividends for all.

How to Get Started with Advance Directives

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Advance Directives are an important way to ensure you are given exactly the kind of care you wish to receive, either through a living will or by designating a health care proxy, sometimes called a health care power of attorney.  You do not need an attorney to create an advance directive, and these steps will help make the process easier.

–          First, decide whether you want to create a living will or designate a health care proxy. A living will allows you to make your own health decisions before you become incapable of making those decisions at a later time. A health care proxy is someone who will make those decisions on your behalf.

–          Next, discuss your decision with your loved ones. Explain to them the reasons behind your decision. If you create a living will, explain why you have selected those health care decisions for yourself.  If you decide to designate a health care proxy, determine who will be the best person to fill that role. It should be someone you trust, and someone who has the same core beliefs about treatment as you do.

–          Then, fill out the actual advance directive. A simple way to do that is by completing the Five Wishes document, which is available from Liberty HomeCare & Hospice Services. Make copies for your family, doctor and any other health care agent.

–          Finally, review your advance directive periodically. As the years pass, you may decide to change your wishes, or designate a different health care proxy if you have chosen one.

These steps will help you make the best choices for yourself, while also keeping loved ones aware of those choices. That’s the best solution for all involved.

Rural Doctors Need More Support than Ever

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National Doctor’s Day is celebrated annually March 30, and that’s a great time to remember the value of physicians throughout North Carolina, South Carolina and Virginia. Doctors throughout our coverage area provide many valuable services, and do all they can to help patients get better.

But many of those doctors face challenges that need to be addressed soon. For rural doctors, an individual practice can be “just not sustainable,” due to the increased paperwork, decreased reimbursement, and surge in workload. A study by the U.S. Department of Health and Human Services illustrates that 20 percent of the American population live in a rural area, but only 10 percent of physicians work there.

That creates difficult decisions for those physicians. They typically see more patients than urban doctors, but often can’t spend as much time per patient. And, with reduced staff, they must do much of the mounting paperwork themselves and face long hours. Add in the declining reimbursement rates for insurances such as Medicare and the problem will continue to grow.

Recent efforts to grow the number of rural doctors have failed, a recent study in Health Affairs revealed. There are programs in place, similar to the Kansas Bridging Plan, a loan forgiveness program for doctors who agree to practice for three years in rural areas. In North Carolina, rural doctors can receive some loan forgiveness or even a service bonus of $50,000 for a 4-year commitment in high needs areas.

There needs to be more done. Rural doctors need higher reimbursement rates from insurance companies, and other measures are also on the table. Rural doctors must be appreciated through the long-term and not just on National Doctor’s Day. Providing an incentive for them is not only an investment in their practice, it is an investment for all who live in those areas.

Remember Senior Medication Safety during Poison Prevention Week

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National Poison Prevention Week is celebrated each March, and Liberty HomeCare & Hospice Services urges everyone to be diligent with senior medication safety as a way to help stop the increase in poisonings.

 

For example, the number of poisoning deaths in North Carolina has more than tripled since 1999, and according to the Carolinas Poison Center, more than 200,000 calls were placed in N.C. in the two-year period of 2010-11.

 

While most people think about young children and poisonings, it is also imperative to educate seniors. Consider:

  • Calls for senior adults increased 30 percent over a 5-year period
  • 50% of senior adults have no routine for taking their medicines
  • 83% of senior adults routinely take at least one prescription medication
  • 50% of senior adults take three or more prescription medications, increasing the risk of drug interactions
  • Prescription and non-prescription pain medications are the most common involved substances in poisoning exposures for all ages.
  • Up to 36% of poisonings in children take place in the grandparents’ home
  • Up to 20% of poisonings in children involve a grandparent’s medication

Liberty HomeCare & Hospice Services is committed to helping reduce poisonings through informative articles and videos, and also participates in other educational events throughout its coverage area.

“National Poison Prevention Week is a good reminder for all of us to take care of medications, particularly for seniors,” said Liberty HomeCare & Hospice Services President Tony Zizzamia. “The troubling trend of increased poisonings only reiterates that importance. We want to help everyone, including seniors, learn about the importance of medication safety.”

Simple Gestures Make Major Impacts for Hospice Patients

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Liberty Hospice recently celebrated National Patient Recognition Week by handing out roses to all of its patients. It has become a tradition for us, and to see the smiles and gratitude that patients and their families express reminds us what an impact a small gesture can do.

That’s a good reminder for anyone who has a loved one in hospice care. Any kind of gesture can make a big impact. We have helped coordinate other kinds of surprises for our hospice patients, from a puppy to a shopping trip, to a ride on a horse. Those moments have helped rekindle a favorite memory, while at the same time creating a new one.

Many people don’t know where to start, but sometimes the best gesture you can do for a loved one occurs even before hospice care begins. By talking to your loved one about hospice care, and its many benefits, you can build a valuable communication that can educate them, as well as yourself, on what is right for your family. If you’re not sure how to start that conversation, we have a web page that can help.

Once your loved one begins hospice care, there are many different ways to honor them. Our staff is always looking for ways to help. Our chaplains may sing with them, or our volunteers may help them write a story. There are many ways we honor our hospice patients, but many times, the involvement of a family member makes those events even more meaningful. Sometimes, just seeing a family member is just as impactful for the patient.

You may not believe you are prepared for such visits, but our volunteers, social workers and other staff can counsel you through it all. We understand there are new, difficult emotions that come with hospice care. But we also realize how hospice care improves the quality of life for patients and for their families too. Let us help you get started.

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