Page 27 - Volume 69 Number 2
P. 27

Did you know that there are 24 hospice providers in Washtenaw County? I didn’t. I always thought there was Arbor Hospice. The concept that hospice providers should be competing in the marketplace of dying patients was inconceivable. But it turns out that there are in fact 24 providers of hospice services in our county, seven of which are not-for-profit organizations, the other 17 for profit. There are 150 state-wide, three-quarters of which are for profit entities. Not all of them are accredited -- accreditation, although voluntary, reflects
a certain amount of due diligence. Not all medical directors are trained in hospice care or board certified in hospice and palliative care medicine (i.e., FAAHPM), which one might think was a prerequisite.
Hospice care became a Medicare benefit in 1983. As a result, hospice providers have to meet certain standards with regard to services – that is, there is government oversight and regulation – and for these services they receive a per diem payment of approximately $150. This is a global payment that must cover physician, nursing, ancillary, pharmacy, and any other services, including bereavement counseling, related to the condition for which the patient has been admitted. The specific diagnosis does not matter; it could be cancer, congestive heart failure, end stage pulmonary, or renal disease. The basic criterion, life expectancy of six months or less if the condition follows its expected course, was based on cancer patients only, but has never been what Medicare or other insurer will (or should) cover - other, non- hospice disease related care separately. This can be confusing, but what it means is that if Mrs. Jones, who is in hospice because she is in the terminal stages of lung cancer, has a stroke (unrelated to her lung cancer), she could, if she wished, be admitted to the hospital for treatment of her stroke and the hospital would look to her insurer (not hospice) to be the payer for that
episode of care.
Although Hospice of Michigan/Arbor Hospice has
some in-patient beds, most hospice care takes place in the home. Room and board expenses at a hospice residential facility are not necessarily included in the basic set of covered services and may be billed separately. Home care, whenever feasible, is preferred.
Hospice Care or Palliative Care?
Paletta drew some important distinctions between hospice care and palliative care. Hospice care services may include palliative care, but “palliative care” does not include hospice care. It is more a concept than a well-defined entity. It is not a defined insurance benefit; there are no established standards. It is more of a consultative service than a care provider. It can vary from place to place and palliative care team to palliative care team. In palliative care only physician and advanced practice provider services are reimbursed, on a visit-by-visit basis, most often under Medicare Part B. Both hospice care and palliative care are important,
but everyone needs to understand the differences and the ways in which they can work together.
Changes on the Local Scene
The local hospice scene is changing this year as a result of the merger of Hospice of Michigan and Arbor Hospice. Arbor Hospice will continue to operate as is has under the same name. The building on Oak Valley Road that housed the Arbor Hospice residential beds is being converted to the main administrative offices for the combined HOM/AH entity, as HOM moves out of its downtown Detroit office. Residential beds will now be located in the former Saline Hospital building.
Questions physicians should ask when considering a hospice provider:
 Was I given 2 or 3 programs to research, or just directed to a specific one?
 Can I reach the nurse and the doctor 24/7? Or do I get an answering service?
 Do the doctors visit patients, or just the nurses?
 Are we allowed to go back to the hospital but stay
on hospice?
 What happens after the death?
Volume 69 • Number 2 Washtenaw County Medical Society BULLETIN 27

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