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 "Concerns About Costs Rise With Hospices’ Use" 
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post "Concerns About Costs Rise With Hospices’ Use"
Maureen, a local support group member, forwarded me this article on hospice costs. The article provides some interesting data:

* "Providing dying patients with palliative care in their own homes, or in a hospice facility or nursing home, is far less expensive than continuing to order up futile medical treatments, studies have shown."

* "The median time spent in hospice care now is just 17 days."

* "Four in 10 Medicare beneficiaries now use the hospice benefit before they die. Patients agree to forgo treatments aimed at prolonging their lives, but can receive pain-relieving medication to ease the symptoms of a terminal illness, as well as attention from nurses, social workers and others."

* "Although the benefit is intended for patients who have no more than six months to live, 19 percent now receive hospice services for longer, according to the Medicare Payment Advisory Commission, or MedPAC, an independent Congressional oversight panel. In 2009, 10 percent of patients remained in hospice beyond seven months."

* "Once a patient is enrolled in hospice, Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, regardless of whether a hospice actually provides services."

One example of this is given in the article. Hospice billed Medicare $4,252 a month for its services, "which included short visits by outside nurses." The family said: "The employees who visited her were really caring people but there only were four or five hours a month when they were actually there."

A local support group member reported at the support group meeting last night that her husband's hospice agency (Sutter) is billing Medicare $333/day (or $1K/month) for hospice services.

* "In response, Medicare has adopted a restriction: It won’t pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal."

* "One of the main reasons for longer hospice stays is the increasing prevalence of patients with diseases, like dementia, that follow sometimes unpredictable paths. For instance, Alzheimer’s patients are three times as likely as cancer patients to stay in hospice beyond six months, MedPAC data show."

Here's a link to the full article.

Robin



http://www.nytimes.com/2011/06/28/health/28hospice.html
(note: the NYT is now charging for access to its website beyond a minimum number of articles viewed each month)


Concerns About Costs Rise With Hospices’ Use
By Jordan Rau
Published: June 27, 2011
New York Times


Mon Jun 27, 2011 9:22 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: "Concerns About Costs Rise With Hospices’ Use"
Thanks, Robin.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Mon Jun 27, 2011 10:35 pm
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Joined: Sun Oct 21, 2007 4:18 pm
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Location: Acton, MA
Post Re: "Concerns About Costs Rise With Hospices’ Use"
I think hospice is wonderful, but this seems like another example of why our medicare system is in financial difficulty. Just my opinion.
Take Care,
Gerry

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Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Tue Jun 28, 2011 6:21 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: "Concerns About Costs Rise With Hospices’ Use"
Gerry,
I agree with you on both counts -- wonderful but there are many areas for abuse.
Robin


Tue Jun 28, 2011 11:56 am
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: "Concerns About Costs Rise With Hospices’ Use"
I also have to agree.

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Tue Jun 28, 2011 12:26 pm
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Joined: Tue Feb 23, 2010 10:32 am
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Location: Kalispell, MT
Post Re: "Concerns About Costs Rise With Hospices’ Use"
My husband Charlie was put on hospice several weeks ago. He truly met all the criteria except the stupid five meaningful words. Who comes up with this stuff? He qualified under the separate category of weight loss.

Today he fell and deeply gashed his chin in 2 places, so we went to the ER for it to be stitched up. I called Hospice as I am supposed to do, but early Sunday a.m., office not open and I didn’t know I could reach a nurse on call.
The ER doc sent him for a scan of his head to eliminate brain injury because of the hard fall and hitting his head. No problems. But now it seems that Medicare won’t pay for any kind of test, even in an emergency situation. ???

Gotta check into that. Tests as to the terminal illness I see, but testing to determine the extent of an injury only loosely connected to the condition seems a bit stupid.
Apparently you can revoke the Hospice care anytime, then reinstate it when you have done what you want without it. Did I say stupid? The fed. Govt? Nah.


Mon Aug 08, 2011 12:20 am
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: "Concerns About Costs Rise With Hospices’ Use"
Gail, I am so sorry that you have to deal with this idiocy in addition to worrying about and caring for Charlie.

Did the ER know that Charlie is on hospice? Seems they should know the limits of what would be covered in that case.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Mon Aug 08, 2011 12:28 am
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Location: Vermont
Post Re: "Concerns About Costs Rise With Hospices’ Use"
I'm sorry this happened. It must have been pretty frightening for all of you. I'm guessing that the reasons behind not paying for any additional testing is that when a person is on hospice they are supposedly dying within a limited period of time. So if further testing would reveal something that requires new meds, surgery or some other intervention, that is against the rules of being on hospice, injury or no injury. It seems logical, but that doesn't mean it feels right to you or your LO.
My dad had this sort of issue addressed in his advanced directive and we reiterated it to the ALF staff regularly, even before he got on hospice. If he needed stitches, to have a broken bone set, fine. But if he had a heart attack or something else on his way to the ER to take care of an injury, they were to NOT treat anything else. He was dying and didn't want his life prolonged in the state he was in. Therefore, no tests of any type. I am glad that he and my mom had made these decisions many years before and he and I went over his wishes at least once a year after she died since I would be his POA.

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Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Mon Aug 08, 2011 8:12 am
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Joined: Wed Dec 30, 2009 1:46 pm
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Post Re: "Concerns About Costs Rise With Hospices’ Use"
Gerry wrote:
I think hospice is wonderful, but this seems like another example of why our medicare system is in financial difficulty. Just my opinion.
Take Care,
Gerry

I agree, Gerry. Back when I was working as an RN for an agency that did Hospice, they were billing Medicare $225 per visit, compared to my $35 per visit which included transportation time, phone calls and a lot of paperwork outside the visit setting. [The agency was quick to explain that they were never reimbursed the billed amount, however.] This was a non-profit agency but the recent proliferation of for-profit agencies doing Hospice now tells me it is profitable.

Health care as an 'industry' will continue to bring soaring costs with no improvement in patient care, in my opinion. And the government 'oversight' of these costs is pathetic, straining at gnats and swallowing camels.

Thanks for the article, Robin.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Aug 08, 2011 9:55 am
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Location: Vermont
Post Re: "Concerns About Costs Rise With Hospices’ Use"
"Straining at gnats & swallowing camels" - love it Pat! What a great analogy.

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Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Mon Aug 08, 2011 9:38 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: "Concerns About Costs Rise With Hospices’ Use"
Gail,

Not everyone who falls while on hospice wants to go to the hospital for stitches or to be checked out with a CT scan. It's a good idea to discuss these various scenarios with your hospice agency up front. (Several years ago I posted to the Forum a list of the scenarios that I had heard about.)

Did the hospice agency not explain to you that you aren't supposed to call 911 or go to the ER...but are instead supposed to contact hospice 7x24? If they didn't explain that to you, I think that's the bone of contention you have with them. Medicare is paying the hospice agency to care for your husband. It can't also pay the hospital to care for your husband. It's really easy to revoke hospice care and you should've been told how to do this upfront (by the hospice agency). Whether that agency would accept Charlie back as a client is unknown.

Robin


Mon Aug 08, 2011 11:25 pm
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Joined: Tue Feb 23, 2010 10:32 am
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Location: Kalispell, MT
Post Re: "Concerns About Costs Rise With Hospices’ Use"
I haven't sorted this out yet, but is somebody supposed to leave a deep gaping cut unstitched? Maybe a little aspirin for "palliative care" for the cut?

I now have a copy of a revocation form that I can fax somewhere when it is needed to revoke, and then get back on apparently with the same criteria as before.


Tue Aug 09, 2011 12:26 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: "Concerns About Costs Rise With Hospices’ Use"
I don't know, Gail, --haven't been there yet myself -- but I think the stitching was OK. It was the scan that Medicare was refusing to pay for, right? I know that ERs don't like to be limited to the injury you came in for and naturally they want to test for other injuries and naturally, without prior instruction, you wouldn't think to stop them.

It is too bad you didn't get more thorough explanations about Hospice. It is really too bad you had an emergency to find out the hard way.

Many of us are learning from your example, but I truly wish you hadn't had to go through this.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Tue Aug 09, 2011 5:55 pm
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Post Re: "Concerns About Costs Rise With Hospices’ Use"
Gail - what has your hospice nurse or other hospice contact said about this scenario? I would think that stitches would be an acceptable practice, but I have no experience with this and no knowledge. It will be very helpful to others, I think, if you can let us know any info. that would be useful in this sort of situation. I can't imagine not getting stitches or setting a broken bone for a LO, hospice or no hospice. In my naive world I'd consider that "comfort care". Lynn

_________________
Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Tue Aug 09, 2011 8:59 pm
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Joined: Tue Dec 29, 2009 2:28 pm
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Post Re: "Concerns About Costs Rise With Hospices’ Use"
Robin, is there an easy way to get to your posting on these scenarios? A search on hospice seems to me to be like looking for a needle in a haystack. Is there a better word to search on?

Does anyone have any knowledge of or experience with medical directives and hospice rules? They must conflict sometimes. And what our LO's put in their directives were probably put there without a lot of information about the rules needing to be followed when on hospice.

This also brings out another item to tackle when you are told to call a particular number before seeking additional help. What can the agency provide as back-up for times when the 24x7 number isn't answered? This is not a criticism of the agency. Maybe the individual answering is overwhelmed by calls at the moment and can't get to them all. Maybe the phone lines have gone down. There could be any number of legitimate reasons for unanswered call, so a back-up number or other method of communications is important. And not just another phone number in the same location, or worse, answered by the same person. It should be an on-call number. Many people don't realize that, if power is lost in the building housing the agency the phones go out, too.

Hospitals prepare for these situations through power-fail procedures, but I'm sure it isn't evident to a small agency. The agency should also be able to ask their service provider to reroute their telephone number if their phones go out.

Or maybe the person who was supposed to answer was just indisposed.

The point is that having only one number or one method to contact such an agency is not enough. Ask the hospice agency to provide you with at least two ways to reach them. (Won't that surprise them!)

BTW, if you revoke hospice, wouldn't that give the ER permission to go into their lifesaving, ignore the medical directive, mode? If you go in with a gash, they are going to worry about the cause of the fall, hence the CT scan and who knows what else they'll want to do. Don't you just love it?

Kate

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Kate [i](Cared for Mom for years before anyone else noticed the symptoms, but the last year of her life was rough and we needed to place her in an SNF, where she passed in February 2012)[/i]


Thu Aug 11, 2011 2:35 pm
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