Focus on quality, not tax status

Outcomes mean more to patients

Headlines comparing the level of care provided by not-for-profit vs. for-profit hospices did not produce a flood of calls to local hospices questioning their quality of care, but it did create some conversations.

The best way to respond to questions from board members or community members who raise questions about quality and tax status is to point out that quality is measured by outcomes, not tax status, says Joan M. Teno, MD, MS, professor of community health and medicine at the Warren Alpert School of Medicine of Brown University and associate medical director for Home and Hospice Care of Rhode Island, a not-for-profit hospice in Providence, RI. Hospices are measuring outcomes now in preparation for public reporting of quality so a more accurate comparison of all hospices can be made, she says. "I don't have a crystal ball but I image we'll see opportunities for improvement in outcomes for not-for-profit and for-profit hospices once we have the ability to see those results."

"We discussed the study and its implications in our administrative staff meeting," says Mark M. Murray, president and chief executive officer of The Center for Hospice Care, a not-for-profit hospice in Mishawaka, IN. "The story wasn't picked up in the local media so we talked about how to handle the conversation if someone brought it up, but we did not take proactive steps to address it in the media or with our staff," he says. "Why create an issue where there is none?"

"I'm not sure the public cares about tax status if your hospice provides the care a patient and family need," says Murray. One of the questions asked of focus groups conducted by Murray's hospice in preparation of a marketing program was "Does it matter to you if the hospice is not-for-profit or for-profit?" "Forty-five percent of the focus group participants said it did not matter or they didn't know if it would matter."

Although the general public may not care, the real concern is that the study will be read by the Medicare Advisory Payment Committee, says J. Brad Hunter, chief executive officer of Legacy Hospice, a for-profit hospice in Charlottesville, VA. "For those of us who are for-profit hospices to select only specific patients based on revenue, we'd have to ignore physician referrals as well as the Medicare Conditions of Participation (COPs)," he says. "If we ignore referrals and COPs we won't continue getting referrals or reimbursement from Medicare!"