Catholic coalition undergoes restructuring
Catholic coalition undergoes restructuring
NHO re-examines Medicare hospice benefit
An ambitious community end-of-life project of five multihospital Catholic health systems has garnered considerable interest from hospices nationwide some of which wonder if it perhaps is needlessly reinventing care of the dying, given that hospices have already paved that path.
Although preliminary research by this new project, Supportive Care of the Dying: A Coalition for Compassionate Care, was highlighted in June at the annual assembly of the Catholic Health Association (CHA) of the United States in Chicago (see Hospice Management Advisor, July 1997, p. 79), the project is still not ready to unveil plans for its first pilot community care programs.
Former national coordinator Alicia Super, RN, has left the project, which is now undergoing internal restructuring in response to growth, reports chairman Larry Plutko, director of the Office of Theology and Ethics for Providence Health System in Seattle. A new national board of directors is being established and will meet for the first time in October in Denver. The project will also be posting a job opening for an executive director.
National Hospice Organization (NHO) chairman John Carney, MEd, CEO of Hospice Inc. in Wichita, KS, has initiated conversations with coalition representatives on how the hospice community might become more involved in the project and share its expertise in caring for dying patients.
"I’d love to see a dialogue between the Catholic Health Association and hospice, especially now, when hospices are trying everything under the sun to break out of the box imposed by the Medicare hospice benefit," Carney says. A video based on the coalition’s focus group research and its presentation at the CHA assembly, titled "Living and Healing During Life-Threatening Illness," has been offered for sale, along with a 16-page executive summary, discussion questions, and related articles. [The total package costs $16; contact CHA at (314) 253-3458 and ask for catalog #397.]
Meanwhile, a committee appointed by NHO has begun an intensive process of reviewing, and possibly recommending changes to the Medicare hospice benefit. The benefit, established by Congress in 1982, has been a fundamental force in defining and financing the U.S. hospice movement, but many in both hospice and the larger end-of-life movement are now questioning its barriers to access.
The Medicare Hospice Benefit/End of Life Care Committee, chaired by Amber Jones, MEd, president of the New York State Hospice Association, first met in August to begin discussing the benefit and how it fits the new health care environment. The 14-member committee includes leading hospice executives, state and national association leaders, and researchers. A broad advisory council is also being formed to review drafts of the committee’s work, while representatives from the American Medical Association, American Hospital Association, and American Academy of Hospice and Palliative Medicine are on tap to address its next meeting, scheduled for Sept. 18 and 19, Jones says.
No foregone conclusions about Medicare
According to an article in the NHO Newsline, there are no foregone conclusions as this committee begins its deliberations. The committee’s charge is to "examine the assumptions on which the Medicare hospice benefit rests," strengths, obstacles to access, functioning, structure, and financing. "The committee is now defining some of the barriers to access perceived or real and looking at characteristics of the hospice of the future, which will allow us to overcome those barriers," Jones says.
"The committee has taken no position on the issues yet. But as an individual, I believe that unless hospice is willing to look at what it does and test its assumptions about how and for whom, we are at grave risk of being marginalized out of existence," she asserts. "The current focus on end-of-life care is also an opportunity for us to step up to the plate and say this is what hospice is good at." But given the rapid pace of change in health care generally, and the multiple fronts in end-of-life care, is this review coming too late in the history of the U.S. hospice movement? Jones asks.
[The Medicare committee will hold a Town Hall Meeting at NHO’s annual meeting in Atlanta in October. Providers may also direct their input and suggestions to committee consultant Dorothy Moga at NHO, 1901 N. Moore St., #901, Arlington, VA 22209. Telephone: (703) 503-3477. Fax: (703) 525-5762. E-mail: [email protected].]
Although the hospice provisions of the Balanced Budget Act are now law, the the Arlington, VA-based National Hospice Organization (NHO) and state hospice associations recommend that providers wait to change their policies until the Health Care Financing Administration (HCFA) issues implementation rules. The rules may go first to HCFA’s regional offices or the fiscal intermediaries, "but we’ll tell providers as soon as we know," says John J. Mahoney, NHO’s president.
Most likely, the government will prioritize its rule making, since some issues, like the redefined hospice benefit periods, need more urgent attention. Others are not set to go into effect until Oct. 1, 1997, Mahoney adds. Providers are wondering whether patients in the fourth benefit period on Aug. 5, when the bill was signed into law, or whose hospice benefits had expired, would immediately qualify for the new unlimited 60-day benefit periods. But they will have to wait for the answers. Also awaiting clarification is the new requirement for billing by patient’s residence, rather than location of the hospice’s office.
Hospice rates also change on Oct. 1, reflecting the cost-of-living increase minus 1%, as mandated by the budget bill, but also the first stage of implementing the revised wage index, which was hammered out by a process of negotiated rule making in 1994 and 1995. The final rule for the new wage index was published in the Aug. 8 Federal Register. The new index is supposed to be a zero sum game, with the winners who get a higher index, reflecting higher local labor costs, balancing out the losers but it produces more losers than winners among providers.
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