Hospices On Life Support In New Federal Budget

May 5, 2008       Eleanor Clift      

Hospice providers from around the country descended on Washington in early April for a lobbying blitz on Capitol Hill. President Bush’s budget proposal for ’09 contains some $5 billion of cuts in hospice reimbursements. Plus, the government agency that oversees Medicare and Medicaid payments is moving to cut reimbursement rates further through a regulatory rule change that doesn’t require congressional approval.   Part of what’s going on is the Washington game where the administration makes budget cuts to reduce the red ink knowing Congress will restore the money to popular programs. That’s been true in the past for hospice, which provides quality care for people at the end of life. But hospice isn’t the sacred cow it once was. It’s too big to be dismissed as “budget dust,” having grown five fold since 1997-98 when it was a $2 billion line item under Medicare to the $10 billion business it is today.   “It always makes people in the government a little nervous when they see numbers like that,” says Jay Mahoney, former president and CEO of the National Hospice and Palliative Care Organization (NHPCO). “They want to determine the basis of that growth.” Full disclosure: I sat next to Mahoney at NHPCO’s April fundraiser in Washington and I joined the organization’s board of trustees after my husband died at home with hospice care three years ago.

The growth of hospice seems obvious with aging baby boomers needing more services. Greater demand in turn brings more providers into the field, attracting the scrutiny of government regulators looking for ways to curb the cost of Medicare.    Hospice is both more familiar and increasingly popular, “the best care nobody wants,” in the words of many patients. To qualify, a physician must certify a patient has six months or less to live.

A decade ago, when Mahoney would go up to Capitol Hill and explain hospice to congressional staffers, “they would look at me with a glazed look.” Now almost everyone, no matter how young they are, has had some experience with hospice care, whether it’s a family member or a friend of the family, they know what it is. They might have seen it featured on “ER” or one of the many medical programs on television. Or, they might remember the controversy surrounding Terri Schiavo, the severely brain-damaged woman who died in a Florida hospice after her husband petitioned the Florida courts to have her feeding tube removed.   Mary Labyak is the president and CEO of the Florida Suncoast hospice that cared for Schiavo. She is on the board of NHPCO and was among those lobbying members of Congress against the proposed cutbacks. “The cuts are dizzying,” she says. “They will put every hospice under water.”

She doesn’t think that her industry is being singled out. She understands that every aspect of Medicare is vulnerable. “There’s no money. They’re looking for whatever they can cut, and they assume we could be more efficient.”

The problem is that nonprofit hospices operate on a one or two percent margin and the rule change that CMS (Center for Medicare and Medicaid Services) is pushing would mean a five-percent cut for most hospices. “It’s not like times are great and we can turn to fundraising,” says Samira Beckwith, president and CEO of Hope Hospice in Fort Myers, Fla.   Bottom line: Bush is a lame duck, his budget is dead on arrival, and there’s a good chance his proposed cuts won’t pass Congress. But CMS is pressing ahead with a rule change best described as a backdoor way to cut payments to hospice providers.

Some powerful figures in Congress are weighing in on behalf of hospice, among them, Sen. Arlen Specter (R-Pa.) who recently announced that his Hodgkin’s disease has returned but that his prognosis is good, and Rep. Chris Van Hollen (D-Md.), head of the Democratic Congressional Campaign Committee. CMS doesn’t have to listen to them, but in an election year, ignoring the elected representatives of the people is bad policy and worse politics. *** Eleanor Clift is a contributing editor for Newsweek magazine. Her column, “Capitol Letter” is posted each week on Newsweek.com and MSNBC. She is a regular political panelist on the nationally syndicated show The McLaughlin Group, which she has compared to “a televised food fight.” She is also a political contributor for the Fox News Channel.

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This article is from NPT Weekly, a publication of The NonProfit Times.

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