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The current Senate and House bills on health care reform contain cuts to hospice that could seriously threaten the viability of the hospice industry. Hospices have been lumped in with the productivity cuts in the bills even though hospices are reimbursed per diem, not based on visits or treatments, etc. like other health care systems.*
Furthermore, community-based nonprofit hospices operate with little to no profit margins, often making fundraising a necessity to continue operations. With the revenue cuts proposed in the current bills, most community-based nonprofits will not be able to continue serving their communities past 2015. HospiceCare Inc., the third largest hospice in the Midwest, is expected to be able to continue operations to 2018.
Please take a minute to contact your Congressmen today and ask them to help reverse the legislation that could eliminate access to hospices accross the country. Share your hospice experience and let them know how HospiceCare helped keep your loved one comfortable in their home and also offered the physical, emotional and spiritual support that your family needed.
Following the contact information below, you will find a timeline of what has occurred, talking points and links to articles referencing how hospices are affected by health care reform. Please contact the HospiceCare Public Affairs Department if you would like more information.
Senate
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Senator Russ Feingold
online contact form
Washington, D.C. Office:
506 Hart Senate Office Building,
District of Columbia 20510-4904
Phone: (202) 224-5323
Fax: (202) 224-2725
Middleton Office:
1600 Aspen Commons, Room 100
Middleton, Wisconsin 53562-4716
Phone: (608) 828-1200
Fax: (608) 828-1203
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Senator Herb Kohl
online contact form
Washington, D.C. Office:
330 Hart Senate Office Building,
District of Columbia 20510-4903
Phone: (202) 224-5653
Fax: (202) 224-9787
Milwaukee Office:
310 West Wisconsin Avenue,
Suite 950
Milwaukee, Wisconsin 53203
Phone: (414) 297-4451
Fax: (414) 297-4455
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House
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Representative Tammy Baldwin
2446 Rayburn House Office Building, District of Columbia 20515-4902 Phone: (202) 225-2906 Fax: (202) 225-6942
Madison Office:
10 East Doty Street, Suite 405
Madison, Wisconsin 53703
Phone: (608) 258-9800
Fax: (608) 258-9808
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Representative Paul Ryan
Washington, D.C. Office:
1113 Longworth House Office Building, District of Columbia 20515-4901 Phone: (202) 225-3031 Fax: (202) 225-3393
Janesville Office:
20 South Main Street, Suite 10
Janesville, Wisconsin 53545
Phone: (608) 752-4050
Fax: (608) 752-4711
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Timeline
The legislative process requires the House and the Senate to create separate versions of a bill. Once the House and Senate bills are passed, a “conference committee” of members from both chambers is held to resolve disagreements on a particular bill. The final merged bill is then presented to the President for signature or veto. The chart below shows how the healthcare reform bill has made its way through Congress so far.
Timeline
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What occurred/ will occur
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How HospiceCare is responding
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2009
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At this point in the healthcare reform process, the House and Senate have created separate bills that both call for cuts to hospice. Both versions lump hospices in with health organizations that are reimbursed on a productivity model. This model, also called fee-for-service, reimburses separately for each visit, medication, etc. In contrast, hospice is reimbursed on a per diem basis, which means we receive a set amount each day to cover patient visits by physicians, R.N’s, C.N.A’s, social workers, chaplains, grief counselors in addition to medications, medical equipment, supplies, etc. Because of this key difference, the proposed cuts are disproportionately devastating to hospice. The reform bill cuts combined with prior cuts (Budget Neutrality Adjustment Factor in Oct. ’09) will soon force nonprofit hospices in rural areas out of business because lower Medicare reimbursements will not cover the costs of care |
After the House passed its bill, HospiceCare Inc. gathered a group of nonprofit hospices and state hospice organizations to go to the Capitol to show 15 congressmen the projections of how the cuts proposed by the House bill will affect hospice.
Our timing allowed us to adjust the Senate bill so it would be less of a hit to hospices, but we were too late for the House bill. We have built support in time for the conference committee process, but most important, we garnered the future support of the congressmen to help change the legislation over the next few years.
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Now
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Senate and House leaders are meeting behind closed doors to merge the two bills and present a final bill to President Obama to sign into law. |
In the final merged bill, HospiceCare is asking Congress to preserve the language from the Senate bill, which calls for a smaller cut in hospice reimbursements. |
2010 and Beyond
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2010 is an election year, and in a typical election year, not much legislating gets done. Nevertheless, we can still be gathering data and strengthening our case to change the legislation and reverse the cuts. |
HospiceCare is asking hospices to use a financial tool that will provide data showing how the cuts affect their business.
HospiceCare will create and lead a coalition of nonprofit hospices from around the country, gather their data and lead a national media campaign to educate Congress and the public on how the legislation will limit access to hospices nationwide. These are our key objectives:
- To garner bipartisan support of hospice in Congress
- To reverse the legislation so hospice is not lumped in with productivity cuts
- To get the Medicare Payment Advisory Committee (MedPAC) to study the cost savings provided by hospice in the Medicare system. MedPAC advises Congress on issues affecting the administration of the Medicare program.
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Talking Points
Q: How does the current healthcare reform legislation affect HospiceCare Inc. and other hospices?
A: If these cuts go through and HospiceCare Inc. continues to accept all patients who are eligible for hospice services, the organization will not be in business past the year 2018, regardless of income from fundraising or any reserve funds. Without a change to the legislation, most community-based hospices serving rural areas will be out of business by 2015.
However, HospiceCare Inc. is the third largest hospice in the Midwest and is one of the best-run hospices in the country. In anticipation of these cuts, HospiceCare has begun a process called “intentional design” that will fundamentally redesign how HospiceCare delivers service to patients, families and the community, so that quality is maintained while costs are reduced. We don’t know yet whether this new operating model will be enough to offset the cuts to Medicare reimbursements, but it is our best hope.
Q: How did the Medicare reimbursement cuts to hospice happen?
A: Basically, the House and the Senate compared apples to oranges. Medicare pays hospices about $160 per day, per patient to provide comprehensive hospice services. This includes the entire interdisciplinary team that cares for the patient and their family, the cost of medications, medical equipment and all expenses included in caring for an individual. In contrast, hospitals, clinics and other healthcare operations are paid on a productivity basis, also called fee-for-service. This means that they are reimbursed not by days, but by each visit, treatment, test etc. they give. Just one visit to the emergency room is reimbursed at about $2,000 – $3,000. Somehow, when cuts were proposed to the entire healthcare industry, hospice was lumped in with organizations receiving productivity cuts, even though our reimbursement pales in comparison to the rest of the industry. To make matters worse, these cuts come on top of cuts to hospice that were legislated in 2009.
Q: What does this mean for me and my family when we need hospice services?
A: HospiceCare Inc. and most community-based nonprofit hospices already operate on very low margins, if any. In order to continue offering hospice services past 2018, HospiceCare could potentially have to limit access to our services or even cut services provided.
Q: What can I do to help change this?
A: You can contact your representatives and senators to let them know that you disagree with cutting funding to hospices, especially the community-based nonprofit hospices serving rural areas that are already operating on low margins.
HospiceCare and Health Reform in the Media
HospiceCare Inc.: A Model for Health Care Reform
Joann Kowalski: Let’s pay for health care quality instead of quantity
"For The Record" with Neil Heinen
*Medicare reimburses hospices about $160 each day to provide comprehensive in-home care to patients. This is the only reimbursement to hospice regardless of the amount of services provided to patients and families. Many times care for patients and families costs more than the $160 each day. Hospices often must fund raise to make up for the difference.
Hospitals, clinics and other areas of health care are in a productivity reimbursement system under Medicare. They are reimbursed not daily, but per patient visit or treatment, etc. Just one visit to the emergency room can result in a $2,000 - $3,000 reimbursement for a hospital.
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