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| News & Events |
| November 01, 2009
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| YOU HAVE A VOICE IN HEALTH CARE... |
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By Stephen Schinnagel, Vice President of Hospice Services
Niagara Hospice
It is difficult to open a newspaper or turn on the TV without being exposed to commentaries regarding healthcare. And despite all the coverage, with both practical and philosophical debates raging in Washington, it is impossible to predict how the healthcare landscape will unfold. There are, however, two strong probabilities: 1) Providers, including hospices, will be called upon to do more with less money, and 2) misinformation about end-of-life care may very well take center stage in the debate on health care reform.
Within the hospice industry, the adage that, “…the Government giveth and the Government taketh away…” has never been more true. With one hand, Congress increased a component of hospice reimbursement by 2.1 percent; with the other, it decreased a different component by .7 percent. The net result for 2010 will be a small increase that falls short of the rising costs for everything from medical supplies to gasoline. Ironically, the one program (Hospice) known to actually save the Medicare program dollars (Duke University 2007), is unduly subject to the same budgetary knife as other more costly political endeavors.
The future seems equally as challenging with cuts to hospice reimbursement being proposed for years 2011 through 2016. The economic consequences of these future reductions will severely impact many hospices’ ability to meet the ever-increasing demands for quality end of life care. Particularly vulnerable are smaller hospices and those primarily serving rural communities. Luckily, there are several factors unique to hospice that should help mitigate a portion of the economic conditions confronting our industry.
First is the resilience and ingenuity of our staff members. The passion of hospice professionals runs as deep as their unyielding commitment to their patients. Many providers who choose hospice as a career do so knowing that their income potential may be better realized in other sectors of healthcare. Despite this reality, their collective devotions continue to help keep hospice afloat during demanding times. The second positive influence comes from the steadfast participation of hospice volunteers. They are the foundation of the industry, selflessly investing endless uncompensated hours of support. Last, but certainly not least, is the community served. Through assistance by the way of donations and advocacy efforts with legislators, the public has been a critical factor in ensuring that friends, family and neighbors continue to have access to hospice services.
The combined diligence of these parties will also be needed to meet another more philosophical challenge. The House of Representatives’ current Health Care Reform legislation, HR 3200, includes a provision that would compensate physicians for discussing end of life planning with Medicare beneficiaries. Oddly enough, this provision has become increasingly controversial; particularly since Section 1233 of the bill encourages physicians to initiate similar discussions with patients that other healthcare organizations have been required to do since the early 1990’s.
Regrettably, some individuals in the political spectrum have promoted fallacies suggesting that the inclusion of Section 1233 is intended to deny seniors proper care. As a healthcare professional for close to twenty-five years, I have come to appreciate how difficult care decisions near the end of life actually are.
Currently, only one third of Americans have living wills or other types of advance directives. It has been my experience when the wishes of a patient are unknown, considerable burdens are placed on providers and, more disconcertingly, on the individual’s loved ones.
Surely, one of the greatest gifts a family can give to each other is to have an honest discussion of how they would like to be treated if a health tragedy should occur. Although this provision impacts individuals 65 years and older, it’s never too soon to start this dialogue. Anyone age 18 or older should consider selecting a health care proxy to ensure that their wishes are expressed in the event that they cannot be personally conveyed. Despite fear mongering by some in Washington, if this very delicate conversation can be facilitated by a physician, then Section 1233 goes a long way in improving our healthcare system.
Niagara Hospice provides specialized care for the terminally ill. No one is ever denied hospice care due to ability to pay. Support is also available to bereaved family members and the community, whether or not their loved one had experienced hospice care. For more information about Niagara Hospice, visit www.NiagaraHospice.org or call 439-4417. |
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