Guest Column: Hospice is integral to health care reform » The Commercial Appeal

Some weeks ago, as the U.S. House and Senate were debating and voting on their respective health care reform bills, CBS' "60 Minutes" aired a report titled "The Cost of Dying." It asserted that health care reform must address end-of-life medical costs, which can reach hundreds of thousands of dollars a patient.

The report stated that in 2008, Medicare paid $50 billion for medical bills in just the last two months of patients' lives, which is more than the budgets of either the Homeland Security or Education departments. "60 Minutes" estimated that 20 percent to 30 percent of those costs had no meaningful impact and postulated that such measures decrease quality of life and don't necessarily prolong life.

The report could not have been more timely or more on target. As I contemplate health care reform, I cannot help but think about the patients and families served through hospice programs and the impact that proposed reimbursement reductions for hospice care would have, both locally and nationally. The hospice community would be greatly affected by passage of either the House or Senate bill. The House bill proposes significant cuts and freezes on hospice reimbursement rates. The bill that was approved in the Senate Dec. 24 would reduce the proposed cuts to hospice by a small percentage. Slashed rates would have a devastating effect on hospices, especially those that serve rural communities where access to health care is already limited.

Baptist Memorial Health Care Corp. has six hospice programs that provide care to individuals regardless of their ability to pay. We serve both rural and urban areas in North Mississippi and West Tennessee. Oftentimes, the hospice nurse is the patient's only link to any type of care at all. Forcing end-of-life patients to drive back and forth to the hospital can cost Medicare anywhere from $1,200 to $10,000 a day -- compounding the problem of rising health care costs and further crippling the economy. Hospice, a much more affordable option, should not be a target of health care reform, but rather should be part of the solution for patients who elect this special level of care.

Medicare's hospice reimbursement rate in our service area is approximately $140 a day for care in the patient's home. This does not come close to covering the actual cost of care, which includes nursing, social work, physician and chaplain services, medical equipment, medications and bereavement counseling. Volunteer and bereavement services are fundamental services that are required in order for a program to receive Medicare funding; however, Medicare does not provide any reimbursement for those services and hospice agencies must absorb their costs. In addition, the cost of medications for pain and symptom management alone can account for significant portions of the daily reimbursement.

Because we consider these programs part of our mission, our primary concern is ensuring that we are able to continue providing hospice care. We find ways to be highly efficient and depend on philanthropy, grants and fundraising to provide the care and services our patients need and deserve. Other hospice programs are not as fortunate, and if reimbursement is cut, they will be faced with limiting services or closing altogether.

With the rising demand for health care by the baby boomer population, the rising cost of health care and the expense of hospitalization, it seems logical that Congress would not target hospice as an area to reduce reimbursement. An independent study by Duke University in 2007 found hospice saves Medicare an average of more than $2,300 for each hospice beneficiary. Additionally, it found that Medicare costs would have been reduced for seven out of 10 hospice recipients if hospice had been used for a longer period of time. Interestingly, Duke also found that hospice patients actually live an average of 29 days longer than those who were not referred to hospice.

Regardless of the government's stand on hospice, Baptist remains committed to providing in-home care and many other resources for hospice patients and their loved ones. Baptist Trinity Hospice is building the first free-standing residential hospice in Shelby County, and it is slated to open this summer on the Baptist Memorial Hospital-Collierville campus.

Baptist is trying to be the best steward possible of the resources we have, reducing costs wherever possible and fundraising for projects such as our upcoming hospice residence and bereavement center. With the reimbursement rate changes proposed in the health care reform bills, stewardship will be even more challenging. Hospice is being penalized when we should be part of the solution.

Nancy Averwater is administrator and CEO for home care and hospice services at Baptist Memorial Health Care Corp.

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