Rick Kasper, CEO of Joliet Area Community Hospice, has an alarming article in yesterday's Illinois Herald-News. He writes that "the state is pondering what “optional services” to do away with in an effort to save Medicaid money. . . . Hospice is one of the services considered 'optional' . . . ."
Kasper rightly notes that hospices "provide Medicaid recipients (as well as all enrolled) with the palliative comfort care services, medications, medical equipment/supplies and visits by interdisciplinary team members (nurses, physician, social worker, chaplain and volunteers as needed) who are expert at end-of-life care. That results in quality care at the site of patients’ preference, as most patients want to fully live until they die comfortably at home or in the facility in which they reside."
He also notes that hospices save money:
- Hospices save the state of Illinois an average of $2,309 per hospice patient, plus an additional 5 percent on room and board on every hospice patient residing in a Medicaid bed in Illinois nursing facilities.
- 34 percent of patients who disenrolled from hospice were admitted to an ER in comparison with only 3 percent of hospice patients.
- 40 percent of disenrolled patients were admitted to the hospital in contrast to 1.6 percent of hospice patients.
- 10 percent of disenrolled patients died in the hospital compared to only 0.2 percent of hospice patients.
- Cost of care for patients with cancer who disenrolled was nearly five times higher than for patient who remained in hospice.
4 comments:
The statistics are not surprising.
Of course, Hospice Care and Palliative Care were meant to keep patients out of ICU and CCU ---especially the elderly with shortened life spans-expectancies!
But! of course the two laws ---the right to live and the right to die --- present problems. The elderly cannot be forced onto Hospice Care under current law! And they can't be kept out of ICU and CCU's even if they are on Hospice Care --UNLESS they have requested "NO CPR" and a DNR is in the hospital or nursing home chart.
Another problem is that Hospice Care requires a healthy and intelligent caretaker to work with the Hospice personnel. The elderly often do not have this healthy caretaker available and our culture is such that many of the "baby boomers" won't have caretkers to work with Hospice, either!
It probably won't be long before Hospice Care on Medicare/Medicaid will only be available if the patient will consent to DNR code in the outpatient and inpatient chart.
DNR status doesn't keep one out of ICU.
DNR status doesn't always keep all of the elderly patients out of ICU, but if the patient has exceeded the DRG reimbursement caps, etc.(the norms) and the hospital knows that they won't be reimbursed for ICU costs, the DNR permits the hospital to care for the patient in a cheaper hospital room outside of the ICU.
When possible, hospitals dismiss elderly patients before three nights in the hospital so that the elderly patient will NOT be eligible for "skilled care" under their insurance plans.
Hospitals are penalized for those elderly patients who die in the ICUs if they have in any way violated "Best Practice" care which is defined by CMS Reimbursement rules and protocol. Hospitals are rewarded when elderly patients don't die in their Intensive Care Units.
Those "elderly" patients who are in ICUs and who do have DNRs in their charts are expected to survive and to leave ICU care and the hospital -- and the hospital expects to be reimbursed for the ICU time.
However, it is public policy to encourage the elderly who have serious illnesses and cancers to die outside of he ICUs and CCUs at less expense to the government snd the private insurers.
Medicare Hospice Care and Pallitive Care is public policy intended to keep elderly patients from dying in the ICUs and CCUs of our Acute Care Hospitals.
Legal DNRs and Covert DNRs and Unilateral DNRs that are the result of the request for "NO CPR" do permit hospitals and physicians to support public policy goals.
DNR status doesn't keep elderly patients out of the Intensive Care Units IF the elderly patient is "medically" judged to be well enough to survive and to leave the ICU and the hospital without exceeding DRG Caps and norms.
It is public policy to PREVENT elderly patients from dying in expensive ICUs and CCUs in order to cap the costs of dying of the growing elderly population.
Hospitals are penalized when elderly patients die in their Intensive Care Units and are rewarded when elderly patients don't die in their Intensive Care Units.
The disparate impact of CMS regulations and reimbursement policies does result in discrimination against the elderly who have requested NO CPR which results in overt and legal DNRs and covert and illegal DNRs in the hospital charts.
It's all about the money!
Post a Comment