Date: 07/08/2009
Final
National Hospice Overview and Medicaid
HOSPICE AND PALLIATIVE CARE
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01:40 PM -- National Hospice Overview and Medicaid
The committee reconvened. Christy Whitney introduced herself to the committee and described her organization, Hospice and Palliative Care of Western Colorado. She stated that over the last ten years, her organization has grown from serving 25 patients to over 300. She also told of how her organization offers bereavement services to children in her community and children that are involved in the criminal justice system. Ms. Whitney also described the organization's free bereavement programs for adults.
Ms. Whitney shared a document on "Barriers and Utilization of Hospice and Palliative Care" (Attachment D). She stated that the transition from an assisted living residence to hospital-based hospice can be a barrier. She said that if a resident of an assisted living residence who is receiving hospice care is hospitalized, they often cannot return home to the assisted living home. Senator Williams stated that in Texas, patients are allowed to return to an assisted living facility after going to a hospice center. Representative Reisberg noted that assisted living homes may have liability issues and therefore may not be able to take a patient back after they have been to a hospice center. Representative Roberts asked where the regulations for assisted living residences come from. Ms. Whitney stated that the Department of Public Health and Environment promulgates the rules for assisted living facilities. Ms. Whitney showed a film describing her organization.
01:58 PM
Ms. Whitney stated that Medicaid does not provide coverage for residential hospice care. She stated that if there was reimbursement available, then there will be incentive to provide this service. She commented that currently people do not have the resources to pay for residential hospice, and instead people are served in nursing homes or end up in the hospital. Ms. Whitney discussed how access to hospice is related to transitioning types of care. She stated that there are some palliative care programs, such as hers, that have a gap program which provides a bridge to hospice care. She noted that her organization offers social work services. She stated that this transition program helps get people into hospice earlier. She stated that her organization charges on a fee-for-service basis at about $200 per month.
02:06 PM
Ms. Whitney commented that in Colorado, most private insurance offers hospice benefits, but that it is usually capped at a certain amount. She stated that her organization loses money on Medicaid patients and private insurance patients, and that they break even on Medicare patients. She explained to the committee that she has some concerns with how hospice care centers are reimbursed by private insurance. She proposed that private insurers pay an equal amount to what Medicare pays for benefits. Ms. Whitney discussed a graph which shows cost savings for hospice during the last two years of life (Attachment E). Ms. Whitney acknowledged that licensing fees for hospice centers are low. She stated that the Department of Public Health and Environment should consider setting licensing fees based on the size of the organization.
02:18 PM
Ms. Whitney discussed differences between hospice care in long-term care facilities versus at home. She also noted that some areas have concerns with coroners. Representative Roberts asked her opinion on the process in which coroners in Colorado get elected. Ms. Whitney stated that she did not think that coroners should be elected, that the job should be evaluated on the basis of one's qualifications, such as a pathologist for example. Representative Roberts asked about advanced directives and what can be done legislatively to improve advanced directives. Ms. Whitney responded that she thinks that the POST medical directive is a good concept. She stated that it would be good to have public outreach in order to help people understand the various legal documents, including living wills and advanced directives.
02:33 PM
Senator Newell asked about the organization's marketing plan. Ms. Whitney describe her organization's marketing events and community involvement. Ms. Whitney discussed her small marketing team and stated that they do not use traditional marketing. Ms. Whitney stated they talk to important stakeholders in the community, such as ministers. She stated that word of mouth in a small community is the best way to affect opinion in the community. Senator Williams asked about serving tribal areas in southern Colorado. Ms. Whitney discussed a Ute colleague who helped with outreach in the Native American community. Ms. Whitney provided a copy of her powerpoint presentation to the committee and 2 handouts,"Comprehensive Hospice and Palliative Care Organizations Interface Between Chronic, Palliative, and End Stage Interventions" and a comparative chart between the Medical Home and Hospice (Attachments F, G, and H).
02:37 PM
Dr. Kassner responded to a committee member's question from earlier in the day regarding how many certified palliative care providers are in Colorado. He stated that there are 59 palliative care board certified physicians in Colorado, including 7 that serve in rural areas in Colorado.