Date: 07/08/2009
Final
Rural Hospice Challenges
HOSPICE AND PALLIATIVE CARE
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02:38 PM -- Rural Hospice Challenges
Donna Roberts introduced herself, and described how she worked as a nurse in Greeley at a small hospital, and then became a director of Hospice of the Plains, which serves northeast Colorado. She then began her powerpoint presentation, as shown in Attachment I. Ms. Roberts noted that Medicare guidelines provide that only a physician can certify someone for entrance into a hospice. Her organization has 40 employees, but more than 200 volunteers. Ms. Roberts shared some of the problems that hospice patients encounter medically, and also described the emotional and spiritual issues that patients confront. Representative Tyler asked about length of stay in her hospice. Ms. Roberts answered that the average stay in their area is about 12 days. She stated that when her organization served primarily Yuma county, that the average stay was about 75 days. She described her organizations expansion and stated that they are still getting to know their new communities and are working with new physicians. Representative Tyler asked if they expect the length of stay to increase. Ms. Roberts stated that they do expect the average to increase.
02:51 PM
Ms. Roberts stated that patients in rural areas often have different concerns than patients of a urban hospice, such as feeding the cows or harvesting the crops. She stated that the hospice in the rural community addresses these concerns. Ms. Roberts stated that rural areas are reimbursed under Medicare at a lower rate than urban areas. She discussed the billing rate and the hospitalization rate for her organization. Ms. Roberts then explained the decision to expand services to Morgan County. She stated that they have nurses living in Morgan County, and the area is served from the office in Sterling. She then discussed the number of patients served and the organization's budget. She stated that patients with insurance are responsibilities for deductibles only. She described how the organization operates on a sliding scale and does not deny service. Ms. Roberts stated that often patients do not pay deductibles or copays. Ms. Roberts noted that prescriptions get filled for 7 days, because 30 day prescriptions can lead to waste if patient cannot tolerate the medicine. Ms. Roberts recounted the story of an individual that was on many medicines, including IV medications, and was in constant pain. She stated that the reimbursement for the medications did not cover the services provided. She discussed the amount of uncompensated care that her organization provides.
03:00 PM
Ms. Roberts stated that her organization is impacted by economies of scale. She stated that the cost per patient is much higher, and that a drop in the number of patients can have a large impact on the finances of the organization. Ms. Roberts discussed the recent rodeo death of a 12 year-old boy and the bereavement services provided. She stated that they offer these services to the community, but are not reimbursed by Medicare. Ms. Roberts discussed the hospice Medicare benefit and how some drug costs can consume large portions of the benefit. She stated that the costs for drugs given to hospice patients can be expensive and described some of the common drugs used and why.
03:08 PM
Ms. Roberts described the services that her organization offers under the Medicare for hospice benefits. She also described services that are provided, but may not be reimbursed under Medicare. She stated that patients may also seek treatment for conditions not related to terminal illness. Ms. Roberts discussed services related to the terminal illness that are not covered under Medicare. She stated that Medicare does not allow skilled nursing in a nursing home to occur at the same time as hospice care, unless the nursing home stay is unrelated to the terminal illness. She stated that hospice can save a large amount of money for families that receive hospice care.
03:19 PM
Ms. Roberts thanked the committee and asked if there were questions. Senator Newell asked about the Five Wishes form, and about what the most important change that Ms. Roberts would want to make to the hospice care system. Ms. Roberts explained the Five Wishes form. Ms. Roberts stated that she would want every terminally ill person to seek hospice and for there to be funding to support it.