Obstacles in Hospice Care…

by Malarie Allen, Development Coordinator

With slow and declining funding from Medicaid, hospice organizations and related healthcare entities statewide must band together to secure the future of hospice care in Alabama, according to Dave White, health policy advisor to Gov. Robert Bentley.

White visited Hospice of Marshall County – Shepherd’s Cove last month, where Shepherd’s Cove Hospice leaders and other state and non-profit hospice officials brought to light current regulatory and funding challenges hospice organizations face throughout the state.

Rhonda Osborne joined the conversation as the CEO of Hospice of Marshall County – Shepherd’s Cove, a local non-profit hospice organization, and as chair of the Regulatory Committee of the Alabama Hospice and Palliative Care Organization.

Chief Nursing Officer Stormy Dismuke, who is also a member of the state Advisory Council on Palliative Care, and Chief Clinical Officer Keri Williams were also in attendance, as well as billing specialist Marie Creel, CFO Brenda Mayhall, Deb Barger, Chief Clinical Manager for Hospice of the Valley in Decatur (another non-profit hospice), and Rep. Kerry Rich, R-Albertville.

Some obstacles hospice care across the state faces include slow and declining Medicaid reimbursement, increasing regulations and payment restrictions that threaten to “squeeze out” small hospice organizations, like Shepherd’s Cove Hospice and Hospice of the Valley, and vast lack of knowledge about the cost savings benefits of hospice care among state and federal leaders.

Generally, hospice patients are those diagnosed with a terminal illness who decide to forgo curative treatments and have a life expectancy of six months or less. Hospice care is referred to as “comfort care” because it focuses on providing physical, spiritual and psychosocial comfort to patients in a way that does not slow nor hasten impending death.

“Human beings do not always fit in a black and white mold,” Osborne said, referring to tight Medicaid regulations. “Human beings are gray.”

Osborne fears regulations and payment restrictions will “squeeze out” small, independent hospice organizations, like Shepherd’s Cove Hospice and Hospice of the Valley.

To add to the issue, Alabama legislature is already struggling to make ends meet in the state budget. The fact that hospice care is an optional benefit under Medicaid regulations “shortens your negotiating power” for state money, according to White. He compared the fight for more funding for hospice care to fighting an “800-pound gorilla” and added that the 2017 budget will likely be even tighter.

“Medicaid has already asked for more money than (legislators) have,” he said. “They’re already looking for places to cut.

However, White suggested the AHPCO, individual hospice agencies and other interested parties might gain good traction if they partner with nursing homes and hospital state associations, which tend to have more money and clout, by demonstrating how securing the future of cost-saving hospice care is beneficial to them. The entities should then present their arguments to legislators and state healthcare leaders now while new regulations are still being drafted.

“Ask sooner rather than later,” White said. “The gorilla doesn’t always win.”

“Mobilize, speak as a group, know your facts and how (regulations and funding) compare to other states. Talk to legislators. Make it a unified push.”

“The little guys can win, but you’re going to win more often if you pair up with big guys.”