Federal maneuvers will take a toll

Bush's proposed cuts jeopardize hospice care in Maryland

Health Care Realities

July 09, 2008|By Erwin E. Abrams

For more than 18,000 Marylanders every year, hospice is an end-of-life care option that provides dying patients and their loved ones with comfort, compassion and dignity. Unfortunately, the ability to provide this greatly needed service is under threat. In April, the Bush administration proposed cutting about $2.3 billion in payments to hospice providers over five years - nearly $23 million in Maryland alone - which would affect 80 percent to 85 percent of each hospice's reimbursement. These cuts could weaken or even close hospice programs, reducing patient access when it is most needed.

Hospice of the Chesapeake has joined the more than 3,500 hospices nationwide in urging Congress to step in and stop the administration's proposal. If Congress doesn't act quickly (the cut could go into effect as early as August) the 30 hospice providers in Maryland could lose nearly $4.5 million in Medicare funding in fiscal year 2009, and hospices could lose $450 million nationally. The cuts would mean less money to care for patients at a time when there are more people needing and using hospice service.

Regrettably, the proposed cuts would harm Medicare's most cost-effective health care program. Hospice saves Medicare an average of $2,300 per patient, or nearly $2 billion each year, according to an independent Duke University study. Patients and families are so satisfied with the care they receive that almost 99 percent of families whose loved one used hospice would recommend it to others, as indicated by family satisfaction surveys.

Last month, the Medicare Payment Advisory Commission, an independent agency established to advise Congress on Medicare issues, reported that the rapid growth of the Medicare hospice benefit was driven by increased numbers of patients using the benefit and more spending per beneficiary. One of the study's conclusions: More data are needed to address the funding issues and to modernize Medicare's payment system for hospice.

Like the advisory commission, we in the hospice community in Maryland recognize that changes are needed in Medicare reimbursement, because the structure of the hospice Medicare benefit has been virtually unchanged since 1983. But it only seems logical to take sufficient time to get it right, to collect enough data to make sound policy decisions.

The administration's attempt to circumvent Congress is unacceptable, and Congress should step in before the regulation goes into effect. Rep. Chris Van Hollen of Maryland has stepped forward in the past to urge protection of the hospice reimbursement structure. That kind of leadership will be needed to set things right.

Hospice is a health care program that is affordable and works well. The Medicare benefit should be protected so hospice can continue to provide Maryland's dying patients and their loved ones with comfort, compassion and dignity at the end of life. Marylanders who are able to speak up need to do so for those who can't.

Erwin E. Abrams is president and CEO of

Hospice of the Chesapeake and president of

the Hospice and Palliative Care Network

of Maryland. His e-mail is eabrams@


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