Revisions to Medicare concern Hospice

Haven Hospice is concerned about more regulation and less reimbursement.

Published: Wednesday, January 5, 2011 at 5:59 p.m.
Last Modified: Wednesday, January 5, 2011 at 5:59 p.m.

One new health care regulation has received the ax just days after it went into effect.


About Haven Hospice:

• The median length of stay over the course of 2010 was approximately 18 days.
• Haven cared for more than 5,800 patients in 2010.
• 55% of those patients received care at home.
• 38% of patient care was in a hospice facility.
• 7% of care was provided in the E.T. York Care Center in Gainesville.

The rule said that Medicare would pay for end-of-life counseling as part of an annual wellness visit with your physician.

It was a regulation designed to give you as a patient and your doctor that opportunity to explore options and spell out just what treatments you would or would not want in the last stages of life.

The White House announced Wednesday that the voluntary doctor-patient discussions, for which physicians would have been reimbursed, would not be part of Medicare policy.

For Tim Bowen, director of Haven Hospice, the end-of-life counseling revision to Medicare would have been a positive outgrowth of the Obama administration's health care reform plans.

"The time to do advance care planning is when you don't need it," Bowen said.

White House spokesman Robert Gibbs said Wednesday, "Nothing about this change should inhibit patients and physicians from having this kind of discussion."

The change in Medicare policy had drawn little comment before going into effect Jan. 1, but Gibbs said the reimbursement policy would be changed anyway because there wasn't enough time for public comment before it went into effect.

"Physicians who know how to have difficult conversations with patients and their families are already comfortable with this sort of counseling," Bowen noted. "I don't know that paying physicians would make a doctor who is not comfortable any more likely to do it."

He pointed out that Haven Hospice offers "Five Wishes," a document to help you spell out your wishes in advance.

"Ideally, you would take it with you to your next wellness appointment and talk about it with your doctor," he said. "It is available on the website ( or we can send it to you by mail."

Other changes to Medicare regulations concern Bowen more, as the head of a hospice system that saw 5,800 patients in 18 counties in 2010.

"For us, health care reform is going to mean more regulation and less reimbursement," he said.

"It is going to be a challenging environment."

For Haven and 5,600 other hospice programs around the country, there won't be a reimbursement rate increase from Medicare for the care they provide for the next 10 years.

"For hospice, the Medicare rates will be the same, even though the costs of everything else will go up," Bowen said. "We're still looking for the positives in this legislation."

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