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Federal changes already threaten hospice care

Despite the debates raging in Washington, it is impossible to predict how the health care landscape will unfold. There are, however, two strong probabilities: 1) Providers, including hospices, will be called upon to do more with less money, and 2) misinformation about end-of-life care may very well take center stage in the debate on health care reform.

Within the hospice industry, the adage that, "The government giveth and the government taketh away" has never been more true. With one hand, Congress increased a component of hospice reimbursement by 2.1 percent; with the other, it decreased a different component by 0.7 percent. The net result for 2010 will be a small increase that falls short of the rising costs for everything from medical supplies to gasoline. Ironically, hospice is the one program known to actually save the Medicare program dollars.

The future seems equally as challenging with cuts to hospice reimbursement being proposed for 2011 through 2016. The economic consequences of these future reductions will severely impact many hospices' ability to meet the ever-increasing demands for quality end-of-life care.

Luckily, there are several factors unique to hospice that should help mitigate a portion of the economic conditions confronting our industry. They include the resilience and ingenuity of our staff members; the steadfast participation of hospice volunteers, who are the foundation of the industry; and the community served, whose donations and advocacy have been a critical factor in ensuring hospice services.

The combined diligence of these parties will also be needed to meet another challenge. The House of Representatives' current Health Care Reform legislation, HR 3200, includes a provision that would compensate physicians for discussing end-of-life planning with Medicare beneficiaries. Oddly enough, this provision has become increasingly controversial; particularly since Section 1233 of the bill encourages physicians to initiate similar discussions with patients that other health care organizations have been required to do since the early 1990s.

Regrettably, some individuals in the political spectrum have promoted fallacies suggesting that the inclusion of Section 1233 is intended to deny seniors proper care. As a health care professional for close to 25 years, I have come to appreciate how difficult care decisions near the end of life actually are.

Currently, only one third of Americans have living wills or other types of advance directives. It has been my experience when the wishes of a patient are unknown, considerable burdens are placed on providers and, more disconcertingly, on the individual's loved ones.

Despite fear mongering by some in Washington, if this very delicate conversation can be facilitated by a physician, then Section 1233 goes a long way in improving our health care system.

Stephen Schinnagel is vice president of Hospice Services at Niagara Hospice in Lockport.

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