30 Years of a Changing Hospice Industry
Posted: May 13, 2014
On June 11, 2014, Arbor Hospice will celebrate its 30th anniversary.
Over the course of three decades, the hospice industry and Arbor Hospice has experienced enormous growth, withstood many regulatory and reimbursement changes and has seen an increase in national attention on the end-of-life. As the healthcare industry continues to evolve, the hospice industry should expect further changes in the patients we see, the way care is provided and the resources that are available.
When Congress first authorized a Medicare Hospice Benefit in 1982, forty hospices became certified to provide care under Medicare, and only four were for-profit organizations. In these early days, hospices served primarily cancer patients, and provided care for a very small proportion of individuals who died each year.
In three short decades, the hospice industry has expanded to care for more than 1.5 million patients and their families each year. An industry that was once a volunteer-driven passion now parallels other sectors of business.
Over the past 15 years, hospice has become big business. The most prominent trend was the shift from non-profit to for-profit ownership. Four out of five new Medicare-certified hospices between 2000 and 2009 were for-profit. Today, the Medicare Payment Advisory Commission estimates that there are nearly 5,500 hospices in the United States and more than 60 percent are for-profit. Hospice is reimbursed by Medicare on a per diem (or daily) amount. This amount must cover all services and supplies related to the terminal diagnoses. Today the largest hospice nationally, Vitas, is owned by Roto Rooter.
The world is changing; the healthcare industry is changing; hospice is changing. People are living longer with advanced illness, a relatively new phenomenon in the history of human kind. This will create a continued need for palliative, or comfort care, a relatively new niche of medicine that focuses on advance care planning and elimination of side effects common with serious illness. Palliative care is holistic, meaning it focuses on the physical, spiritual and emotional needs of patients and their families.
The industry will need to continue to innovate to ensure we are providing the right care at the right time at the right place. Not everyone will be appropriate or “ready” for hospice care. One in six Medicare patients is readmitted to the hospital within 30 days of being discharged exceeding $17 billion a year. Palliative care programs, like Arbor Palliative Care, reduce the likelihood of hospital readmissions and keep patients where research says they want to be – at home, without pain, surrounded by loved ones.
Declining reimbursement and increased regulation will continue to challenge hospice providers. Hospices will need to continue to be pioneers, expanding their use of technology and the way we interface with patients, families, healthcare providers and members of the community. Increased use of technology to implement quality check systems will also more effectively meet the needs of patients and families. In addition, other innovative care including music, massage and pet therapies serve to help patients and families experience dignity, comfort and peace during their journey.
And, just as it has been over the past 30 years, education will play a vital role. Our society is still uneducated and uncomfortable when it comes to death, dying and serious illness. Physicians often do not have the time to initiate important conversations, or do not have them because of the sensitive and uncomfortable nature of the conversation. There are many organizations (The Conversation Project, Prepare and Aging with Dignity) emphasizing the importance of advance care planning and initiating end-of-life discussions. When these conversations are had, people understand their options and can choose care that better aligns with their goals, enhancing their quality of life. That, after all, is what hospice is all about.
Gloria D. Brooks, President & CEO, Arbor Hospice