Hospice Providers Say State Medicaid Cuts Will Mean Higher Costs
Posted: September 29, 2013
"We have asked the state to reconsider these cuts because it will be more expensive for the state if it eliminates these services," said Gloria Brooks, CEO of Arbor Hospice in Ann Arbor. "These are high-risk patients and will get shifted back to hospitals for expensive care."
Besides Arbor Hospice, the other hospices affected as of Tuesday will be Angela Hospice Care Center, Livonia; Woodland Hospice, Mount Pleasant; Hospice of North Ottawa Community, Spring Lake; Hospice House of Mid-Michigan at Sparrow Hospital, Lansing; The Poppen Residence of Harbor Hospice, Muskegon; Hospice of Little Traverse Bay, Petoskey; Trillium Woods Residence of Faith Hospice, Grand Rapids; Genesys Home Health & Hospice, Grand Blanc; and Allegiance Hospice, Jackson.
Arbor Hospice, which cared for 71 hospice patients last year at its 26-bed inpatient unit at the Residence of Arbor Hospice in Ann Arbor, projects it could lose $500,000 per year because of the cuts. Medicaid room and board payments amount to about $200 per day.
"We will not be able to have Medicaid patients reside in the residence" if the cuts stand, Brooks said. "We will work with referral sources to find places for patients to go. The problem is there is a scarcity of places because there are few beds for Medicaid patients at nursing homes."
Brooks said Medicaid patients who are admitted to inpatient hospice residential units are very sick and often require intensive care-type services. Some do not have homes or live in complicated family settings inappropriate for home hospice services, she said.
Nick Lyon, Community Health's chief deputy director, said the state conducted a review last summer of Medicaid funding and determined inpatient room and board is not a covered service. The state will continue to reimburse hospices for medical care of inpatients, he said.
Lyon said new federal regulations also require hospices to be licensed as skilled nursing facilities to receive Medicaid inpatient hospice reimbursement.
Since 2001, however, Michigan has allowed 11 residential hospices to operate 150 special nursing home beds to accommodate Medicaid beneficiaries' end-of-life care, said a statement by the Hospice and Palliative Care Association of Michigan.
"Hospice care is a very valuable service for end-of-life care," said Lyon, noting that average daily census was 48 patients, or 33 percent of the 150 available beds. "We are funding hospice care at the same levels as last year ($115 million for fiscal year 2013-14). This was not a budgetary decision."
Brooks said a hospice provider workgroup submitted a compromise proposal to Community Health that could delay the cuts.
Under the proposal, inpatient hospice payments would continue for six months, during which a study is conducted by the hospice association and Keystone Center for Patient Safety and Quality through the Michigan Health and Hospital Association, Brooks said.
"We want to show that outcomes are better for these patients and costs are contained compared with hospitals. We can show that," Brooks said.
Lyon said the department is studying the proposal and will make a decision by Tuesday, when the state's new fiscal year starts.
Sam Watson, senior vice president for patient safety and quality with the hospital association, said the association supports continued inpatient hospice funding and is designing the outcomes study.
"If funding for hospice room and board is discontinued, the state Medicaid system could see an increase in hospital acute care inpatient readmissions or long-term care facility admissions," said Watson.
Lyon said Medicaid will continue to reimburse providers home hospice services, hospice care in nursing homes and some home caregiver services.
Angela Minicuci, a Community Health spokeswoman, said the department is taking into consideration the impact to families from payment changes.
"We remain committed to ensuring that Michigan families and their vulnerable family members receive quality care," she said.
Jay Greene: (313) 446-0325, firstname.lastname@example.org. Twitter: @jaybgreene