Hospice of Martha's Vineyard to align with Cape agency
Hospice of Martha's Vineyard, the nonprofit organization that has provided end-of-life care for Island residents for 28 years, will align itself with a Cape-based hospice provider, rejecting a possible merger with the Island's Visiting Nurse Association (VNA) that would have had Hospice of M.V. become a part of VNA. The VNA announced in February its plan to become a Medicare-eligible hospice, in competition with Hospice of M.V. (Hospice).
Hospice will continue to offer free care, regardless of the health insurance circumstances of its clients. Free hospice care is at the heart of the organization's mission. Under an agreement with Hospice and Palliative Care of Cape Cod (HPCCC), Hospice will, for the first time, also provide patients access to hospice services covered by Medicare, Medicaid, and private insurers.
HPCCC can provide access to insurance benefits for Hospice patients because it is a Medicare-certified hospice provider, something the volunteer-based nonprofit Hospice has steadfastly chosen not to become, in order to offer end-of-life care independent of Medicare rules.
"Through the unique alliance with HPCCC, Island residents will continue to be able to access the free expertise provided by Hospice from the day of diagnosis," said Terre Young, executive director of Hospice, in a press statement provided to The Times. "But as their disease progresses, they will now have a choice as to whether or not to access the hospice insurance benefits. When a patient chooses the hospice benefit, the two organizations will collaborate at all levels to ensure continuity of care and a seamless transition for patients and families."
Most important, Hospice officials said, is that the deal, described as an alliance, allows Hospice to remain independent. "Although HPCCC and Hospice are embarking on this collaboration together," said Ms. Young, "each organization will maintain its independent status, identity, mission, and philanthropic pursuits."
At the core of the issue is the hospice benefit associated with some insurance coverages. If a Medicare, Medicaid insured has a doctor's diagnosis that he or she has less than six months to live, a Medicare-certified hospice program will provide all medications, palliative radiation, equipment (such as a hospital bed), occupational and physical therapies, home health aides (for example, for bathing), and social counseling. If the patient lives longer than six months, the hospice benefit may be renewed, but it may not begin before the six-months-to-live point.
Because Hospice does not have a six-months-to-live rule, it can begin working with clients and families earlier in the course of a life-ending illness.
Hospice is certified as a hospice by the Massachusetts Department of Public Health and is financed entirely through local fundraising. It provides professional nursing care and the services of a professional social worker. Non-professional volunteers are a large part of Hospice, assisting patients and their families by running errands, doing housework, visiting with the patient or family members, or responding to other requests.
While all of Hospice's services are free, other medical needs must be paid for by the patient's insurance. These include drugs, therapists, home health aides, and medical equipment.
When a hospice patient requires hospitalization, Hospice follows. Ms. Young said HPCCC has not yet concluded a deal with the Martha's Vineyard Hospital. She said that arrangement could not be instituted before last week's agreement was signed.
VNA stunned
The Hospice announcement is a blow to the VNA, which announced in February that it would add Medicare-certified hospice care to its list of home health-care services.
At the time of the announcement, VNA said it would establish the program to provide Hospice patients with access to insurance benefits not now available on the Island.
VNA said it expected the formal Medicare certification process would take eight to 11 months to complete. VNA is a 25-year-old nonprofit provider of home health-care services for patients and families in need of care for short-term, long-term, and chronic illnesses.
"We are, of course, mindful of the admirable work that the Hospice of Martha's Vineyard has provided to end-of-life patients for years," Bob Tonti, VNA executive director said at the time. "We have opened up a frank dialogue with them to see if we can come together as one organization to better serve the community. We also understand, however, that Hospice of Martha's Vineyard has elected not to directly pursue Medicare certification at this time."
In an interview with The Times in February, Mr. Tonti was asked if the VNA and Hospice would both be able to offer services under the auspices of the VNA umbrella, but follow separate models. Mr. Tonti said, "Technically, the answer to that is no. We cannot work with them unless they are a certified hospice."
Mr. Tonti said he could not predict what a future model might look like but added, "Our hope, and the reason we approached them, very openly and aboveboard, was to try and work out a way for them to join with us, and I don't have the answer as to how that could happen."
The VNA announcement presented a direct challenge to Hospice. Representatives of both organizations met over the winter and spring to discuss what form a partnership might take.
Ms. Young told The Times on Tuesday that Hospice created a task force to explore all options. She said the task force had discussions with HPCCC and VNA, with a primary goal of maintaining Hospice's identity and mission.
VNA really wanted a merger, Ms. Young said, something that Hospice would not accept. "We tried, and I think they tried," she said.
On May 21, Hospice signed an agreement with HPCCC.
"We hope to remain who we are," said Ms. Young. "We are not really changing, we are enhancing."
In an OpEd published on page 13 of today's Times, Polly Brown, Hospice board member and treasurer, said a merger with VNA would have prohibited Hospice from offering free care to those who either are ineligible or choose not to access insurance benefits. "Our collaboration with HPCCC enables us to continue to offer the free care that is our hallmark," she wrote.
"With our new alliance," Ms. Brown continued, "Hospice will continue to be a distinct organization, and will continue to provide care from the day of diagnosis for free. When patients become eligible and want the extra services that a hospice insurance benefit offers, they will have the choice to receive care from HPCCC or any other Medicare-certified hospice provider."
Ms. Brown said that HPCCC will offer employment to Hospice staff and, as necessary, will supplement staffing by hiring on the Island. "This approach will enable continuity of care for those patients cared for by Hospice who elect the hospice insurance benefit through HPCCC," she said. "There need be no change in the Island-based care team."
Mr. Tonti said he learned of the agreement yesterday. In a telephone call not long after he spoke to Ms. Young, Mr. Tonti expressed shock and said he thought the negotiations between VNA and Hospice continued.
"At no time did we come to any final conclusions; at no time did we reject any offers or say we would not discuss it further," said Mr. Tonti. "We thought we were in the middle of talking about things, assessing things. I was very surprised and shocked that they signed an agreement."
In effect, the patients VNA expected to attract will now have a choice when deciding to take advantage of their hospice insurance benefit.
Ms. Young said HPCCC is based in Hyannis and has an office in Falmouth. She said the company plans to add staff.
Mr. Tonti said he is extremely disappointed that Hospice thought it had to invite an off-Island company to open offices on the Vineyard. "I am very disappointed and don't see the need for it," he said. "I thought we were still in discussions. All of this is a surprise.
