Op-Ed : Hospice of Martha's Vineyard makes a change but holds fast to its mission
On May 28, Hospice of Martha's Vineyard (Hospice) and Hospice and Palliative Care of Cape Cod (H&PCCC) announced an alliance that will bring expanded hospice services to Martha's Vineyard, while preserving the traditional role of Hospice. This letter is an effort to set forth my personal feelings and the Hospice board's rationale for this innovative undertaking.
For 28 years, Hospice has served the Island as a hospice licensed by the Commonwealth of Massachusetts, giving all nursing, social, spiritual and volunteer services without charge. Periodically, we have reconsidered our initial decision not to seek Medicare certification. To date, we have always chosen not to be regulated by the rules that insurers impose.
The most objectionable of the insurer-imposed rules is that a Medicare-certified hospice that receives insurance reimbursements may not provide free care to patients who do not meet their hospice eligibility requirements. Hospice has traditionally given free care to everyone, including people who would not be eligible for insurance benefits. Our Hospice board and staff have been and continue to be unwilling to discontinue giving free care, believing strongly that hospice services should be available at the time of patient need, not just at the time of insurance eligibility.
The extent of any financial benefit from insurance varies from patient to patient. Typically, our patients have regular health insurance coverage that pays for medicines, doctors' visits and some medical equipment, such as wheelchairs or hospital beds. In those cases, our hospice patients are responsible for co-payments. In contrast, the hospice Medicare benefit eliminates those co-payments and covers all services, medications, equipment, supplies, treatments and therapies related to the terminal diagnosis.
Last spring, we did one of our periodic reviews and contacted H&PCCC to inquire about both the advantages and restrictions relative to Medicare certification. We again confirmed that the provision of all medically appropriate services can be very expensive, and since insurance pays only a fixed per diem rate, certification represents a significant financial risk to a small organization like ours. With our caseload of 60 or so patients a year and our unique Island location, we believe that we could not afford to provide all the services that we want to give. Again, most importantly, we would not be allowed to be both Medicare-certified and to provide free care to our patients who are not eligible for the hospice Medicare benefit. This would have forced us to deny care to patients whom we now are able to serve. So, once again, we confirmed our decision not to seek Medicare certification.
On a personal note, I was skeptical about Medicare certification, since when my husband was dying of cancer, a Medicare-certified hospice would not serve us because he was taking palliative treatment. The staff at H&PCCC explained that all Medicare-certified hospices are able to determine their own philosophies of care and related admission criteria. H&PCCC's philosophy is to serve patients regardless of the complexity of their care needs or the related costs of such care. As an example, they routinely provide for palliative treatments and interventions such as chemotherapy, radiation, blood transfusions, artificial nutrition, and hydration - whereas many hospices are not able to or choose not to do so.