VNA joins Hospice MV in Cape link
By Nelson Sigelman
Published: December 10, 2009
An agreement announced yesterday between Hospice & Palliative Care of Cape Cod (HPCCC) and the Vineyard Nursing Association (VNA) provides Island residents facing end-of-life decisions with expanded options. It could also help heal the rift that developed between the VNA and Hospice of Martha's Vineyard when the VNA announced its intention to provide a competing hospice service.
HPCCC officially began operating on Martha's Vineyard December 4, under the name, "Island Hospice" as part of a collaboration with Hospice of Martha's Vineyard.
Yesterday, VNA announced that it had signed a staffing agreement with Island Hospice. The VNA will provide patient care resources for HPCCC that will also allow it to provide continuity of care for patients entering the hospice program.
This week leaders of Hospice MV and the VNA said they look forward to meeting together and working in the interest of the community.
Robert Tonti, VNA's chief executive officer, told The Times, "We recognize that there were some bruised feelings, and we think that this goes a long way towards rectifying the situation."
Asked about news of yesterday's agreement between the VNA and Island Hospice, Terre Young, Hospice MV executive director, told The Times, "I think it's fabulous. Our work is really all about the patients, and if we are all working together for our neighbors, to give them the best care, they're going to get it."
Ms. Young said she had always wanted to work with the VNA. "And here is our chance. I'm excited and hopeful," she said.
Last January the VNA, a nonprofit home health care provider, announced that it planned to add Medicare-certified hospice care to its list of home healthcare services. The VNA said it was establishing the program to provide hospice patients with access to insurance benefits not now available on the Island.
Without a Medicare-certified hospice provider on the Island, residents of Martha's Vineyard with Medicare healthcare coverage had not had access to their hospice healthcare benefit without leaving the Island. The VNA expected that the formal Medicare certification process would take eight to 11 months to complete.
The VNA announcement presented a challenge for Hospice of Martha's Vineyard, the volunteer-based nonprofit that has provided emotional, spiritual, physical, and medical support for people with life-ending illnesses since 1981. Hospice MV was established in 1981, to provide care free of charge and without many of the encumbrances associated with Medicare or other insurers' rules and regulations.
Hospice MV had made a deliberate choice to forego the Medicare benefit in order to avoid Medicare's restrictions. Patients (or their families) have often come to Hospice MV in advance of the six-months-before-death time frame during which Medicare benefits may be accessed. More importantly, once a patient elects a Medicare hospice benefit, Medicare will no longer pay for aggressive clinical treatments such as chemotherapy, radiation, dialysis, or surgery, which HMV clients often want to continue.
Hospice MV operates from a trailer parked on the Martha's Vineyard Hospital grounds and relies entirely on fundraising.
Although representatives of both organizations met to discuss a consolidation, they were unable to agree on how it might work. The discussions and the possibility of two competing Island hospices left some damage in the aftermath.
In May, Hospice MV announced an agreement with Hospice and Palliative Care of Cape Cod. That meant that Island residents would be able to continue to access the hospice care provided by Hospice MV. Then, upon reaching eligibility, they would also be able to access their hospice healthcare insurance benefit - whether from Medicare, Medicaid, or a commercial insurer.
The new agreement changed the landscape for the VNA.
Mr. Tonti told The Times yesterday that after Hospice MV signed an agreement with HPCCC, he met with David Rehm, president and CEO of HPCCC and began learning about the organization.
"We started to say, here is what the VNA wanted to accomplish," Mr. Tonti said. "We wanted to have a Medicare-certified hospice on the Island. We wanted our patients to have access to Medicare-certified hospice and the hospice benefit, and we wanted to continue to care for our patients through end-of-life."
Mr. Tonti said he started speaking with HPCCC about how both organizations could meet their goals. The result was yesterday's announcement.
Providing an example of how the arrangement would work, Mr. Tonti said a home-care patient who enters an end-of-life period and wants to take advantage of his or her hospice insurance benefit would be discharged from VNA home health care and readmitted under the Island Hospice program that would hire VNA to provide care services. All of the person's familiar home health care workers would remain the same.
"Nothing changes for the patient," Mr. Tonti said.
Medicare hospice eligibility is based upon two criteria: physician judgment of a six-month prognosis should the disease follow its predicted course, and the patient's desire to receive hospice services.
"This reinforces our commitment to increase access to care and to serve all who are eligible and entitled to the full range of hospice services." Mr. Rehm said, adding that insurance-eligible hospice patients would have the option to be admitted to Island Hospice while continuing to be cared for by their existing nurses. This means that patients can preserve valued relationships with those who have been caring for them - as they transition to Island Hospice care, a press release said.
Hospice MV, the VNA and HPCCC will each maintain its independent not-for-profit status, its identity, its mission, and philanthropic pursuits. HPCCC does not plan to do fundraising on the Island, and all funds raised by Hospice MV or VNA will continue to exclusively benefit the Island community, according to the release.
