Editorial : A smart, compassionate deal will coordinate and expand end of life care here
Here's some good news in this bad news health care world we are told we inhabit.
The deals negotiated last fall and concluded in December among Hospice & Palliative Care of Cape Cod (HPCCC), Hospice of Martha's Vineyard, and the Vineyard Nursing Association (VNA) will improve access for Vineyarders to end of life care.
The cooperative effort, known as Island Hospice, that is the result of this three-cornered deal-making, testifies to the good-hearted, forward-looking, practical leadership of all three organizations.
HospiceMV, the Island's centerpiece for hospice care, depends on volunteers, its endowment, and fundraising to deliver blessed care to patients and families, at no charge. It eschews Medicare licensing to preserve its ability to offer help to patients and families however they may need it.
VNA, the only home care service for Islanders, is a private nonprofit supported by insurance reimbursements and fundraising, beset by growing demand and incomprehensibly political pressures on its reimbursement rates. VNA's mission is essential, without a peer on-Island, and, despite its indispensability to the community, uncompensated by the community with public funds.
HPCCC is a Medicare licensed, Cape Cod based hospice that accepts all comers. Because of the arbitrary, one-flat-fee-for-each-and-all way Medicare pays for the end of life services it funds, many Medicare eligible hospices discriminate among the patients they accept by making a calculation as to whether the anticipated cost of care will or will not exceed the fee Medicare will pay. It's a risk management hedge. HPCCC does not manage risk this way. Instead, it fundraises privately.
As David Rehm, HPCCC president and chief executive officer, told Times managing editor Nelson Sigelman, "This is a unique and complicated relationship in some ways. It was relatively easy to figure out the common sense way to make this work best for the patient. The complexity was figuring out how to do it in a way that fits within all of the regulatory worlds." No surprise, that.
For finding their way through the maze, Mr. Rehm, Robert Tonti, VNA chief executive, and Terre Young, Hospice MV executive director, deserve enormous credit.
As Mr. Sigelman explains in this morning's account of the creation of Island Hospice and its anticipated benefits for Vineyard families facing end of life decisions, there remains one link to be forged to complete this rather symphonic collaboration.
In part because Medicare benefits for hospitalized patients are lower than the Martha's Vineyard Hospital's customary reimbursements, Island Hospice must negotiate a deal, this one with the hospital for medical care for Medicare hospice patients. The deal is not done, but negotiations continue. For now, a patient who needs hospitalization may still receive free Hospice MV care while an in-patient, but the cost of the medical care provided during the hospitalization would be born by the patient or his insurer.
Such determined and good-hearted caregivers as lead Island Hospice and the hospital will certainly solve this last problem.