Medicare Hospice Cap Update

I gave an impromptu lesson in government in my recent update on the Medicare Hospice Rate Cuts post, and figured I should extend that to what is going on with the Medicare Hospice Cap issue.

In the prior post, I discussed the fact that congressional fights are much easier won when your side can claim victory through congressional inaction. Doing nothing is a strong suit of our folks in Washington. In the rate cut debate, to have the rate cut stopped Congress must pass a bill, thus inaction has allowed the rate cut to take effect.

In the Medicare Hospice Cap issue, those on the side of a cap moratorium are in the unfortunate position of needing Congress to pass a bill to help them out. The Hospice Cap is the law. It has been in the law for years. The moratorium, or flat out end of the cap for that matter, will require Congress to write a bill, push it through committee(s), get it to the floor, and pass a vote. The only thing that has to happen for the cap to be enforced as the law requires is nothing. Again, it's easier to do nothing than something, so nothing usually wins.

Last year those pushing the cap were able to get a moratorium bill written and introduced. It was sent to committee, and, unless I missed it, never was even heard in committee. Inaction wins again! I'm sure they will try to get the bill submitted again this year, and maybe it will get further this time around, but, in the end, they are fighting against congressional inaction. That seems to be a hard battle to win.

The Rate Cut

I guess I may have left some of you hanging on the subject of the Medicare Hospice rate cut. Sorry about that, I haven't updated, because there hasn't been any motion.

One of the big lessons I picked up along this adventure is that Congress' strength is inaction. Whoever is on the side of inaction usually wins when it comes to our government. In this instance, the rate cut was sent down from on high at CMS, so congress would have had to act to stop it. They did not act, so it was not stopped. The concept of congressional inaction being a strength is so accepted (and true) that congress itself uses it as a tool. The example of our times is the "Bush Tax Cuts". If you take a peak back into the history of those tax cuts, the Democrat Party told the Republican Party that they would go along somewhat quietly if the Republicans would agree to put time limits on the tax cuts. Today, those time limits are running out. That means that congress will have to vote to reinstate them. The only thing the Democrat party has to do to get rid of those tax cuts is do nothing. There will be no bill, debate, or vote, but in the end the tax cuts will disappear. The side of any debate that must rely on congress actually doing something is at a steep disadvantage to the side that wins by congress doing nothing. The Democrats knew this when setting up the "Bush Tax Cuts" years ago, and CMS new that when they enacted a hospice rate cut without going through congress to do it.

My random civics lesson here is all to say that congress has to act to change this thing, and that isn't something that happens easily. NHPCO has not given up, but in the meantime the rate cuts have gone into effect. Supposedly, when congress comes back after the elections they may take up this issue, but...

The lawsuit is also hanging out there somewhere. No word on where it is, where it is going, or when it may be heard. My big question at this point would be whether we could actually get the money we should have been paid if the rate cut is found to be illegal. This month I am billing less than I would have if the rate cut wouldn't have been enacted. If the courts find that it shouldn't have been enacted, will I get the difference paid retroactively? I know nobody knows the answer to that question, but I'd sure like to know if it is an option.

Wow, that's quite a long post to say that I haven't been writing about the rate cut because there hasn't been anything to write about. Our rates have been cut. I, personally, don't hold out much hope that it will be "uncut", but only time will tell.

Till Death Do Us Part?

There is an interesting article on MSNBC.com about long time married couples dying within a few months of each other. It gives research evidence that the phenomena does exits and a mixture of medical and psychological factors that may explain the phenomena. If nothing else, reading it may just tug at your heart.

As someone who has seen their share of hospice patients, I sure can't deny that it is possible that a spouses death "causes" the surviving spouses death. We have, no doubt, had instances where the second one was referred for our services shortly after the first one's death, but I always wrote that off to coincidence and a family's appreciation for how great hospice can be.

More than anything, I know enough about death to know that I don't understand it. Do I believe spouses can "die together"? Sure. Do I believe that people can "stay alive" until a loved one arrives? Yes. Do I believe that people can time their death so that they are either surrounded by loved ones or all alone? No doubt. (They often wait until the family has left them alone - even if they just leave the room to refill their coffee so they can continue their vigil.) I digress.

Like I said, interesting article. It's worth taking a moment to read it.