Engage With Grace

Here's wishing each of you a wonderful Thanksgiving. Before you head off to dinner with the family, there is a project I would like to draw some attention to. The following is a post that you will find on a handful of blogs this weekend. Please read on and think about what you can do to help your family prepare for their end of life journey. God bless.

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it. This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences.But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get
people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started. Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was
written by Alexandra Drane and the Engage With Grace team)

A sign of what is to come?

I concluded a post recently by saying that the big corporate hospices had won another battle, and that it was going to be even harder for the small guy to make it. Guess, I may have overestimated the health of the big hospices. Trinity Hospice, which is a subsidiary of Sunrise Senior Living (NYSE: SRZ), is shutting it's doors. Here is the "announcement" within their most recent financial report:

In October 2008, the Company determined not to provide any additional funding for ongoing operations to our Trinity subsidiary due to the continued losses experienced by that subsidiary. As a result, the Company expects to write-off the remaining goodwill and other intangible assets related to Trinity of approximately $9.8 million in the fourth quarter of 2008. As a result of this decision to cease funding by the Company, Trinity's board of directors has decided it will discontinue operations by the end of the year.

Trinity's website is already gone, so I can't figure out how many offices Trinity had. I know there are a lot of Trinity Hospices across the nation, but I can't quite figure out if they were all related. There is a press release from the time Sunrise acquired Trinity that says that Trinity was the eighth largest hospice in the nation and that the purchase price was 68 million dollars.

I guess there is pain all around the hospice industry. I'd love to know if the Medicare Cap, bad business practices, or just plain life was what brought this company to its knees.

If you know more about this, please feel free to leave comments to supplement the limited information I have here.

Interesting Research Numbers

NHPCO has published its latest statistical compilation on hospice care in America. It is the 2007 numbers on hospice care and covers a lot of information. Good stuff to know when looking at the industry as a whole. (I think it's a free link, but if not, it's just another reason you may want to consider membership.)

Palmetto GBA, one of the handful of Medicare Intermediaries that work with hospices, has released a PowerPoint presentation that contains Non-Cancer Length of Stay information for the states it covers. This is a trove of information that can help inform the Medicare Hospice Cap discussion. The general feeling is that Non-Cancer Length of Stay is one of the leading culprits in hospices who have cap issues, and Palmetto covers most, if not all, of the states that are best known for their cap issues. I have not had time to do more than a cursory look, but I think we will find some telling trends when these numbers are more closely scrutinized. (One note to help you read the charts: a non-cancer length of stay of .15 means that 15% of admissions stayed on hospice more than 210 days. As you'll see, it appears that the cap problem states seem to have a handful of hospices that have significantly higher NCLOS than most.)

Hopefully, I'll remember to get back to these reports later when time has allowed me to look at them a little closer.

New Hospice Billing Changes

Medicare has released its next round of billing changes, and this one won't be fun. (The last one wasn't fun either, but that's beside the point.) You can find the information here. (Click on the zip file to read the .pdf explanation of the proposed changes.) Clearly, there will be more on this as comments are made and the final rule is posted, but here is my quick gut take.

The biggest change in terms of implementation is that we will now be reporting the time of visits in 15 minute increments. For many hospices, this won't be a big deal at all. As usual, this rule will be much more painful for smaller hospices than large ones. The small hospices across the nation are going to have a hard time meeting both the new Condition's of Participation and these new billing rules without converting to an electronic documentation system. Figuring out how in the world to do all of this on paper will be very hard and time consuming.

Just to summarize here. In June Medicare published new rules that make it harder/more expensive to stay in compliance, in October they cut our rates, in November they released billing changes that forced small hospices to spend a lot of money converting to electronic charting. Hmmm, any chance we see another round of small community based hospices going out of business and large stock exchange based hospices taking over? Another bad day for the patients and another good day for the corporations.