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Hospice care, patients feel effects of Medicare cuts

San Diego Hospice forced to cut staff, discharge patients

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San Diego Hospice will see its budget drop by $20 million, layoff about a fourth of its staff and be forced to discharge roughly 400 patients as Medicare enforces stricter compliance with its guidelines, which limits care to patients that have only six months or less to live.

A 93-year-old patient who received in-home care from San Diego Hospice for a year had to be let go from service since he had what’s called an “extended prognosis” — he exceeded the maximum of six months that Medicare will cover for hospice services.

His family understood why hospice care could not be extended, but is disappointed that he will no longer receive the emotional and spiritual support San Diego Hospice offered, which helped improve his quality of life.

This patient is just one example of many patients who have been let go since one of the largest hospice programs in the country was audited for its admittance practices.

As hospice care payments nationwide top $13 billion, Medicare is bringing the whole industry under the microscope -- and San Diego Hospice is one of the first to be scrutinized by the federal government.

“The challenge is that this is a fairly new audit and there’s not a lot of history of how organizations come out of them," said Kathleen Pacurar, San Diego Hospice CEO. "We’re nationally renowned and one of the first going through this, so the industry is watching us to see how we emerge."

San Diego Hospice’s annual budget will drop from $83 million to $63 million, as it reduces its staff from 870 to 600 and patients by 300, closes a 12-bed in-patient facility in Carlsbad and reviews eligibility criteria more carefully prior to future admissions into the program.

And once the results of the audit, which began in February last year, are tabled, it may have to return millions in reimbursements that it received from the federal government, because it allowed some latitude in keeping patients on hospice programs.

Pacurar emphasized that patients receiving in-home care, which comprise 95 percent of its services, will not feel the impact despite the budget and staff cuts.

“As our census decreases, we don’t have as many patients to treat,” she said.

So what happens to patients?

They will miss the support and care they received from a team of hospice staff, and many will see their health decline rapidly. Some of them may end up in the emergency room and then come back into service, Pacurar said.

This is what happened with an Alzheimer’s patient in his 90s, who had been receiving hospice care for two years and had to be discharged in August this year. His health declined and he was readmitted in September, and died three weeks later.

“Who’s in there to keep them from going into the ER? Our industry is going through this battle now — the scrutiny is not allowing us to touch some of these patients who would benefit tremendously,” she said.

San Diego Hospice was founded in 1977 and provides palliative care, relieving pain and suffering for terminally ill patients who range in ages from children to the elderly; hospice care for patients nearing the end of life; manages medication and therapy needs; and provides emotional and spiritual support to patients and bereavement support for their families.

It also provides services in under-funded areas such as education, research and therapy, all of which will be curtailed because of budget cuts.

Among the patients it services, cancer is the leading cause of death, accounting for more than 40 percent of illnesses, followed by other diseases and age-related debilitation.

There are about 18 hospices in San Diego County, some of them for-profit. The San Diego Hospice was the first program in the county and is nonprofit.

Pacurar said the community continues to be supportive — for 2010 to 2011, it received $7.5 million in gifts from individuals and organizations — and referrals keep coming.

The staff cuts have been hard, but Pacurar said employees have told her that working at the hospice was a fulfilling experience.

For families seeking hospice care for patients with longer prognosis, there are a few new programs being created, according to Pacurar, but there are not a lot of options when it comes to juggling the care and personal needs of their loved one, so the stricter compliance has created a hole that highlights the need for services that have now been curtailed.

-Nagappan is a San Diego-based freelance writer.

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1 UserComments
Marie 9:19pm December 11, 2012

Wow! I received a 48 hour notice that my mother will no longer receive hospice care. She is an Alzheimer's patient, non-verbal and receives total care from her caregivers. It's a shame that a person cam work their whole life and can't depend on the system to take care of them in their final years. Thanks for putting this in your paper... Guess I'll have to take a 2nd job to pay for her medication and extra care costs. This wiil, of course, take away from the precious time I spend with her during our visits. God help us all.