Text Size

  • Increase
  • Decrease
  • Normal

Current Size: 100%

Don Schumacher Responds to Media Attention

To:         NHPCO Membership
From:    J. Donald Schumacher
Date:    August 17, 2011

Message from Don Schumacher

Members may have seen the recent articles about hospice appearing in USA Today by journalist Kelly Kennedy, “Medicare costs for hospice up 70%” (08/08/11) and “Hospice lobbyists battle over Medicare payment system” (08/16/11).  First, I wanted to let you know that all of us at NHPCO have seen these articles and I have responded – both in a letter to the editor and op-ed submission. 

I wanted to offer some additional thoughts to you all in light of these recent articles.

What I found particularly troubling is that Ms. Kennedy fails to acknowledge much, if anything, that’s good about hospice, thereby presenting a distorted picture of the hospice model of care.

Having been interviewed by Ms. Kennedy, I would have to say she fails to grasp the fundamental issues of caring for the dying and does not seem interested in providing necessary context for her arguments.

While editorial guidelines prevent me from sharing my letter or the op-ed that was submitted to USA Today, I would like to share some of the key points I made that seem necessary in any informed discussion about hospice care:

  • The principal reason Medicare spending for hospice has increased is because hospices are reaching more dying Americans, 1.5 million a year – and that’s a good thing.
  • Hospices are serving a more complex patient population (in addition to cancer diagnoses that now account for less than 40% of patients) where the trajectory of an illness and accompanying costs of care are more difficult to project.
  • Hospices are better equipped to serve patients in a variety of settings and not just the family home; given that one out of four Americans will die in a nursing home, this seems particularly relevant.
  • Independent research out of Duke University found that on average, every person who elected hospice saved Medicare $2,300.
  • Beginning in the mid-1990s, the Centers for Medicare and Medicaid Services put a lot of effort into increasing the use of hospice care.
  • NHPCO and the hospice community have been actively engaged in quality efforts well before health care reform was enacted.

Regarding Ms. Kennedy’s focus on lobbying on behalf of hospice, it’s critically important to remember that hospice providers are uniquely reliant on Medicare and Medicaid for payment (not surprising given our patient population) and we all have a lot at stake in healthcare budget debates.  It’s essential that we make our voices heard among on Capitol Hill.  What was left out of this recent article was the unified voice working on behalf of the entire hospice provider community.  Guiding these efforts is NHPCO’s public policy agenda and putting this agenda into action is the Hospice Action Network.  It should also be mentioned that the board members of both NHPCO and HAN represent a cross section of the diverse hospice and palliative care community in the US. 

For those familiar with lobbying on Capitol Hill, it’s hard to take Ms. Kennedy’s argument seriously when the amount spent on hospice lobbying in one year does not match the amount spent by larger industries in a single day. 

Current support for legislation calling for more consistent oversight of hospice builds on past work of the National Hospice and Palliative Care Organization.  This will help ensure quality care is the standard. Dollars spent trying to make that a reality will ultimately benefit care at the bedside and are well spent.

The hospice community works hard to respond to the changing profile of the dying in this country – a difficult job but one that makes a great deal of difference to the dying and their families.  For example, research out of Brown University (ironically released on August 8 and not mentioned in Ms. Kennedy’s articles) shows the value of hospice care to patients and families with dementia who are living in nursing homes. This is the sort of context that is necessary in an exploration of hospice care in the US.   Fortunately, our colleague and board member, Dr. Joan Teno, along with Dr. David Dosa of Brown University wrote a letter about this important research that was printed by USA Today. I thank them for their effort.

Ms. Kennedy is concerned about the rising costs of caring for the dying under hospice care, I think she would be more concerned by the costs required to care for them without hospice.  If any members would like some more specific talking points, please email communications@nhpco.org and request them – we’ll be happy to share them with members. In thinking of these and other recent news articles, I’m reminded of the very personal connection hospice has to the emotional pulse of society today. The services and compassion we provide and the journey we share with those we care for is sacred. The very element that makes our work so unique – and essential to humanity – is the same element that results in sensationalized news stories.

As I have often shared with you, it is critically important that we in the hospice and palliative care community continue to speak with one voice, support one another, and continue in our steadfast mission to provide the best care possible to all those we serve.

I’m proud to be working with you all.

J. Donald Schumacher
President and CEO