One of New Hampshire’s largest hospice providers, a for-profit agency, recently announced its intention of shutting down operations in Dover and in Concord. A spokesman for the company said the Dover and Concord locations were not meeting their financial targets and are part of a restructuring that is taking place across the country.
In New Hampshire, community non-profits are still the primary model for the delivery of hospice care. Those of us who work for non-profit healthcare are accountable to NH communities – not to shareholders living someplace else. We are mission driven, not profit driven. And our quality metrics are excellent. While the national average length-of-stay in hospice was 86 days in 2010, our non-profit agency average length of stay was 41, less than half the national average. What is the difference? Like our non-profit colleagues, our agency is guided by a mission to our community – to maximize the services available to those in need. In contrast, no matter how well meaning, the mission of a for-profit is to maximize returns to the shareholders.
The hospice movement in the United States emerged during the late 1970s and 80s, borne from a social interest in applying humane care to the dying. Communities across the country began to develop charitable hospice organizations offering palliative care to people when cure was no longer possible. Then in 1983, the Medicare program began to pay for hospice care for beneficiaries who had a life expectancy of six months or less. Medicare-certified hospices are paid a fixed sum for each day an individual is enrolled in the program. During the first decade of the Medicare hospice benefit, most of those served had a diagnosis of cancer, they typically entered hospice late in the course of illness and had a brief length of stay. Hospice providers often struggled to make financial ends meet. Over time, though, hospice expanded its care philosophy to minister to those with other end-stage chronic diseases such as Alzheimer’s dementia and congestive heart failure. The program also expanded to serve those in nursing homes and other facilities. The length of stay increased and opportunities to generate handsome profits opened up, particularly if a hospice focused on low cost patients.
This opportunity invited many newcomers, most of them for-profit entries. In 1990, there were fewer than 750 hospices in the nation – nearly all of them non-profit organizations. Today, there are over 5,300 hospices in the US, and the overwhelming majority of hospices are now for-profit. Hospice has gone from being a community based service provided by local non-profit agencies to a $17 billion industry dominated by for-profit corporations. These trends inflate the price tag for the American public, but they do not necessarily improve the quality of service.
For decades hospice enjoyed a positive reputation in the US healthcare system, but that reputation is eroding as costs rise and exploitive practices become commonplace. The entry of many for-profit hospices has led to meteoric rises in the cost of the program. In response, the Medicare program has imposed new regulations and proposes a revised payment structure. We are in favor of those payment reforms. We believe they will restore hospice to its core mission and reduce the opportunity for payment exploitation. This may encourage some providers to leave the field as the opportunity for profit declines, but the non-profit hospice providers that are committed to their mission and their community plan to stick around as long as there is a need and community support.
About the Author
Margaret Franckhauser is Chief Executive Officer of Central New Hampshire VNA & Hospice. The Mission of Central New Hampshire VNA & Hospice is “Promoting dignity, independence, and well-being through the delivery of quality home health, hospice and community-based care services.” Central New Hampshire VNA & Hospice serves Lakes Region communities in Belknap and Southern Carroll County and provides Home Care (nursing and rehabilitation services in the home); Pediatric Care (direct health care, education and support services for children and families); and a comprehensive, team-based Hospice program. Central New Hampshire VNA & Hospice is a not-for-profit, Medicare-certified provider of home care and hospice services, licensed by the State of New Hampshire. The agency is governed by a volunteer Board of Trustees and supported by private and corporate donations.