Can non-profit hospice survive high cost of palliative care?

[Mazzi]

I am finding oncology departments offering chemo and radiation as a form of palliative care for pain, n/v, ect. This is very high cost. With what the govenment alots for Hospice Medicare Benefit to be paid to the hospice organiation, are you finding it is becoming impossible to keep your doors open?

A non-profit hospice used to be able to take any and all paitents that was less than 6 months live expectacny and give them the care they required. You gained income on some and lost on others, but in the end came out even. But what I'm beginning to see is new high tech treatments being offered and the cost sooo high that there is no monies left for the simple mouth swabs and depends. (example only). Are you other hospice nurses feeling frustrated over this palliative/comfort care only change being seen??

[webblarsk]

This is what I don't understand. Why does for-profit hospice's get bashed so often. The funding is the same. Non profit and For profit gets payed the same rates. Medicare, Medicaid and Insurance. The only difference is that at the end of the year For profit hospices pay taxes while non profit dosen't. And non-profit hospices can accept donations, do fundraising etc..... Maybe its because I am in a rural area and there are only 2 hospices in a 60 mile radius. 1 being non-profit, 1 being for profit. Yes I work for a for profit hospice. But I personally haven't run into any cost issues with my company. My owner's phillosophy is that its all about the patient, no matter what the cost. We don't cut costs, we provide what the patient needs. In fact there have been complaints about the non-proft hospice in our area cutting costs. Not providing all the medications needed, or the DME's that are needed. And in general the patient care. So I guess the point is that there are bad owners on both ends of the spectrum, not doing the right thing. I believe that as long as the patient's and familys are recieving the care they need and deserve it dosen't matter if its coming from a non-profit or for-profit hospice. Whew.................. I am done with my rant. Sorry but its a major pet peeve of mine to here the non-profit vs. for profit arguement.

[webblarsk]

There was a constant push to cram as many visits into a day as possible; visits were supposed to be short but sweet. Forget about taking time to just talk to the pt./family...

quote]

I have spent many a late night, in fact all night with my dying patient, or my patient in crisis. As I know the rest of my staff has. Heck just the other night I spent 24 straight hours with my dying patient in a Nursing Home because his family couldn't stand to be there. Our patients are treated supremely and I am proud of that fact. But like I said before I live in my rural glass bubble, and I hate to here of any hospice not on the up and up.

[RnRatchet]

In fact there have been complaints about the non-proft hospice in our area cutting costs. Not providing all the medications needed, or the DME's that are needed. And in general the patient care. So I guess the point is that there are bad owners on both ends of the spectrum, not doing the right thing.

I'll have to agree with you then.. lucky for you in your "rural glass bubble" because these same complaints get aimed at the for profits in this area..

I think it's all in how you word and say things sometimes too.. some people just can say a nasty thing so nice and no one ever notices..lol

We're all in this for the same reason.. and I tell families that when I meet with them for admissions.. sometimes it's just an informational meeting and they knew from the start they didn't want to start hospice services yet. I always tell them it's an option for your care we want to make sure you know that you have.. it's not a mandatory thing. When they ask about other hospices I always say we all have the same goals for comfort and support for our families just owned by different people... like there are different hospitals.. etc.. often times I find people think we're all one thing.. like Medicare or something.

[Katillac, RN]

This is what I don't understand. Why does for-profit hospice's get bashed so often. The funding is the same. Non profit and For profit gets payed the same rates. Medicare, Medicaid and Insurance. The only difference is that at the end of the year For profit hospices pay taxes while non profit dosen't. And non-profit hospices can accept donations, do fundraising etc..... Maybe its because I am in a rural area and there are only 2 hospices in a 60 mile radius. 1 being non-profit, 1 being for profit. Yes I work for a for profit hospice. But I personally haven't run into any cost issues with my company. My owner's phillosophy is that its all about the patient, no matter what the cost. We don't cut costs, we provide what the patient needs. In fact there have been complaints about the non-proft hospice in our area cutting costs. Not providing all the medications needed, or the DME's that are needed. And in general the patient care. So I guess the point is that there are bad owners on both ends of the spectrum, not doing the right thing. I believe that as long as the patient's and familys are recieving the care they need and deserve it dosen't matter if its coming from a non-profit or for-profit hospice. Whew.................. I am done with my rant. Sorry but its a major pet peeve of mine to here the non-profit vs. for profit arguement.

I believe that the difference is that the for-profits are set up to. . . make money. So there may be an interest in spending as little as absolutely necessary on patient care in order to maximize profits, and in fact some administrators are really pushed to do just that. In contrast, the not-for-profits legally can't show a lot of profit or they risk losing that tax-free status. So there is not as much temptation to reduce costs associated with giving care. Not to say there aren't for-profits that give wonderful care, though!

[webblarsk]

I believe that the difference is that the for-profits are set up to. . . make money. So there may be an interest in spending as little as absolutely necessary on patient care in order to maximize profits, and in fact some administrators are really pushed to do just that. In contrast, the not-for-profits legally can't show a lot of profit or they risk losing that tax-free status. So there is not as much temptation to reduce costs associated with giving care. Not to say there aren't for-profits that give wonderful care, though!

Yes, so the non-profit in our area gives hefty staff bonuses at the end of the year, pays a huge salary to all the employees and dosen't give back to the community in our area or to the patients.

[Katillac, RN]

Yes, so the non-profit in our area gives hefty staff bonuses at the end of the year, pays a huge salary to all the employees and dosen't give back to the community in our area or to the patients.

OK, well. . . it seems like this is a sore spot for you. I can't imagine why a health care agency would scrimp on patient care in order to give big bonuses and huge salaries to staff and nothing to patients, though I guess it could happen. The bad PR would get them in the end, though. There are bad apples in every barrel, profit and not-for-profit.

It's heartening to hear that you work for an agency whose owner is compassionate and ethical. I feel bad for everyone connected with an agency where this is not the case.

[webblarsk]

There are bad apples in every barrel, profit and not-for-profit.

It's heartening to hear that you work for an agency whose owner is compassionate and ethical. I feel bad for everyone connected with an agency where this is not the case.

That's what I have been trying to say. I get tired of hearing for-profit bashed so often when it clearly happens with both for-profit and non-profit. Its all about the patient care. And shouldn't matter if the hospice is for profit or not for profit as long as the patient is being taken care of!

[andyg]

This is the first time I have responded but I've got to say "you ask for it" anytime you bring up for-profit and non-profit hospice. I've worked for both and there are pros and cons to each. Back to the original question and obviously none of you are from TN where we have Tenn Care instead of Medicaid. We are a non-profit and are very lucky to belong to a large hospital system. Our coverage is rural and we cover approx. 6600 sq. miles in 14 counties. What allows us to do radiation and other treatments is our census. We avg. about 100 ppd but are currently zooming above 120. Statiscally it has been shown that on avg. when your census goes between 40-50 ppd then you start having some "profit" areas when it gets larger then you have so many that it tends to off-set the treatments, so you are able to continue to provide the quality of care to all you serve.

[jking]

I work for a for-profit hospice in a rural area. The "county" non profit hospice seems to be doing everything you all are saying the for profits are doing. The non-profit is supported by the hospital and docs so their census stays fairly well. But, I cannot tell you the numbers of patients that we have recieved because the non-profit hospice told them they would have to pick up the tab for a lot of supplies, meds, etc. The patients were going to have better coverage if they just went to the hospital everytime something came up. Of course we lose money on these patients. We really have great admin and they want to help people, it's not about money. I have to say in our area the for profit patients definately recieve better care. I mean, we go to the nursing homes and hear what staff says. The quality is definately lacking in the non profit hospice here.

Also, one more point. Not to offend anyone, but please remember all hospices recieve same payment from payer source wether for profit or not for profit. The big difference is as for profit we are unable to fund raise and don't recieve funds from sources such as United Way, etc. Also, our memorials have to be spent in certain ways.

So everyone please remember for profit or not for profit there are good and bad in both arenas. And, most everyone in this business to try to help people and not for the money. Don't blame staff for bad decisions by admin!:uhoh21:

[doodlemom]

Non profit hospices have to hire all of their administrative staff, HR, payroll, supportive staff, Executive director, Financial officer, etc...to work in their local office. For profit hospices have most of thier corporate and supporitve staff located in their corporate office - this saves lots of $$$. The staff in the local offices basically are worker bees. It costs a great deal more money to run a non profit because of this. 'Executive directors" in a for profit office don't run the show...they have to speak to some big hoo haa in the corporate office before making any big decisions. There are always strings attached to the corporate office, who makes the policies. Non profit executive directors speak to a board of directors (who are not paid.) Changes in policies are easier with such a small chain of command. If non profit hospice's did not have donation money,they could not exist. Some non profits are able to provide just as much (supply wise) as the for profits. It depends on how well the board and the executive director, CFO, have managed their money.

[jking]

Sorry if I offended anyone. Guess I was just trying to make the point that not all for profits are bad and not all non profits are good. It's the staff and admin who make or break a hospice, not where the money comes from.

[webblarsk]

I work for a for-profit hospice in a rural area. The "county" non profit hospice seems to be doing everything you all are saying the for profits are doing. The non-profit is supported by the hospital and docs so their census stays fairly well. But, I cannot tell you the numbers of patients that we have recieved because the non-profit hospice told them they would have to pick up the tab for a lot of supplies, meds, etc. The patients were going to have better coverage if they just went to the hospital everytime something came up. Of course we lose money on these patients. We really have great admin and they want to help people, it's not about money. I have to say in our area the for profit patients definately recieve better care. I mean, we go to the nursing homes and hear what staff says. The quality is definately lacking in the non profit hospice here.

Also, one more point. Not to offend anyone, but please remember all hospices recieve same payment from payer source wether for profit or not for profit. The big difference is as for profit we are unable to fund raise and don't recieve funds from sources such as United Way, etc. Also, our memorials have to be spent in certain ways.

So everyone please remember for profit or not for profit there are good and bad in both areas. And, most everyone in this business to try to help people and not for the money. Don't blame staff for bad decisions by admin!:uhoh21:

Well said, that is what I have been trying to say!