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

aimeee, BSN, RN · Sep 27, 2005

Our hospice has never provided chemotherapy or radiation for patients. To do so would indeed take away from our ability to serve our other patients who did not opt for these expensive treatments. This means our census is smaller, but we are able to provide more benefits for those who we do serve.

We are, however, in the beginnings of instituting a palliative care program which will allow us to give some services to those who are still receiving palliative treatments. Our hope is that it will allow us to reach a greater number of folks and that they will actually end up entering hospice care somewhat earlier since we will have had the opportunity to come to know them and for them to come to trust us.

saribeth · Sep 28, 2005

We are also a non profit, small hospice and we certainly can see that palliative txs are an up and coming thing, but we would never be able to support any type of radiation or chemo...medicare better step up to the plate if the push for palliative tx continues which I have no doubt will...providing excellent care and balancing cost is the ongoing challenge but we usually pull it off however there have been times when our agency has lost $45k in a month!!!!!!!!! :uhoh21:

Katillac, RN · Sep 28, 2005

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??

My hospice sees it as part of their mission to provide the best symptom relief, or palliative care possible given the available options, with cost as a consideration. If palliative radiation is the best option to treat symptoms, we have done that. Sometimes our ethics committee will meet if there is a question about an extremely pricey option being considered. If, for example, there was a palliative chemo being offered and our IDG felt the symptoms could be addressed effectively with a less expensive treatment, our hospice MD would probably talk to the oncologist. But I would see it as my management's job to draw the line if the cost of treatment for one patient was so high that it drained the agency of resources needed to serve all of its patients.

On the other hand, we also have non-hospice palliative care patients on our service. For them, because we don't need to pay for their care out of a per diem and they don't have a six month prognosis and can still be pursuing curative treatment, a wider range of treatment options is considered.

webblarsk · Oct 6, 2005

I have a question, and don't mean to offend anyone. But I work at a for-profit hospice. I know that with non-profit hospices donations are recieved all the time. And the non-profit hospice in my area (rural area) does fundraising all year round and recieves mega donations. Can't that money be used towards patient care? i.e. Palliative chemo and Radiation? I am just curious because with a for-profit hospice we cannot take donations or do fund raising. We can accept memorials after a patient has passed away. But that money has to be kept account of and is used for special events. i.e. Flying a family member home for a funeral, etc.... Just curious.............thanks in advance!

Mazzi · Oct 6, 2005

I have a question, and don't mean to offend anyone. But I work at a for-profit hospice. I know that with non-profit hospices donations are recieved all the time. And the non-profit hospice in my area (rural area) does fundraising all year round and recieves mega donations. Can't that money be used towards patient care? i.e. Palliative chemo and Radiation? I am just curious because with a for-profit hospice we cannot take donations or do fund raising. We can accept memorials after a patient has passed away. But that money has to be kept account of and is used for special events. i.e. Flying a family member home for a funeral, etc.... Just curious.............thanks in advance!

Great question!!!! The non-profit hospices end up taking the uninsured, non medicare, non medicaid pt. You would not believe how many people fit into that catagory. Persons that are hard working, have assets should not have to deplete all of their hard working assets to pay for medical/hospice/radiation/chemo to die in a dignified,comfortable state. These people so easily fall through the cracks of our society. Sad to say..

Financies of a non- profit hospice are starting to become even more thin because the amount Medicare/Medicaid pay is not enough to cover the new pricey Radication/Chemo treatments for palliative care. But should not all patients have the right/freedom to choose these new high tech treatments and not have to worry how it will be paid for??? Also... non-profit hospices tend to be small and cannot carry the patient load to off set cost as a larger for-profit hospice can. This is not to say for-profit hospices are a bad thing. We all are just trying to take care of our patients the best we can.

doodlemom · Oct 7, 2005

We are a non profit and we provide palliative radiation. We have a really good deal with a local hospital. We do not provide chemotherapy. In my opinion there is no such thing as palliative chemotherapy and it irks me when doctors use this term. What symptom are they palliating by giving chemo? I think most doctors use this term because they think that if it is not curative then it must be palliative. What they really mean is that "it is not curative, but it will possibly give you more time." What do you think?

Katillac, RN · Oct 7, 2005

I have a question, and don't mean to offend anyone. But I work at a for-profit hospice. I know that with non-profit hospices donations are recieved all the time. And the non-profit hospice in my area (rural area) does fundraising all year round and recieves mega donations. Can't that money be used towards patient care? i.e. Palliative chemo and Radiation? I am just curious because with a for-profit hospice we cannot take donations or do fund raising. We can accept memorials after a patient has passed away. But that money has to be kept account of and is used for special events. i.e. Flying a family member home for a funeral, etc.... Just curious.............thanks in advance!

My hospice is a not-for-profit hospice, and we use donated monies for a lot of our patient care budget items. We are allowed to do that because unlike the for-profits, our financial focus is not on making profit, but in raising a budget through reimbursement, private pays, fees, donations, etc. and spending it on the patients. I don't think either one is better necessarily, but their financial goals are different.

Our board and management still have the job of seeing that the budget is spent appropriately, and yes, sometimes there are dilemmas that come up when a very expensive palliative treatment for one patient means we may not be able to do something else for many patients. But that's why we have an ethics committee.

As to whether patients should be able to choose any treatment and not worry about cost, in an ideal world, yes. But health care costs would quickly spiral completely out of control. And it's a slippery slope, yes? Who would be accorded this right? Hospice patients? Children? Everyone? And what would be covered? Everyone can agree that palliative radiation "should" be available to dying people, but how about bariatric surgery for someone not morbidly obese and with no comorbidities? Cosmetic surgery to cure a self-esteem deficit? With whom and at what procedures should we draw the line? It's a great issue for debate.

webblarsk · Oct 10, 2005

Great question!!!! The non-profit hospices end up taking the uninsured, non medicare, non medicaid pt.

For profit hospices take uninsured, non medicare, non medicaid also. Its a Federal Law. Anyone that qualifies for hospice must be accepted regardless of abilities to pay.

doodlemom · Oct 10, 2005

For profit hospices take uninsured, non medicare, non medicaid also. Its a Federal Law. Anyone that qualifies for hospice must be accepted regardless of abilities to pay.

Good point! I wonder if they are a little slower at scheduling admissions for these patients, therefore the patient or the hospital calls us. We do seem to get an awful lot of unfunded patients.

RnRatchet · Oct 10, 2005

Although they should take the underinsured, no insurance, and such.. the for profits in our area have a nice catch phrase we've heard families tell us when we come to service them...

"...we can't meet your needs..."

I'm sure not all for profits are like this.. it's just been our experience in this area I guess.

It's usually the very costly wounds or mega meds (IV pumps.. etc.)

sjrn85 · Oct 10, 2005

For profit hospices take uninsured, non medicare, non medicaid also. Its a Federal Law. Anyone that qualifies for hospice must be accepted regardless of abilities to pay.

I worked for both, and in my exp., the for-profit hospices are not as focused on the quality of care. Both of the for-profits I worked for did things I found very objectionable, like trolling ECFs for potential patients and fooling around with pts. meds just to get something cheaper, even if it was less effective.

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...

This was just my exp.; maybe someone who works in a for-profit that doesn't operate this way could post his/her experience.

As far as tx., my understanding was that if it was the best option for the pt., the tx. should be covered, regardless of cost. That doesn't mean some providers won't try to wiggle out of doing it, though.