By Mike Lee
Hospice administrators and members of the Oklahoma Hospice and Palliative Care Association recently learned that Oklahoma hospice providers may be facing difficulties with Medicare after a government representative gave an update on Medicare’s reimbursement status.
Gregory A Wood, president of the Oklahoma Hospice and Palliative Care Association, said the booming industry in Oklahoma is due for a slowdown and possibly even the closure of some smaller providers.
Hospice administrators learned in late June from the Centers for Medicare & Medicaid Services that the Oklahoma Department of Health has been instructed to survey hospices on a four-tier level criteria and as a result, hospice programs wanting to start up are now being placed on the bottom of the list for initial surveys which will slow the trend of new hospices being established.
Wood confirmed there are 14 applications on the desk of the department of health and those initial surveys will proceed, but after that he expects a slow down in the growth of hospice providers. More troubling from the CMS representative was that providers who have exceeded their allowable billing will be forced to pay money back to the government. Wood says those providers who have exceeded their caps face imminent financial danger.
"If hospice providers do not figure out a way to manage the Hospice Medicare CAP allowance per patient, the financial liability to the hospice will be enormous and the Medicare payback in some cases, could possibly close down the hospice provider," Wood said. "This has already happened to some hospices in our state."
Wood says whatever happens the face of the industry will be changing in Oklahoma.
"I do anticipate the hospice movement will experience changes in the coming months as we have already started to see the effect of hospice providers facing the Hospice Medicare Benefit CAP problems," Wood said. "One of the things we as the Oklahoma Hospice & Palliative Care Association are looking into is the fact that some hospice providers are facing Medicare CAP problems and other providers are not, at least for now.
"For the sake of the terminally ill patients and the integrity of what hospice care provides, it is vital for us to figure out ways to support hospice providers facing the challenges that each of them encounter."
One of the problems appears to be the relatively large number of providers in the state, Wood said.
"The Oklahoma hospice provider market is extremely competitive," he said. "In fact, Oklahoma has the highest number of hospice providers per capita in the United States."
Wood says the exact number of hospice providers in the state has been a difficult figure to pinpoint as the number is constantly changing and growing.
For instance, in Oklahoma City, there are over 60 hospice providers and the same is true in Tulsa, with a total of close to 160 hospice providers and a number of these providers have satellite offices in other communities as well. With so many providers, competition is brutal.
According to the National Hospice and Palliative Care Organization, the number of hospice programs nationwide continues to increase - from the first program that opened in 1974 to more than 4,100 programs in 2005.
Nationally, over 1.2 million patients received services from hospice in 2005, an increase of more than 150,000 people from the previous year. The 1.2 million hospice patients served includes about 800,000 who died, 200,000 who were admitted in 2005, but carried over to 2006, and 200,000 who were discharged alive.
Mickey Key, owner of Compassionate Care Hospice, agrees her industry is at a turning point.
"It’s in turmoil," she said. "A lot of us have been hit by caps. It is tough. There has been so many that have had to close their doors."
One such example may have been Lion Hospice after employees were abruptly notified that the hospice provider was closing its doors immediately.
A lagging market share and low census numbers led Lion Hospice to cease operations in Oklahoma City," said one former employee, who asked to remain anonymous as he still works in the industry.
"They were trying to overcome that. I think they had turned the corner actually. They really got a good group of nurses and marketers and we were impressed with the crew there at the end, but there was no indication they were going to shut down."
Not having enough marketers soliciting business in the early going was one reason the company stumbled, the former employee said.
Started in 1994 in Texas, Lion Hospice arrived in Oklahoma in 2001. Lion operates three hospice agencies, but the Oklahoma City location was the only one in the Sooner State.
Employees were called in for a team meeting and then asked to stick around for a benefits meeting, according to the employee.
"The benefits package was basically that we didn’t have one and they were closing the doors that week," the employee said. "It was a surprise for everyone."
Oklahoma City is one of the most competitive hospice markets in the nation with more hospice companies per capita than any other state in the nation.
According to the most recent census information, the Oklahoma City metropolitan area was home to nearly 1.1 million people.
Comparatively, the Dallas-Fort Worth Metroplex has a population of nearly six million people with the same number of hospice companies.
"That puts us in a hard spot here in Oklahoma," the employee said.
According to a source, the CAPs allowance issues could have possibly played a major role in the facility’s closing as well.
Lion did not respond to numerous requests by phone and e-mail for comment.
Terry Gonsoulin, RN, serves as the executive director of Hospice of Oklahoma County. She is also a past-president of the Oklahoma Hospice and Palliative Care Association.
She said under current conditions the industry must watch its resources while still providing for the needs of patients.
"The hospice industry has a strong presence in Oklahoma," Gonsoulin said. "While Oklahoma does have the highest number of hospices per capita it does not have the proportionate penetration rate of numbers of individuals served by hospice.
"There are very reputable and strong programs that exist in the state of Oklahoma providing superb end of life care to Oklahomans."