Delaware Hospice officials announced layoffs statewide including 18 healthcare workers in Sussex County.
In all, Delaware Hospice CEO Susan Lloyd said, 52 healthcare workers in Delaware and Pennsylvania lost their jobs as the result of changes in the way Medicare reimburses the organization.
Lloyd said Medicare officials are more strictly following guidelines to determine which patients are appropriate for hospice care; Medicare has declined to reimburse hospice for care already provided to hospice patients who had previously been qualified to receive service.
About 200 patients have been discharged because of changes in Medicare reimbursement for hospice care. In 2012, Delaware Hospice was serving about 600 patients; today it is serving about 400 residents statewide.
Lloyd said Delaware Hospice's previous service structure is no longer sustainable; restructuring was necessary for Delaware Hospice to remain in business.
“When a patient comes into hospice, they have been diagnosed with a terminal illness, so there is not a time frame attached to that,” Lloyd said. In the past, she said, no matter how long the patient was in hospice, Medicare would pay.
But that may no longer be the case.
According to a March 2012 Medicare Payment Advisory Commission report to Congress, the number of hospice patients on Medicare reached 1.1 million in 2010 with reimbursements to providers totaling $13 billion. From 2000 to 2012 the number of hospices nationwide increased 53 percent with nearly all of the growth coming from for-profit organizations.
The commission found that long-term stays in hospice became very profitable for providers, which in some cases may have led to inappropriate use of the Medicare benefit.
As a result, Medicare officials are tightening the reins on hospices nationwide to make sure money is being spent only on eligible patients – those who have less than six months to live.
When hospice care was established, it was mostly for cancer patients. Medicare established a six-month window for patients to be cared for under hospice, said Beverly Crowl, spokeswoman for Delaware Hospice.
“In the past 30 years, hospice has grown to encompass every type of condition, including disease, Alzheimer’s or a disability,” Crowl said. “While we are still working within a six-month prognosis, it can be hard to predict end of life.”
At the end of six months, patients must be re-evaluated; at that time, they can be readmitted to hospice or they can be discharged. Delaware Hospice offers longer-term programs such as palliative care for patients with more than six months to live, Crowl said. She also said she is unaware of any long-term patients receiving Delaware Hospice care.
Crowl said Delaware Hospice is recognizing a difference between the criteria it uses to admit a patient to hospice and the criteria Medicare follows. The change is causing Delaware Hospice to restructure and re-evaluate how it places patients in hospice care. She also said it led to the discharge of hundreds of patients that Medicare deemed inappropriate for end-of-life services.
"At this point we are engaged in discussions with Medicare and working with the national hospice organization, which has started a national initiative to look at the hospice industry," Lloyd said. "Delaware is one of 16 states affected by these changes."
Don Schumacher of the National Hospice and Palliative Care Organization in Washington, D.C., said hospice has grown dramatically over the past two decades as communities have become more aware of the services it provides.
“We used to be relatively small in terms of Medicare, but now hospice is a $14 billion to $15 billion expense, so the government is just increasing its scrutiny to make sure it gets what it is paying for,” Schumacher said.
Schumacher said he expects the stricter reviews will slack off in the next several months.
“We are working with Medicare contractors to slow down the reviews and help them recognize that hospices are being unfairly burdened by the scrutiny,” Schumacher said.
He said healthcare reform and an increased surveillance of government spending are two reasons for the intensity of the reviews. He said all aspects of healthcare are being looked at more closely.
Lloyd said, “It is unfortunate we had to make these changes in our staff. We are upset about it.”
She said the change will be hard for families. “What is going to happen is families don’t have the support they are used to having in Delaware. We hope they stand behind us and try to get these guidelines loosened.”
All employees were provided severance packages to ease the transition, Crow said. The package included wording urging former employees not to discuss private details. "We are trying to do everything we can for them, but we think they should keep private things private,” Crowl said.
According to a press release, Delaware Hospice is the largest and only licensed, nonprofit, community-based hospice serving Delaware and southern Chester and Delaware counties in Pennsylvania. Since 1982, Delaware Hospice has provided care and support to 41,500 patients and their families.
“Delaware Hospice has been a leader in providing end-of-life care to patients and their families for 30 years, and it is committed to being a strong community partner for many years to come,” Lloyd said.
For more information on Delaware Hospice, go to www.delawarehospice.org.