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Hospice care industry, meet Obamacare

The Affordable Care Act of 2010 has something to say about end-of-life treatment, but how much the federal healthcare program will impact that industry remains to be seen. Only two things appear certain now: more paperwork, and a lot of confusion.

Like every aspect of healthcare, the hospice industry is trying to determine what impact the Affordable Care Act will have on its day-to-day operations.

With some of the federal healthcare reform – better known as Obamacare – already in place, there are differing opinions about what the new law means for end-of-life care.

Florin Rominu, founder and chief administrator of Inland Regional Hospice in Corona, believes most of the changes will be clerical. Unlike other elements of the healthcare industry – hospitals, for example – the ACA isn’t likely to overwhelm hospices with major changes, Rominu said.

At least not anytime soon.

“If you look at the [Affordable Care Act], it doesn’t say too much about hospices or hospice care,” said Rominu, who also owns and operates two assisted living facilities in Redlands. “The main difference is it requires more detailed reporting on a patient’s condition. Most of this we didn’t have to do before.”

Rominu is referring in part to the ACA’s Hospice Quality Reporting Requirement, which became mandatory for all hospices on Oct. 1, four years after the first part of the Affordable Care Act became law.

No more than fourteen days after a patient is admitted to a hospice, hospice officials must submit to the Centers for Medicare and Medicaid Services a report on the person’s medical status at the time of admission. The data is used to determine what kind of treatment a person will receive.

The hospice has 30 days from date of admission to submit that data to CMS, Medicare being the primary insurer for hospice treatment.

At discharge – death or otherwise – the hospice has seven days to complete all data on the patient’s stay and treatment and 30 days to submit that information to CMS. Any missed deadline can result in a two percent reduction in payments from Medicare.

The goal is to reduce the number of discharges back and forth between hospices and hospitals, a practice that can cost both sides a lot of money. Another goal is to prevent the system from being abused.

“They’re looking for more transparency,” said Rominu, who said Inland Regional charges an average of $170 a day for treatment. “There’s a lot of data in these reports because they want to get as much information about a patient as they can.”

Rominu reassigned one of his employees to handle Inland Regional’s quality reporting duties exclusively when the ACA’s hospice requirements became law.

“They’re a lot more detailed than what we’ve had to deal with in the past, and more open-ended,” he said. “Before, there weren’t really any deadlines, and there weren’t any penalties.”

Some hospices, including Inland Regional, will be forced to hire outside agencies to conduct surveys of family members and care-givers. That’s another ACA requirement of hospices that is being tested now and will become official April 1.

“None of this is going to be easy,” said Rominu, who believes hospice care should be more of a six-month service, not something that’s used only in the last week or two of life.

The hospice reporting programs aren’t as far along as other aspects of Obamacare, and there’s no mechanism in place for the public to access the information that hospices provide to the government.

Still, Medicare officials support the extra reporting, saying that more data, particularly when it’s shared among doctors, leads to better treatment.

“CMS’ goal is to adopt measures for the Hospice Quality Reporting program that ensure care is patient and family-centered and is safe and high-quality,” Dr. Patrick Conway, chief medical officer and director of the Center for Clinical Standards and Quality at CMS, told the website, in a statement.

The National Hospice and Palliative Care Organization also issued a statement saying it “fully supports quality reporting,” but added that the practice has caused “significant additional expenditure of resources over a short period of time” for end-of-life facilities.

One element of Obamacare could have a major impact on hospice care should it end up being successful, said Susan Negreen, executive director of the California Hospice and Palliative Care Association in Sacramento.

End-of-life treatment has never included curative care, but a three-year pilot program in the Affordable Care Act is making an exception to that practice: hospice care for chronically ill children – meaning anyone less than 18 years old – that does include treatment intended to save the patient’s life, Negreen said.

If that works – at this point it’s only being tested in a few markets – it could someday lead to curative care in some or all hospice treatment, Negreen said.

“It’s understandable that parents never want to give up on the life of their child,” Negreen said. “You now have a form of hospice care that does include curative care, and that could become permanent. That could lead to some major changes in end-of-life care.”

Correction: Susan Negreen’s name was misreported in the first installment of this series, which was published last Monday.

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