Wednesday, March 6, 2013

A Closer Look at San Diego Hospice

Posted by Blog Contributor Shelley Sansbury, health care strategist and former hospice and home health care executive

Is the Decision to Close San Diego Hospice Reasonable?

 A review of available reports suggests the possibility that the decision to close San Diego Hospice may have been made in haste by a CEO with no previous hospice operations leadership experience and with limited involvement by its Board of Directors.

While it’s never easy to evaluate a situation based entirely upon press reports, one can piece together the salient events that led to a decision to (a.) terminate the Chief Medical Officer (b.) declare bankruptcy (c.) disclose plans to become subsumed by Scripps Memorial Hospital.

It has been reported that the Medicare audit examined records of 149 patients admitted to service between Jan 1, 2009 and Nov 30, 2010. Undoubtedly the audit selected those patients for whom Medicare made the largest payments, that is, patients with the greatest length of stay. I have been unable to ascertain the actual audit results.

On Nov 12, 2012 the San Diego Times Union reported:  Pacurar said she believes the hospice is vulnerable to millions in rebates to Medicare because the program has not been strict enough in making sure that its patients are truly suffering from an illness likely to cause death within six months. She said doctors and care givers operated for decades on an “open access” policy that kept patients on hospice care for longer than six months, sometimes without being able to demonstrate that their condition was worsening.”   

As noted recently by the same reporter a similar Medicare audit was conducted in 1997. In that situation of 37 patient records examined with the greatest lengths-of-stay, Medicare sought repayment from SDH of $2.1M. According to the report, Chief Medical Officer Laurel Herbst, MD said the organization fought hard to convince the government that its decisions to keep the patients on hospice service for so long, in one case four years, were appropriate. “We fought every one of those cases, and we ended up winning all of them,” Herbst said.

One should also note that while press reports cite millions of dollars in Medicare payments potentially subject to recovery, according to the Annual Report as filed with the California Office of Statewide Planning and Development, the agency received $7.15M in memorials and contributions in 2011 alone. By way of perspective it seems that even absent any effort whatsoever to appeal the audit findings, at the very least a Medicare overpayment repayment plan could and should be proposed. One doubts that DHHS Secretary Kathleen Sibelius and the Centers for Medicare and Medicaid Services under her command have any desire to deliberately contribute to the demise of this esteemed organization.
Among the many important accomplishments (and assets) of this organization is the Institute of Palliative Medicine In addition to patient care, The Institute for Palliative Medicine is internationally recognized for its excellence in palliative care education and research and has achieved international recognition for its innovative education programs, patient/family-centered research and evidence-based advocacy since 1989. The Institute for Palliative Medicine trains more than 2,000 healthcare professionals each year in the advances in hospice and palliative care. One would hope in the weeks and months to come, as the bankruptcy proceedings ensue as does the absorption of San Diego Hospice by Scripps Memorial, the Institute for Palliative Medicine would find a means to emerge with the autonomy it deserves.



Anonymous said...

I'm sure the contributions of the Institute are notable, but was it worth the provost making $450K, as noted in the UT San Diego article:

Strategist said...

Raally Shelly, you think that "it’s never easy to evaluate a situation based entirely upon press reports?" How about the press reports are pretty inaccurate. You felt the need to knock out a blog post without even a phone call to someone in the know? San Diego Hospice was in trouble. A 15 year long cultural disregard for the compliance requirements of Medicare came back and bit them. New CEO attempted to change the culture, replace the executive team responsiblle for this but it was too late. Shelly, familiar with the financials? Did you read the bankruptcy filings?
Next time get some facts before you cast dispersion on something you don't really know anything about.

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