Friday, March 15, 2013

A Closer Look at San Diego Hospice (continued)

Contributor Shelley Sansbury responding to comment (below) about CEO's effort to change culture:

Please be assured my intention was not to cast aspersions on anyone. Rather it was to question the necessity of the decision to shut down the very highly regarded San Diego Hospice and Institute for Palliative Medicine in the wake of a Medicare Post-Payment Review of 149 patients.

What you call a 15 year long cultural disregard for the compliance requirements of Medicare mischaracterizes the Open Access policy pioneered by HSDIPM and now employed by more than one in four hospices throughout the country. Medicare eligibility rules clearly do not allow hospices to serve patients who seek curative care, and both the hospice physician as well as the patients’ physician must certify (and periodically re-certify) that the patient is terminal with a prognosis of less than 6 months to live. Within this framework however hospices are permitted to establish their own policies, procedures and criteria for admission and discharge. Whether a patient has a willing and able caregiver available at home can affect whether a hospice accepts or declines to serve a patient who meets all Medicare Hospice eligibility requirements. Abundant research has examined restrictive enrollment policies as barriers to hospice care. (The Debate in Hospice Care, J Oncol Prac, May 1, 2008: 153-157 It appears to me SDHIPM's efforts to maintain an Open Access policy is commendable. You ascribe the fate of this organization to a new CEOs attempt to change the culture, purge the executive team, but it was too late…for what? Too late to manage to achieve proper alignment between a commitment to provide the best possible hospice care and Medicare regulatory compliance, an intention the executive expressed in a Nov 13 press report.

I am familiar with the financials, as reported to the CA Office of Statewide Health and Development (and available to anyone with an internet connection). In 2011 this hospice, with an annual unduplicated census of 4,665 patients spent $320K in palliative radiation therapy alone. In total for 2011, net operating expenses of $81M exceeded net patient revenue of $71M. Non-operating revenue including community support such as “donations and contributions” amounted to $12.5M, producing a positive total fund balance.

Another interesting item included in this report is the 78,375 “Medicare Reportable Hours of Volunteer Services”. While this may be of little relevance to the bankruptcy court, it is, and I hope you would agree, a genuine asset, and perhaps one more small reason to hope that those involved in the governance of this voluntary non-profit organization would muster the devotion to emerge from Chapter 11, rather than permanently abandon operations and put an end to the mission on which the organization was built.


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