NHPCO NewsLine Spring 2020 - 10

continued

care. For $180 a day you're not
going to be able to provide a
multitude of services and
supports for everybody. Nor do
most people need that level of
support and service. But you're
right. I think that there's the
promise of what hospice can be
for everybody and there's the
reality of what some people get.
And that disconnect is something
that we need to fix.

Journalist: Are there problems
with the way reimbursement is
structured?
Edo Banach: This is probably a
Edo Banach: A couple of things

are top of mind for me. Utilization
of volunteers would be one
example. All hospices are required
to have five percent of their
patient care hours be provided by
trained volunteers. I think it's
important to look for hospices
that are going above and beyond
the bare minimum. Bereavement
care would be another example.
Some have more robust
programs than others and offer
support for a longer period of
time, often to the broader
community. Some do it more in
person and less telephonically
than others. Certainly, allied
therapies are important. What
the rest of the health care system
believes is sometimes ancillary:
Music therapy, occupational
therapy, massage therapy. These
are all things that can be very
therapeutic for people period, but
certainly at the end of life. You
also want to make sure that the

10

Newsline / Spring 2020

people who are working for the
hospices are certified. I would
also ask if they are a We Honor
Veterans partner if your family
member or loved one is a veteran.
We also want to make sure that
they are actually providing 24/7
access. It's important to know
that they will be there when you
need them.

Journalist: I look at what

Medicare requires of hospice and
it includes home health aides and
even homemaker services. It feels
very disconnected from the actual
consultations that I hear about
between hospice agencies and
patients.

Edo Banach: Well, I think part

of the problem is reimbursement.
A hospice is paid about $180 a
day to provide care. As you know,
there are different layers of
reimbursement, but most people,
98% of people, get routine home

good way to segue to delivery
system reform. Right now, the fee
for service benefit doesn't pay for
quality. It pays for service that
you get. And we've had this
ongoing debate with MedPAC
over how hospice should be paid
for and whether reimbursement
should be cut or not.

Journalist: MedPAC talked

about cutting reimbursement,
right?

Edo Banach: They did, and we

were able to stave off a two
percent reimbursement cut. And let
me say why I think that a cut would
not be a good idea. Not only is
Medicare spending on hospice quite
low when you compare it to
anything else, but it's also the case
that the hospice benefit is limited
in a couple of crucial ways. One is
the six month benefit. And it is for
individuals with a prognosis of less
than six months to live. Some get
care for longer.
NHPCO NewsLine Spring 2020

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