Louisiana-Mississippi Hospice & Palliative Care Organization
December 21.
Regarding Governor Jindal’s Elimination of the Medicaid Hospice Benefit
The Louisiana-Mississippi Hospice and Palliative Care Organization’s (LMHPCO) Board of Directors is shocked and saddened to learn of Governor Jindal’s decision to eliminate the Medicaid Hospice Benefit, effective February 1, 2013. While the Board strongly disagrees with this decision, the Board is even more confused by the Administration’s assertion that this action will save the state $10.6 million in FY2014? For 10 years, the Medicaid Hospice Benefit has provided terminally ill patients and their families in Louisiana with the confidence they need to forgo expensive end of life hospital admissions.
According to the Administration, Louisiana Medicaid spent $11,430,414.14 on hospice services for some 5,189 recipients in 2012 –an average of $2,202.81 per patient. With or without hospice, these terminally ill patients will die. The average length of stay for hospice patients in Louisiana is 72 days, with 50% of our patients dying within 26 days of enrollment. Without hospice, as these terminal patients decline, they will typically be transported to the nearest hospital emergency room by ambulance, and will subsequently be moved into the hospital’s intensive care units – costing the state’s Medicaid system at least four times the cost of hospice care. For over 25 years, hospice agencies in Louisiana have demonstrated their ability to deliver effective and efficient care and support to patients and their families facing the end of life. Only hospices are licensed and certified to deliver this specialize care and hospice agencies in Louisiana consistently receive high scores on patient and family satisfaction surveys.
LMHPCO also takes exception to the Administration’s claim that Louisiana Medicaid paid the Room & Board charges for 25,328 hospice patients residing in nursing homes in 2012 totaling $52,160,238.60 (i.e., $2,059 per patient). The Board is unfamiliar with the methodology Louisiana Medicaid used to arrive at this number. Louisiana hospices reported serving 1,647 Medicaid recipients (per their 2010 cost reports: 7% of all hospice admissions) and according to 2011 Medicare claims data, admitted only 23,010 Medicare beneficiaries throughout the state. Therefore, the Administration’s number would require combining all Medicare and Medicaid hospice beneficiaries in the state, for the entire year, to equal its number of nursing home hospice patients in the state. We strongly dispute this to be the case since the 2011 Medicare claims data also indicates that 67% of Medicare hospice services in Louisiana were delivered in beneficiary’s home, and much smaller percentages of Medicare hospice services were delivered in unskilled (24%) or skilled (4%) nursing facilities.
Of note, in 2009 the state of Arizona eliminated their Medicaid Hospice Benefit. Upon reviewing end-of-life care costs the following year, Arizona determined their Medicaid costs increased by ~4.4% by having others provide the same services. In 2010 Arizona reinstated their Medicaid Hospice Benefit and encouraged acute care providers to contract with hospices to reduce costs.
The LMHPCO Board of Directors is committed to promoting better end of life care in the state. We are troubled that the elimination of the Medicaid Hospice Benefit will result in significant numbers of terminally ill patients and their families having to face death without access to quality end of life care.