No longer is Maine an outlier when it comes to Medicare Hospice referrals. Now, more individuals and families are receiving high quality, supportive services the last weeks of life. Since 1999, Maine has gone from 49th out of 50 states to 28th in utilization of Medicare Hospice services. The national average according to Cordt Kassner of Hospice Analytics is 39 percent utilization (2009 Medicare Claims Data). Maine is presently at 37 percent.
What happened to effect this change? Was it merely coincidence? Was it going to happen sooner or later? The answer is both yes and no.
Social change does take time, even generations. And, as we know, changes in end of life care are about changing attitudes, changing culture and changing practice behaviors. It’s also about empowering consumers. Giving consumers information and empowering them to be advocates for themselves, their family members and friends. To help them know what they don’t know and then asking their health care providers and their insurance companies for what they need.
Hospice has been part of the fabric of our health care system since the late 70s; part of our reimbursement system since the early 80s. So you might ask, “What’s taken so long?”
Two factors to be considered are determination and collaboration. The realization that we have a shared responsibility to change the outcome is taking a long time and part of this is due to the structure of our system itself. One entity can’t be responsible for all the changes. A public/private partnership is the solution.
Time is a significant factor. In the past 30 years,
more and more people have read stories and seen statistics about dying, pain management, grief, loss, and reimbursement , or lack thereof. There has also been more coverage of end-of-life stories from the on-line, print and broadcast media.
In addition, there has been more attention from entities who licensing and certify health care professionals and institutions. Maine has several physicians and nurses who have certification in Hospice and palliative Care. Institutions have committed more financial resources to Palliative Care Programs and the In-patient Hospice facilities in our communities have brought more attention to the needs of families regarding the dying process.
State organization efforts have also played a major role. Over the past thirteen years, the Maine Hospice Council, in collaboration with the Office of the Attorney General, has convened several forums about Hospice utilization. Inviting questions and discussion from consumers, Government officials, legislators and health care professionals has created a much higher profile about the challenges/successes in end of life care. It has also made a clear statement that end-of-life care is a consumer protection issue and we all need to work together to ensure individuals and families have access to high quality end of life care.
Therein lies an important factor in Maine’s increased utilization. Increasing the state’s utilization of Medicare Hospice has been a priority of the Maine Hospice Council for since 1999. It was unacceptable that individuals and families were not receiving the services that they needed, wanted, and were qualified to receive. It took us a while to identify the issues and bring the partners together and we still have a long way to go. However, more families in Maine are receiving Medicare Hospice services today than ever before. Grant money, staff time and other resources continue to be allocated to improve utilization.
To all our partners over the past thirteen years, thank you. Because we worked together, many more individuals and families in Maine are receiving Medicare Hospice services.