Traverse City Record-Eagle

November 15, 2013

Competing hospice workers get pushed out

Traverse City Record-Eagle

---- — TRAVERSE CITY— Munson Medical Center no longer will allow competing hospices to care for their patients at the hospital.

As of Nov. 1, patients of a competing hospice were required to either go to a skilled-care, nursing facility for inpatient hospice care or switch to Munson Hospice if they prefer to stay at the hospital.

The new policy will help Munson Hospice remain financially viable and make hospital operations more seamless, said Munson spokesman Ian Jones.

But the change that ousts Hospice of Michigan and others who provide care for terminally ill patients didn’t sit well with some relatives and others.

“It’s a shame it’s come to that,” said Mary Iwanicki, who helps care for her ailing mother, Catherine Suhy, 93, in Honor. “We’ve been very happy with (Hospice of Michigan). ... My mom is slipping away and doesn’t remember as much. So keeping with the same people is better in my mom’s case.”

Munson’s policy could force hospice patients and families into a difficult choice at a very vulnerable time, said Cathy Klemish, Hospice of Michigan’s regional director of clinical services of northern Michigan.

“With Munson being the only hospital facility in the Traverse City area, and one of the few large medical centers in northern Michigan, the effect on patients in these communities is significant,” she said.

Munson officials changed policy in order to provide patients with “seamless care,” said Shari Wilson, president of Munson Home Health, which oversees Munson Hospice.

Munson, she said, is following the industry lead and is behind the curve in Michigan.

Wilson mentioned three downstate hospitals with similar policies. Sparrow Hospital and Henry Ford’s main hospital don’t allow competing hospices, but Henry Ford community hospitals and Ascension’s five hospitals do, said hospital media spokesmen.

Munson’s discharge planners also no longer will provide outgoing patients with a list of alternative hospice organizations, which include Hospice of Michigan and Heartland Hospice Services, Wilson said.

Medicare law no longer requires Munson to do so, although patients can still obtain information from a competing hospice representative upon request, Wilson said.

“If Hospice of Michigan or Heartland had a facility, I don’t expect they would let outside providers come into their institution,” Wilson said. “It doesn’t interfere with patient choice, interfere with care delivery or violate Medicare guidelines.”

Klemish said hospice patients need inpatient hospice care only rarely — only 12 to 15 Hospice of Michigan patients went to Munson in the past year.

Most commonly, a hospice patient needs inpatient care when their symptoms or pain become uncontrollable. They also can be admitted for an unrelated reason, such as broken bones or other injuries.

“They fall, break a hip, and that becomes a chain of events. We had two at Munson within the last three months, where they fell and they both went down very quickly,” Klemish said. “For some who are very debilitated, who are actively dying, transferring somewhere else might not be an option.”

Kathryn Holl, a grief support services manager for Hospice of Michigan, said the new policy doesn’t consider the close bonds patients and families develop with hospice workers.

“To lose that relationship because their loved one went into the hospital and not have them follow with hospice care, that would be very devastating. … There could be a lot of anger,” she said.

Wilson said that scenario is extremely rare. They wouldn’t be taken to Munson, but to a skilled-care, nursing facility, which has contracted in advance with the hospice agency.

Klemish countered those facilities don’t offer 24/7 emergency care.

“If it’s in the middle of the night or on the week-end, long-term, skilled care facilities might not be staffed during those hours,” she said. “Even if it occurs during the middle of the day, during the week, you have to look for bed availability with a facility that says to us, ‘Yes, we feel confident we can provide this level of care for a patient.’”

Wilson believes the real issue for Hospice of Michigan is money. Hospice of Michigan dwarfs Munson Hospice with annual revenues of about $70 million, according to a Guidestar report.

Munson’s palliative care reported revenues of $139,456, with expenses totaling $555,697, according to a 2011, Form 990 federal tax return.

Klemish countered that Medicare reimbursement is the same, no matter where the patient receives care. She met with Munson officials and told them competing hospices bring patients to the hospital.

“What we tried to let them know is when we have our patients there, we are bringing revenue into the hospital,” she said.