Hospice Owner Fights Rising Medicare Debts

Unfunded Congressional Mandate Sticks Hospice Owner Bobbie Fleming With $3 Million Bill

(CBS)  Registered nurse Bobbie Flemming drives about 1,000 miles a week around the Mississippi Delta, making dozens of house calls.

But Fleming, a hospice owner, is not out to save lives. Her goal is to help her terminally ill patients die in peace, by offering, as she says, "Just a small amount of comfort and compassion on this end-of-life journey."

But there's a problem: 11 years ago, Congress mandated that terminally-ill patients are entitled to unlimited hospice care - but Medicare only pays the hospices for six months' worth, CBS News correspondent Thalia Assuras reports.

So when the federal government realizes its been paying for people like throat cancer patient Willie Ross for well over six months, Medicare demands its money back - plus 12 percent interest.

Flemming's current bills show she owes more than $3 million.

She says whatever funds she has go to purchasing drugs, buying medical equipment and paying staff salaries. And she has no intention of denying her patients treatment.

"I'm not the one to say because you're not dead, I'm just going to dump you," said Flemming. "It's not in me to say that."

Medicare declined to comment to CBS News, citing a lawsuit on the issue. But it has offered Flemming a choice - either pay up or declare bankruptcy.

"I've always done the right thing about end-of-life care," said Flemming. "I'm going to continue to do it and someone is going to eventually hear this."

Flemming recently took her case to Capitol Hill with other hospice owners, asking Congress to freeze their debts until it can come up with a way to pay for extended hospice care.

Until then, Flemming said she's not going to play God by turning away patients just because they don't die on schedule.

[grammawhamma]

I "used" to work for a Catholic run hospice program. The way they got around this was to start upping the morphine doses before the six months were up. The patients that were allowed to linger longer were those who had substantial wealth and paid their own way.

[bcanipe]

This is just like all other goverment programs, people will try to "work" the system and this only hurts the people that need the help. Remember a rotten apple spoils the whole basket.

[unicorn261]

I think having worked for Mrs.Flemming, Hospice is a wonderful thing for the terminally ill patients who truely need it, but if her patients are carefully evaluated you will see that many of them don''t qualify for hospice. They will let you know that they are there for a free ride. They will tell you that there''s nothing wrong with them they are just on it for the free medication. Now you tell me, is that really hospice appropriate?

[dbrazeal2]

dbrazeal2 Continued:

Shame on the hospices who aren''t standing up for the rights of those who continue to be eligible for their hospice benefit, yet haven''t died within an acceptable financial timeframe. We should ALL be standing together in this horribly financially devestating time for any single hospice over cap, much less the numbers reported from 2005. Our common sense should tell us that statistics from 2005, are only bound to foretell of future cap problems for many more. So...if you are not discharging eligible patients, and you are billing for every patient you have on service...tell the truth...how long before you have a cap problem?
Let''s all support the PATH bill and let our legislators know that we are united in focusing our efforts on the quality of care for those we serve, and want to stop, thru the Moratorium (PATH) the quarrelling and arguing, which is distracting us as an industry.

[dbrazeal2]

I own and operate a hospice in Tulsa, OK. I appreciate CBS''s coverage of this very important and daunting situation. It is important, to at the very least inform the public regarding this "cloud" over the end of life benefit which we have all paid for and should expect to be available when we reach the point of medical eligibility...without worrying about "out living" our benefit.
The Senators and Congressmen who sponsored the PATH Bill are to be commended for taking the time and making the effort to understand the end of life needs of their constiuents. Too many time our legislators "land their jobs" and then forget who they represent.
(Continued)

[gcmc1]

Great show on Hospice! My mother is on Hospice and this story really needs to be told so that Hospice Care in rural areas can survive.

[capt_rich]

Having worked for Mrs. Flemming, I think if they carefully evaluated her current and past patients for meeting the guidelines for hospice, it would become clear why she is having a problem with Medicare Cap.

[rememberme51]

Having been a Hospice Nurse for 11 years now, I fully understand the "cost" of the cap which weighs heavily on us all. I am blessed to now work for a company who does the right thing despite the monitary cost. It is unfortunate that many of our patients who are truly appropriate and who meet qualifications to receive Hospice Care have come "discharged" from other Hospices who have kept them as patients long enough to cover cap costs, but then have "dumped" them with few options after they failed to die in 6 months or less. The "cost" of caps is measured in much more than dollars. How demeaning and undignified it is to cause undue worry on families who are already suffering tremendously! I pray that when the time comes for me to need Hospice Services I wont have to worry whether or not I will be cared for after my alloted 6 months are up! The alternative of dying in the hospital at twice the cost to the government in an unfamiliar setting without all of the people I care about around me is less than appealing.

[serenity394]

We at Serenity Hospice are in agreement with other Hospice Agencies as related to PATH ACT and feels no one should be denied care or hospices denied payment because of a flawed law many years ago that didn,t get revisited.Patients are entitled to end of life care regardless of length of time to one''s eternity which can only truthfully be decided by one and his name is jesus.

[serenity394]

We at Serenity Hospice are in agreement with other Hospice Agencies as related to PATH ACT and feels no one should be denied care or hospices denied payment because of a flawed law many years ago that didn,t get revisited.Patients are entitled to end of life care regardless of length of time to one''s eternity which can only truthfully be decided by one and his name is jesus.

[jessidawn87]

Myself and all of the empolyees at the hospice i am empolyed at will agree with Bobbie Fleming. It isn''t easy to take away the help you have provided for a patient just because they have lived to long. This is exactly what medicare expects hospices to do. I hope that the decision of congress will benefit hospices so that many hospices, including ourself, will be able to continue to provide the care that our staff gives to our patients.

[chasdh]

Hospice is a wonderful program and I have seen it help many people. I love my job with hospice and I dislike seeing a hospice punished for doing the right thing and taking care of a terminally ill person. It is wrong to punish the patient, their family and the hospice that provides the service just because medicare feels that they should die in six months or less. If a patient continues to meet the guidelines then they are eligible for hospice. I think that if medicare is going to give a patient unlimited time on hospice then the hospice should be able to bill and keep the money for which they bill. Hospice provides a terminally ill patient with nursing care, a home health aide, spiritual counseling, a social worker, and different types of therapy, along with providing all medicine that is related to the terminally diagnosis all medical supplies and equipment that the patient needs. The money that is paid to the hospice by medicare is put to good use and is spent wisely. I think by making hospice pay back money that some people will let their patients go at the end of the six months because they dont wont to be penalized and have to pay back large amounts of money, then that leaves the patient out in the cold with no help which is wrong. I hope that medicare will think about what their doing and if they need to cut back spending that they will find another area to do so not one that is so important and needed by so many people.

[jgodwin5]

VASOCWKR---YOU ARE AN IDIOT!!!Medicare does not look at a case by case basis to see if patients were appriate. You can have 100% appriate patients with great documentation to that affect and medicare''s going to day "so what, pay us our money back." It''s a numbers game to them.

[jgodwin5]

It''s not hospices with a CAP problem that are doing something wrong. Many hospices don''t have CAP problems becuasue they discharge patients after 6 months if they don''t die. Some tell patients that Medicare only covers 6 months of service and others just admit "to soon" and discharge quickly to "steal the CAP." If you really understood CAPs you would see that the people with CAP problems are doing the right thing...taking care of people that qualify for hospice until the day they die. That may be in 3 months, six months, or maybe a year, but it''s on God''s timetable. Keep doing the right thing and it will payoff in the end.

[l7201613]

Everyone is entitled to their own opinions. I work for this hospice as a office manager and know for a fact that paperwork is filled out correctly because you cannot bill for any services without proper documentation. Trust Me when I say Ms. Flemming is a "stickler" when it comes to accurate documentation and proper procedure of rules and regulations. She not only has compassion for her patients she has it for her employees. Government is trying to calculate death timetables and there is no such thing. We all know only one person holds all the markers when our time is up. Many hospices in our areas have closed and left employees without pay. Although Medicare has put this burden on Ms. Flemming we have continued to work and receive our payroll. At times it has been late but nevertheless we received it and she hasn''t thrown her patients or employees out on the street. Continue the fight Ms. Flemming you will be blessed many more times than the government has control over. The government should quit changing the rules when they run short on money. These people have paid their hard earned dollars and deserve respect and dignity until their days are over here on earth. Thank you for the job and the opprotunity to work for such a dedicated company. sign me a Laurelite

[prohospice]

Reponse to neg1920 - yes there may be hospices that don''t have CAP issues right now, but what about the many hospices that ARE having Cap issues and that are going out of business because Medicare has sent them a bill DEMANDING payment for millions? I don''t see how it''s right for Medicare to request that Hospices pay millions of dollars back to them. This money has been spent on patient care!! I agree with darnedsocks maybe our gov''t should stop caring so much about the illegals in this country and focus on our aging citizens!

[prohospice]

Reponse to neg1920 - yes there may be hospices that don''t have CAP issues right now, but what about the many hospices that ARE having Cap issues and that are going out of business because Medicare has sent them a bill DEMANDING payment for millions? I don''t see how it''s right for Medicare to request that Hospices pay millions of dollars back to them. This money has been spent on patient care!! I agree with darnedsocks maybe our gov''t should stop caring so much about the illegals in this country and focus on our aging citizens!

[peanutsgigi]

The cap is not about a few providers admitting ineligible patients as some would insist. It is a provider regulation that is now inconsistent with an eligible patient''s unlimited benefit. The CMS change to the benefit in 1998 created a different picture of the typical hospice patient--no longer short stay cancer patient. CMS began to actively promote hospice in 2000 and last year the Duke Study confirmed that hospice is "the rare situation whereby something that improves quality of life also appears to reduce costs.%u201D As a certified hospice and palliative care RN, I am glad that the hospice that provides care for my 106 year old grandmother in another state has not chosen to "manage" their cap by discharging a clearly eligible patient because she has lived too long. Thanks for bringing the issue to a very public forum for discussion.

[dcforhospice]

I also work for Hospice in rural Oklahoma. It saddens me to see how this issue has become so divided. I have often asked myself who will care for the dying if we can no longer afford to stay in business. Our hospice has hit the CAP and has had the courage to also stand up for what we know to be right and in the best interest of those dying. Just this week I went to a patients funeral and was reminded how each moment is cherrished for families we serve. Many wish for more time they do not have and would be saddened to see that living more than Medicare allows has put such a burden on the hopsice that served them. I think until you have walked in a patient or families shoes how can you know how important one more day, week or month of life be when hospice has improved the quality at less cost to the government. I truly feel blessed every day knowing we do the right thing. Yes we have patients who get well enough to no longer need our service and we rejoice at those moments. Sadly most die, with some taking longer than Medicare allows. I applaud CBS for featuring the human side of death that may some day become lost if we do not stand up for those dying. After someone dies do we still hear their need? All some hear is silence and continue on. It would be great to get the story from the hospice patient faced with their hospice closing because Medicare does not hear the need because they did not die soon enough.

[darnedsocks]

THIS IS B.S.! MEDICARE NEEDS TO PONY UP AND PAY FOR END-OF-LIFE HOSPICE CARE FOR THE TERMINALLY ILL UNTIL THEY CROAK! IF MEDICARE WANTS TO SAVE MONEY, PERHAPS THEY SHOULD MAKE SURE THEY ARE NOT PAYING FOR THE CARE OF "ILLEGAL IMMIGRANTS"! THAT WOULD SAVE BILLIONS!