On June 27, the Tennessee Health Services and Development Agency voted 7 to 3 to grant my CON for Hearth Hospice to serve Hamilton, Bledsoe, Bradley, Marion, McMinn, Meigs, Polk, Rhea, and Sequatchie Counties. It will be the first physician-owned and operated hospice in this area.
Hospice and palliative care are very personal to me. They have become my life's work and my passion.
Hospice has become big business to many, and the leadership of the local $30million+ nonprofit are paying big money to fight the area’s only physician-owned hospice practice. Hearth, LLC is 100% owned by a local doctor passionate about each individual experience of hospice patients in her hometown. Please let the Hospice of Chattanooga Board members know that you would like them to stop fighting my efforts, and put that money towards care of patients.
After many years of trying to provide personalized care within the policies and procedures of larger organizations, I believe that a small hospice provider owned and operated by a physician, can provide the most personalized care. The best organizational structure is the one that puts the fewest obstacles in the way of what needs to be a very close relationship between the patient and the providers.
Earlier this year, I formed my own small company called Hearth, LLC and began the Certificate of Need process to be able to practice hospice as an independent physician in Tennessee.
Most states do not require a Certificate of Need (CON) for a home-visiting hospice: it requires no state resources, and hospice has been demonstrated to save Medicare dollars. I successfully made the case for the need for more hospice care in this area and laid out my plan for providing it in innovative ways. I was humbled by the more than 150 physicians, elected officials, hospice staff, and families who wrote letters of support. These letters are public and available for review.
In 2007, an independent Robert Wood Johnson Foundation-funded study by Duke University found that hospice reduced Medicare costs by $2300 per patient, amounting to more than $2 billion in savings per year. Overall, these patients and families had a higher satisfaction and quality of life. More Medicare money is saved the longer they are under the Medicare hospice benefit, and a 2010 study published in the New England Journal of Medicine showed hospice and palliative care improves survival and quality the earlier it is introduced for patients with advanced lung cancer.
The Medicare Hospice benefit is intended for the last 6 months of life, however the median length of stay is less than 3 weeks, indicating a need for a new, innovative provider. Current providers are paying lawyers to argue that the area does not need more hospice capacity; however, based on the limited 2-3 weeks most patients experience the Medicare hospice benefit of an in-home, interdisciplinary home care team, I believe there is room in this growing market for all hospice agencies to grow and improve together.
Hearth will also address the largely unmet need for physician home visits for chronically ill patients who are not sick enough for hospice care. Many homebound and debilitated people are not eligible for hospice care but are too sick to travel. Many very sick people make a lot of trips to the Emergency Room in ambulances because they are too frail to ride in a car and they do not have physician home visits. That's hard on them and very expensive.
I will also take steps to assist hospice employees in staying healthy, including mandatory vacation and emergency day care. This is incredibly stressful work, perhaps the most demanding area in health care because it is so high-touch and staff members become attached to patients and families. We have to take care of employees, too, so they can keep on doing this work.
I am grateful to all those who supported me during this process and so deeply humbled to serve these vulnerable patients and families. Hearth Hospice will strive to meet physician, patient and community expectations in the way we conduct our business and the care received.
I have been a full time hospice and palliative care physician since I left Sale Creek Clinic in 2001. I am board certified in both Family Practice and in Hospice and Palliative Medicine. I am on the National Research Committee of the National Hospice and Palliative Care Organization, and the Public Policy Committee of the American Academy of Hospice and Palliative Medicine. I hope to form a collaborative effort with other hospice agencies in our area to organize and expand non-reimbursed and indigent care services. I grew up in this community and I want to make things better within my area of expertise.
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