Hartline works to raise census following review

by Karen E. Culp

SBJ Staff

Hartline Hospice will build its patient census numbers back up to 43, the break-even point for the company, in about 60 days. That was the message the company sent to the U.S. Bankruptcy Court Feb. 4.

Hartline Hospice filed for protection from its creditors under Chapter 11 of the U.S. Bankruptcy Code Dec. 15 after a focused medical review, administered by Medicare through its intermediary, Wellmark, constrained the company's cash flow, said Mark Fitzsimmons, attorney for Hartline Hospice. The company entered into a "standard cash collateral agreement" in court Feb. 4, Fitzsimmons said.

"Basically, the company is allowed to spend up to an amount in the budget agreed upon by the bank and Hartline Hospice. The time we've allotted is 60 days," Fitzsimmons said.

During that 60 days, Hartline will be able to increase its average daily patient census from its current 26 to 43, Fitzsimmons said.

Prior to the focused medical review, the hospice's census was holding at about 106, Fitzsimmons said. Once the focused medical review began, Medicare withheld payments to the company that accounted for approximately 52 percent of its income. The restraint on the company's cash flow eventually forced it into Chapter 11.

Hartline Hospice was notified by mail Feb. 2 that it had been released from focused medical review as of Dec. 31, said Dottie Hart, a registered nurse and vice president of development for the company.

The procedure during the review was for Medicare to withhold payment for a given patient chart until its own personnel had reviewed the information. In the beginning, the hospice was registering at about a 56 percent denial rate, which dropped back to 10 percent after a few months. (The company was on review for a total of nine months.)

The denials were all based on simple errors, Hart said, such as a missed date beside a doctor's signature. Once the percentage dropped, the reviewers began requesting old files and using newly-imposed standards to evaluate those files, Hart said.

"They would look at a file from April, and use new standards they'd adopted in August to review that file. We were being held to standards that weren't in place at that particular time," Hart said.

The most disconcerting aspect of the focused medical review was that Medicare sent letters to Hartline's patients informing them that the company was "being investigated for fraud," Hart said. Patients were advised to consult friends or other health care professionals, but not hospice officials.

"Our dying patients were getting letters that were saying we were being investigated. Those letters told them not to ask the health care professionals who were with them daily, making them comfortable, holding their hand, but to ask friends, neighbors, anyone else about what this means," Hart said.

A 40-year veteran of the nursing profession, Hart and her husband, Richard Hart, formed Hartline Hospice in 1992. Their daughter, Kristen Hart, is working in accounts payable for the company while she completes her degree at Drury College.

"My parents are in their 60s. They've invested their life savings into this company, everything they had," Kristen Hart said.

Hartline Hospice is making slow progress toward its goal of raising its census to 43 within two months, Dottie Hart said.

"We're having to fight a reputation now. We have no intention of not paying our bills. I've always paid my bills, and I come from a long line of people for whom that was very important," she added.

The company is still owed about $200,000 from Medicare on patient charts that are either still in review or under an appeal, Hart said.

"What has happened to us is not a result of mismanagement on our part. We have always provided quality hospice care. That's what we came here to do and what we are still doing," Kristen Hart

said.

The Harts were also principals in another company, RS2DJ, which owned a tract of land and some of the office equipment it leased back to Hartline Hospice. The property was sold prior to the bankruptcy in order that those funds be invested in the business while it was struggling for cash flow under focused medical review, Fitzsimmons said.

During the nine months it was under review, no fraud or abuse was uncovered, Dottie Hart said. The company was not offered any reason for being placed on the review, other than the selection was random, she said.

She added that the reviews in the Midwest are the second round of reviews which began in five other states: California, New York, Illinois, Florida and Texas. Those reviews did not involve suspension of cash flow, Hart said.

"We need to get our census up and make people aware that we're still providing the same comfort and care. That never stopped," Kristen Hart said.

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'What has

happened to us is not a result of mismanagement

on our part...'

Kristen Hart

Hartline Hospice[[In-content Ad]]