The aging baby boomer generation is serving as a natural business lead for hospice care providers.
But while several Missouri companies want to jump at the chance to meet demand, the government is trying to slow the industry's rapid growth - and the state is caught in the middle.
According to the Missouri Department of Health and Senior Services, the federal government is worried that too many hospice providers are entering the fray and has asked states to temporarily halt licensing for new hospice offices, pushing the state into an industry tug-of-war.
Kansas City-based Omega Health Care Inc., for instance, is ready to expand into southwest Missouri, but the state last month said it would not offer an additional license for the two-year-old company's hospice care - services for terminally ill patients that allow them to remain at home during their last weeks.
In late January, DHSS gave notice to Omega Health Care - and other hospice companies with expansion applications under state review - that new hospice certifications were temporarily on hold. Department spokesman Kit Wagar said the state is following a 2007 federal request to restrict new hospice operations because government oversight and funding were slipping. The request, made by the U.S. Centers for Medicare and Medicaid Services, also applies to hospitals, ambulatory surgical centers and home health agencies.
Boomer demands
U.S. Labor Department data is eye-opening for hospice and home health agencies. The Bureau of Labor Statistics estimates that the number of people 65 and older in Missouri - currently at almost 800,000 - will increase by nearly 500,000 between 2010 and 2030.
"The older baby boomers are starting to reach their late 60s and early 70s, and as that age group continues to mature, the need for in-home care is going to continue to rise," said Omega Health CEO Russ Rogers, whose company offers nursing care, home health aides, and physical, occupational and speech therapies in conjunction with hospice. "Our plan is to have offices all across the state of Missouri ... to meet the growing need."
Omega Health through its three existing Kansas City-area offices has grown from the six employees and six patients it started with in 2007 to 50 employees and 135 patients today. The company plans to add three offices across the state, in Marionville, Columbia and St. Joseph.
For the planned Marionville office, Omega Health already has lined up staffing and is advertising in the 2008-09 Shepherd's Guide Christian business directory. Company officials said their plans had the green light from the state last year.
According to Wagar at DHSS, through part of 2008 Missouri was the only state still certifying new hospice companies, and Gov. Jay Nixon's administration began enforcing the federal request this year.
While acknowledging that demand for hospice services will grow, Wagar said the state is confident there are currently enough services to meet the need.
"We've never had a call that people seeking (home health) services couldn't find anybody to supply them, especially hospice," Wagar said. "The question then becomes, what about in 10 years or 15 years?"
Wagar said DHSS is in the midst of a study to answer that question.
Dealing with growth
A review of DHSS records shows that five hospice companies in the Springfield metropolitan statistical area, representing five local offices, received initial state certifications in the last four years, in addition to five already operating in the area.
"The impression our department got was that there was starting to be an overexpansion in the industry, people going into this and providing services that weren't even demanded," Wagar added. "The cost of paying for the care was going through the roof, and I think (CMS was) looking for a way to slow down the growth."
An internal report in April 2007 serves as the basis of CMS' stance and prompted its letters to the state health departments. The report revealed a void in government oversight in noting that 46 percent of hospices surveyed were cited for health deficiencies, and many of those issues were related to patient care. Additionally, the CMS report stated that its budget for Medicare survey and certification - the process of certifying new and existing companies to provide Medicare services such as hospice - has been below requested levels since 2005, while the number of hospice providers has grown by 37.4 percent between 2002 and 2007.
In response, CMS asked states to reprioritize their work with Medicare-certified health care providers in this order: reaccreditation requests first, followed by complaint investigations and then new business certification.
CMS spokespeople say the agency's prioritization remains in effect. The agency also notes that hospice companies have the option of paying a private accreditation company to certify their business rather than waiting for the free state services; companies that have received private accreditation are higher on the agency's priority list.
Omega's Rogers said that the company had considered the private route but was told by the state that they still would be on hold to receive state approval.[[In-content Ad]]
