Hospice to lose funding

FLORENCE - The Centers for Medicare and Medicaid Services will stop funding A&E Hospice in Florence on Dec. 5, a move that will force the facility to find new hospice care for its patients.

The action comes on the heels of a series of visits since August by members of the survey team from the Alabama Department of Public Health that culminated in a formal four-day visit in October.

Lee Millman, spokeswoman for the Atlanta regional office of Centers for Medicare and Medicaid Services, or CMS, said the termination of funding comes as a result of "A&E's failure to comply with the conditions of participation" in the hospice program.

Among the charges leveled against A&E in the surveyor's 26-page report are a failure to appropriately document patient care.

Rick Harris, spokesman for the state health department, said the findings are a "big concern."

"It's a dead give-away that the people in management are not looking at the charts," he said. "Nurses and caregivers will make charting errors because they are human. It's OK to correct these errors when you do it the right way, but when we see a lot of uncorrected charting errors, then it tells us that there's no systematic chart review going on with the provider, which tells us, in turn, that (management) has no idea what the staff is doing out there."

Although CMS has given A&E 30 days to relocate its patients and while the termination of funding process continues, Harris said there were no procedures in place to revoke the facility's license.

"It's not so much of an urgent matter because once they lose their funding they won't be able to serve many patients, if any," he said.

A&E applied for a hospice license in June 2001 and opened for business in February 2002. The facility is owned by Andy Eddins, who also owns A&E Medical. Eddins said he was notified of the action Nov. 6, one day after the information appeared in The Birmingham News.

"I've been through this kind of thing before, when I had errors, lots of errors to be corrected," he said. "I corrected them, and everything was fine, which is why I'm so surprised by this. But patient care wasn't an issue then, and it's not an issue now."

Eddins said he has notified the patients and their families about the issue, and he said he's sought employment for nurses and other health-care providers on the A&E Hospice payroll.

"We feel like we weren't given a chance to correct these mistakes," he said. "When (the surveyors) were here in October, I begged them to tell me what to do to fix this, and I got nothing."

Millman said there is an appeals process, one that can be taken up with an administrative law judge, and Eddins said he plans to pursue that option.

Although he has not formalized his request, he said it would be filed by next week.

From that point, the judge will have 60 days to make a decision. If A&E wins the appeal, the soonest it could reapply for funding with CMS would be mid January to early February.

Both Eddins and Harris agree, however, that the move by CMS and the action taken by the state health department are largely the result of an overabundance of hospices in Colbert and Lauderdale counties.

The region is served by more than a dozen hospices.

"And we just don't have that many sick people to support all of them," Eddins said. "But why should I be picked on when there are all these others?"

Harris said the volume of hospices comes down to reimbursements. It's one of the few areas in health care that can be profitable for providers.

"Get out your calculator and do the math," he said. "If Medicare reimburses $113 a day, and a hospice cares for just 30 patients, multiply that by 365 days a year and see what you get.

"That's a huge cash flow for a provider not giving housing or meals."

Michelle Rupe Eubanks can be reached at 740-5745 or michelle.eubanks@TimesDaily.com.