On May 28 Hospice of Martha’s Vineyard and Hospice & Palliative Care of Cape Cod (H& PCCC) announced an alliance that will bring expanded hospice services to Martha’s Vineyard while preserving the traditional role of Hospice. This letter is an effort to set forth my personal feelings and the board’s rationale for this innovative undertaking.

For 28 years, Hospice has served the Island as a hospice licensed by the Commonwealth of Massachusetts, giving all nursing, social, spiritual and volunteer services without charge. Periodically, we have reconsidered our initial decision not to seek Medicare certification. To date, we have always chosen not to be regulated by the rules that insurers impose.

The most objectionable of the insurer-imposed rules is that a Medicare-certified hospice that receives insurance reimbursements may not provide free care to patients who do not meet their hospice eligibility requirements. Hospice has traditionally given free care to everyone, including people who would not be eligible for insurance benefits. Our Hospice board and staff have been and continue to be unwilling to discontinue giving free care, believing strongly that hospice services should be available at the time of patient need, not just at the time of insurance eligibility.

The extent of any financial benefit from insurance varies from patient to patient. Typically, our patients have regular health insurance coverage that pays for medicines, doctors’ visits and some medical equipment such as wheelchairs or hospital beds. In those cases, our hospice patients are responsible for co-payments. In contrast, the hospice Medicare benefit eliminates those co-payments and covers all services, medications, equipment, supplies, treatments and therapies related to the terminal diagnosis.

Last spring we did one of our periodic reviews and contacted H& PCCC to inquire about both the advantages and restrictions relative to Medicare certification. We again confirmed that the provision of all medically appropriate services can be very expensive, and since insurance pays only a fixed per diem rate, certification represents a significant financial risk to a small organization like ours. With our case load of 60 or so patients a year and our unique Island location, we believe that we could not afford to provide all the services that we want to give. Again, most importantly, we would not be allowed to be both Medicare-certified and to provide free care to our patients who are not eligible for the hospice Medicare benefit. This would have forced us to deny care to patients whom we now are able to serve. So once again, we reconfirmed our decision not to seek Medicare certification.

On a personal note, I was skeptical about Medicare certification since when my husband was dying of cancer, a Medicare-certified hospice would not serve us because he was taking palliative treatment. The staff at H& PCCC explained that all Medicare-certified hospices are able to determine their own philosophies of care and related admission criteria. H& PCCC’s philosophy is to serve patients regardless of the complexity of their care needs or the related costs of such care. As an example, they routinely provide for palliative treatments and interventions such as chemotherapy, radiation, blood transfusions, artificial nutrition and hydration — whereas many hospices are not able to or choose not to do so.

After reviewing all the issues, the boards of Hospice and H& PCCC decided to enter an alliance, bringing to the Island Medicare-certified hospice services and the associated hospice funding. H& PCCC has a large enough patient base to make it economically feasible to offer a full range of services to the Island. Importantly, under this alliance, Hospice will continue to operate independently, offering its services for free.

The Vineyard Nursing Association asked us to merge with them when they become a Medicare-certified hospice. We have always worked collaboratively with VNA and honor their commitment to our Island community; however, we believe that the low number of patients on the Island would make it financially impossible to offer the full range of services. Additionally, a merger with VNA would have prohibited us from offering free care to those who either are ineligible or choose not to access insurance benefits. Our collaboration with H& PCCC enables us to continue to offer the free care that is our hallmark.

With our new alliance, Hospice will continue to be a distinct organization, and will continue to provide care from the day of diagnosis for free. When patients become eligible and want the extra services that a hospice insurance benefit offers, they will have the choice to receive care from H& PCCC or any other Medicare-certified hospice provider.

H& PCCC will be offering employment to Hospice staff and, as necessary, will supplement staffing by hiring on the Island. To meet their own patient care needs, Hospice will contract with H& PCCC for clinical staffing. This approach will enable continuity of care for those patients cared for by Hospice who elect the hospice insurance benefit through H& PCCC. There need be no change in the Island-based care team.

Many patients will continue to seek our help from the moment of diagnosis, before they would be eligible for a hospice insurance benefit. We will continue to provide services to them at no charge. In addition, we will continue to offer bereavement services to everyone on the Vineyard, whether they have benefited from hospice services or not.

Hospice has been a vibrant part of our community for some 28 years. We are fiscally prudent and financially sound. We are proud of this new alliance which will bring expanded hospice services to our Island. Hospice will continue to work with the community and will continue to seek support from you, our friends. We thank you for your past support and look forward to a continuing relationship.

If you have any questions or comments, please feel free to call Terre Young, our executive director, at 508-693-0189.