Hospice hearing draws a crowd

Nonprofit's application for inpatient center finds criticism and support




A public hearing Tuesday on granting a certificate of need for what would be Clark County’s second inpatient hospice center drew a crowd of nearly 100, mostly employees of two hospice providers at odds over the need for the proposed facility.

The hearing focused on whether there is enough demand for inpatient hospice care to justify construction of a 15-bed hospice center at 3100 N.E. 136th Circle in Salmon Creek. The main opponent to the project is nonprofit PeaceHealth Southwest Medical Center, owner of Clark County’s only hospice center, Ray Hickey Hospice House, 2212 E. Mill Plan Blvd., near downtown Vancouver.

Community Home Health & Hospice applied to the state Department of Health for the certificate of need. A decision will take about two months.

The nonprofit hospice provider contracts with Ray Hickey House to serve Clark County patients who don’t want to or can’t remain at home or travel to the provider’s hospice center in Longview in Cowlitz County.

The majority of Ray Hickey House patients come from PeaceHealth and Kaiser Permanente.

The proposed $2.4 million hospice center would serve Community Home Health & Hospice clients in Clark County. It also would include offices for the nonprofit’s other Clark County operations, including home health, in-home hospice, private-duty home care and grief support.

Community Home Health & Hospice claims its existing Clark County client base provides enough demand for the proposed center. Need for beds will only increase as the senior population continues to burgeon in the next 20 years, said CEO Greg Pang. Construction of the 40,000-square-foot building would be phased in, with 10 beds opening in 2013 and five additional beds in 2016.

Administrators with PeaceHealth Southwest say data don’t back up Community Home Health & Hospice’s claim. The nonprofit health group submitted a position paper to the health department refuting claims in Community Home Health & Hospice’s application for a certificate of need.

“Our basic position is the numbers in their application bear little resemblance to their own data that is publicly available,” said Marc Berg, PeaceHealth Southwest hospice director. “When their application is repopulated with their actual numbers, they fail to meet (Department of Health) criteria for approval of their application.”

PeaceHealth Southwest claims that Community Home Health & Hospice inflated its projections for occupancy and for revenue.

“The net revenue is grossly overestimated,” said Bill Swanger, budget director at PeaceHealth Southwest. He did an analysis of the project and concluded that Community Home Health & Hospice would see $800,000 in losses to operating costs.

PeaceHealth Southwest administrators say they’re concerned opening a second center could cause financial ruin of both facilities given low demand for inpatient services.

“The ultimate harm we hope to prevent is having two failing hospice (inpatient) facilities in the community,” Berg said. “If that happens, we all lose.”

Ray Hickey House often has empty beds, said Sonjia Hauser, Ray Hickey clinical manager. The 20-bed facility was at an average of 70 percent of capacity in 2010. It was full just three days out of 2010, Hauser said. She said there is room in the existing center for Community Home Health & Hospice’s clients.

Other speakers disputed that statement.

Dr. Melissa Goebel, a palliative care physician at Legacy Health in Vancouver, said she has had cases when there were no beds at Ray Hickey House.

“There is often a small window of opportunity to transport them safely (to a hospice house),” she said. “We often miss that window of opportunity, and the patient dies in the hospital.”

Palliative care is trending toward in-home care rather than inpatient care, said Gail Haskett, a Vancouver gerontologist and member of the state Council on Aging. That trend may offset the growing senior population that Community Home Health & Hospice is counting on to keep beds full, Haskett said.

“People want to stay at home, and they want to die at home,” Haskett said.

Pang dismissed such concerns. “We’ve seen our agency grow by 500 percent in the past six years, and Southwest Hospice has grown by 112 percent at the same time,” Pang said. “There is clearly room for multiple growing hospice providers in Clark County.”

Vancouver resident Dan Herman said he liked the idea of having a choice between two hospice centers.

Community Home Health & Hospice collected 500 signatures on a petition in support of the project and submitted that to the health department.

Analyst Karen Nidermayer with the state Department of Health took 30 comments and 32 questions from attendees during the nearly four-hour hearing.

The health department is expected to make a decision April 23. The department will consider a formula that calculates need based on Community Home Health & Hospice’s existing client base as well as accessibility and availability of hospice in the community. Nidermayer said the weight of each factor is at the discretion of the health department.

On the Web: To see an earlier story, visit http://www.columbian.com/news/2011/oct/30/peacehealth-challenge-rivals-bid-hospice/