Dr. David Tribble

An article appeared in The Tennessean newspaper recently in which for-profit, corporate hospice care was presented as the rational maturation of the hospice movement which was pictured as evolving from small “mom-and-pop” nonprofit agencies to large corporate for-profit entities.  The intimation was that the corporate environment was more efficient, more capable.

Indeed, hospice care has changed greatly:

• We have ongoing clinical research which allows us to apply real data to our decision making in terms of efficacy of interventions, prognosis in various diseases, and such.
• With the advent of the Medicare Hospice Benefit, agencies that had to struggle to provide minimal care on donated dollars now can provide sophisticated end-of-life care involving the use of complex treatments the originators of hospice in America never had available.
• Hospice and Palliative Medicine has achieved recognition as a subspecialty for physicians, with a certification process now approved by the American Board of Medical Specialties.
• There is now good information that hospice care is not associated with earlier death, but rather with better survival.

It occurs to me that this maturation of hospice care only matters if it remains attached to a sense of MISSION. It is, in fact, the dedication of those early hospices to the mission of compassionate, capable end-of-life care that gave rise to these maturational changes.

There are large nonprofit hospice agencies, which have grown out of those early days, that provide the same efficiencies, economies of scale, and mature care models ascribed to the corporate entities while maintaining the focus on mission. I am proud that Alive Hospice is one of them.

In their book First Things First, authors Stephen R. Covey, A. Roger Merrill and Rebecca R. Merrill tell us, ”The main thing is to keep the main thing the main thing!” In hospice care, the main thing is still compassionate, capable end-of-life care for all who need it.  Whether organized around a for-profit or a nonprofit model, the measure of any hospice is its willingness/ability to keep the delivery of quality end-of-life care as its main goal: to keep the main thing the main thing.

Dr. David Tribble is Alive Hospice’s chief medical officer.