Healthcare • Missouri Hospice and Palliative Care Association

In 2011, with the Great Recession in full swing, Jane Moore met with the chairperson of Missouri’s healthcare budget. Moore is the CEO of the Missouri Hospice and Palliative Care Association (MHPCA), and the Missouri statehouse was looking to cut costs by reducing Medicaid payments to hospice facilities. Moore believed that hospice care was more affordable than hospitals, and she tried to make her case.

“I’ll never forget the conversation,” she says. “He looked me dead in the eye and said, ‘There are many good causes that need funding, but I don’t want to hear a heartstring story. You’d better tell me how you’re going to save the state some money.’”

So, Moore figured out how to do the telling. In 2012, MHPCA began contacting the state’s Medicaid director for data on its expenditures on end-of-life care in hospices and hospitals. She met with a lot of stonewalling. Moore heard of similar resistance among her colleagues in other states. But a year after that statehouse conversation, Moore made headway by explaining the narrow focus of her research. Also, she was stubborn.

“I just kept coming back and coming back. I would not go away, like a bad penny,” she says. “Finally, the director for Medicaid sent me an email, saying, ‘OK, this is what we’ll give you.’”

MHPCA didn’t actually know if the numbers would show that hospice care saves Medicaid money. But indeed it did.

Moore didn’t actually know if the numbers would show that hospice care saves Medicaid money. But indeed it did: The 2011 data that MHPCA accessed showed that patients under hospice care incurred costs that were 45 percent lower than those in hospitals. A follow-up survey using 2012 data delivered similar results.

Since then, MHPCA has been using its findings to preserve Medicaid funding for hospice care in Missouri. And there’s a twist: Everybody else is using the data too. With other states’ Medicaid offices still reluctant to release data that would allow for comparisons between hospices and hospitals, The Missouri Hospice Medicaid Study has proven to be an essential document for other organizations around the country making similar lobbying cases to legislatures.

Missouri’s position as a state that’s neither too wealthy nor too poor makes their data a helpful example, Moore says. “People can say, ‘If Missouri does that and they’ve been able to save this much, think of what we could do.’”

Now, with state legislatures looking to trim budgets yet again due to the economic fallout from the coronavirus pandemic, Moore is preparing to reargue her case.

“We worry about doing it again, because it’s all about how the stars align,” she says. “The data will have to come from the Medicaid director, which changes all the time, and we’ll have to go through the same processes we did before. But the thing we have going for us if we do it again is the fact that they did it one time for us, two years in a row. There’s more of a possibility of us getting it than anybody else out there. We have the best chance.”

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