A local doctor has applied for a certificate to open a hospice in the Chattanooga area, citing a need for additional services and research for hospice patients.
But other local hospice providers and some doctors have written letters to the state, asking that the certificate be denied because the area doesn't need another hospice.
Hospices provide end-of-life care outside a hospital, often for terminal cancer patients. A doctor must state that a person only has about six months to live for Medicare to pay for hospice care.
Dr. Deanna Duncan filed a hospice application in March with the state Health Services and Development Agency, asking for approval to open Hearth LLC on Rossville Avenue. The nonresidential hospice would serve nine Tennessee counties and is projecting to serve 76 patients the first year and 212 patients the second.
Duncan, who previously worked for the nonprofit Hospice of Chattanooga, said she decided to open the new hospice to provide quality care for residents in the area.
"Chattanooga is my hometown, and this community is very important to me," Duncan said. "I know how important it is to provide consistent quality care; it impacts the families forever."
Officials with Hospice of Chattanooga, the largest hospice provider in the area, said they plan to attend the hearing to oppose the application.
"We do not think there is a demonstrated need for another hospice provider in the area," said Garry Mac, spokesman for Hospice of Chattanooga.
In addition to Hospice of Chattanooga, there are at least five other hospice providers in the area, according to the Tennessee Department of Health database.
The state agency's board meets once a month to approve or deny certificates and will hear Duncan's application petition June 27.
More than a dozen letters in support of Duncan's hospice have been sent to the state agency and almost that many letters against it. Jim Christoffersen, general counsel for the Health Services and Development Agency, said the board will read carefully the application for a certificate, allow both sides to present their arguments and then make a decision.
Exactly how much hospice care is needed in an area can be difficult to assess, some experts say, especially since both hospice providers and demand for their services have seen a dramatic growth in the last decade. Not only is the nation's population aging, but more people now seek hospice care.
According to a congressional report given by the Medicare Payment Advisory Commission in March, the supply of hospices increased 53 percent from 2000 to 2010. Medicare expenditures, which cover the majority of hospice services, increased from $2.2 billion to about $13 billion during the same time period, the report showed.
Most of the growth has been in the for-profit hospice arena, the report noted.
Hospices also have seen a shift in patients, with the number of noncancer patients increasing.
Tennessee has followed national trends, with an increase in both hospice patients and providers, said Mike Dietrich, executive director of the Tennessee Hospice Organization.
"The numbers have gone up substantially in the last decade," Dietrich said. "As a whole, we generally have an adequate number of hospices in the state."
The state agency received two hospice applications in 2011, and both of them were heard in March. The application for Bristol Hospice, which included services to several counties surrounding Chattanooga including Bradley, Bledsoe, Meigs, Marion, Rhea, McMinn and Sequatchie and others further northeast, was denied. An application for a hospice in Cheatham County was approved.
The application for Duncan's Hearth hospice points out that the Chattanooga area has a higher than state average of elderly. The city ranked ninth in the nation for having the highest percentage of people age 65 and older, according to a 2011 Brookings Institute study.
The application also argues that the "Guidelines for Growth" formula used by the Health Services and Development Agency is no longer adequate for the area's population. The formula shows there are fewer hospice patients in the area than are now being served by the existing hospices, the application notes.
The state formula emphasizes the number of cancer deaths and doesn't take into account the increase in hospice use by noncancer patients, the application says.
Dietrich and Christoffersen said revisions are under way on "Guidelines for Growth." Until those changes are made, the formula will remain as the state's guideline, they said.
Both men said they do not know how the formula may be revised.
Dietrich said the Tennessee Hospice Organization supports the state formula.