By Mike Boyer
The Cincinnati Enquirer

Death is something everyone faces, but facing it with hospice care is still relatively uncommon.

Less than half the roughly 1.8 million people who die annually from a chronic or terminal illness have access to hospice care, says Mark Cohen, vice president of public relations for Miami-based Vitas Healthcare Corp., the nation's largest provider of end-of-life care.

"There's a huge unmet need in every community in the nation," he said.

Founded in the 1970s by a Florida minister and a registered nurse, Vitas, acquired in February by Cincinnati's Roto-Rooter Inc., daily cares for about 8,000 patients in 25 states including Ohio.

The vast majority of hospice care is provided in the patient's home, he says. Vitas does lease hospital beds when necessary.

"The biggest misconception is that hospice is about giving up," he said.

What it really involves is developing a care plan that focuses on the patient's comfort and well-being rather than a cure.

In some cases that can mean increasing medication to eliminate pain or decreasing it so the patient can be alert to spend time with family or friends.

In the face of skyrocketing health-care costs, hospice and hospital-provided palliative care are being increasingly viewed as less-expensive and more humane than trying to extend life with expensive drugs and other treatments.

The Wall Street Journal recently reported that a Virginia Commonwealth University medical center study found the cost of treating the last five days of a terminal cancer patient in a palliative care unit was less than half that elsewhere in the hospital.

Since 1982, hospice care has been a 100-percent Medicare-funded benefit, and 9 out of 10 Vitas patients are covered by Medicare, the company says.

Under the Medicare rule the patient are eligible for hospice if they have a life expectancy, generally, of six months or less at the time that their physician certifies their life-limiting prognosis.

Although Vitas, with revenue of $420 million last year, is the largest for-profit provider of hospice care it isn't the only one.

Dallas-based Odyssey Healthcare Inc. reported profits of $31 million, or 84 cents a share, on revenue of $274 million last year, caring for an average of 6,400 patients daily.

Scottsdale, Ariz.-based Vistacare Inc., last year reported profits of $15 million, or 89 cents a share, on revenue of $192 million, caring for a daily average of 5,200 patients.

E-mail mboyer@enquirer.com