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GREENSBORO — With high ceilings and natural light, patchwork quilts on the beds and oil paintings over the oxygen valves, Hospice of Rockingham County is built to feel like a home, not a hospital.

Nothing can change that, says Rhonda Lucas, the center’s director of facility and support services,

But she’s well aware that proposed cuts to the state and federal funding for her organization could change a lot of things for it and other hospices down the road. Those changes could potentially determine who gets help and how it is paid for.

“We’re not so tight that we squeak,” Lucas said. “But we have to watch our pennies.”

The latest possible cut, announced earlier this month as part of the health care overhaul legislation in Congress, would lower funding to hospice Medicare providers by $2.3 billion over a five year period and nearly $10 billion over the next decade.

That cut comes on top of another that the hospice community has been fighting for more than a year. That cut, which could determine how hospice Medicare reimbursements are calculated, could amount to a loss of $11 million in North Carolina for 2010 alone. On a national level, the plan would phase out $3 billion from hospices over the next five years.

Finally, the state legislature’s health and human services subcommittee has considered removing all Medicaid optional offerings such as transportation, rehabilitation services and optometrist services from the state budget. Hospice care falls under that category

We’re facing “cuts on top of cuts,” said Pat Soenksen, president and CEO of Hospice and Palliative Care of Greensboro.

The drop in Medicare funding could be especially devastating, she said. Those reimbursements make up 92 percent of hospice revenue.

Soenksen said her hospice is luckier than others; as a large facility, it can adjust for decreases.

But for smaller providers like the Hospice of Rockingham County, it may be more difficult.

The small building on U.S. 65 in Wentworth cares for about 50 patients a day, Lucas said. As many as eight patients receive care at the hospice; the rest receive care in their homes

Lucas said the hospice will need to increase those numbers to make up for the decrease in funds.

Soenksen and Lucas both said they are adamant about not letting patient care suffer. But they’re less sure about how to make that happen, especially because none of the proposed cuts has been made final.

Until those decisions are made, hospice administrators said they are left to guess at what changes will need to be made.

They hope trimming will be superficial — skimping on office supplies and buying generic medications rather than name-brand. But they know major changes in organization will be necessary, such as focusing more on fundraising.

Greensboro’s hospice relies on about $1 million in community support each year. This year, the hospice is already $80,000 under its goal.

“How do you go into a community that is already suffering and ask for more?” said Ursula Robinson, vice president of clinical services.

Lucas said small, rural hospices may close, with people force to go farther for care.

“The hometown, family feel may not be there,” she said.

Ultimately, Soenksen said she’s worried fewer people will take advantage of hospices.

In the end, that would cost the government more money, she said, because hospices streamline the health care process. Patients who don’t use hospice end up making more trips to hospitals, racking up expensive emergency room bills.

According to a 2007 Duke University study, hospices actually save more than $2,000 in Medicare spending per person.

Hospice officials are trying to drive that point home with legislators.

Hospices should be treated differently than hospitals or clinics in current health care reform, they said.

“We have been storming the gates of Washington…,” Susan Cox, vice president of clinical services at Greensboro’s hospice said. “We need others out there to storm these gates too.”

Contact Tricia Nadolny at 373-7028 or tricia.nadolny@news-record.com