The Hospice Organization and Palliative Experts of Wisconsin (HOPE-WI)
is a membership organization
comprised of hospice and palliative programs in Wisconsin.

The HOPE of WisconsinOur members are committed to providing the highest quality services to people across the state. Since 1985, we have worked diligently to ensure that every person in Wisconsin entitled to hospice care is able to access it. Today, HOPE serves individuals in every Wisconsin county, touching over 25,000 lives annually. From traditional hospice care to family bereavement services for up to one year following a patient's loss, HOPE strives to support the entire family with compassionate and comprehensive services.

Through the support of various foundations, HOPE has developed many innovative projects in collaboration with other organizations, including state and national regulatory bodies. Our commitment to provide access to hospice care for all who desire it inspired a partnership with a South African hospice. This world-view-expanding project helped solidify our belief that together we can make a significant difference in people's lives, even half a world away.

The future of hospice and palliative care is rife with challenges and opportunities. HOPE is now working to develop community-based palliative care services throughout Wisconsin. Palliative programs serve any person, regardless of age, receiving curative treatment for a serious progressive illness. Like hospice, an interdisciplinary medical team serves both patient and family during this challenging time. Implementing community palliative programs makes a tremendous difference for persons living with chronic illnesses.

A leader in national hospice advocacy and education, HOPE champions Wisconsin's pioneering work in the development of hospice residences. These invaluable assets assist local residents who may have few other options and/or desire the full-time support a residence can provide. HOPE also offers a variety of educational opportunities that help hospice team members keep current and learn more about promoting hospice services in an ethical and strategic manner.

Executive Q&A: Competition, technology forcing nonprofits to change

August 24, 2014 8:15 am  •  PATRICIA SIMMS For the State Journal

Melanie Ramey CEO Hope of WisconsinThe nonprofit world has changed in the last 10 years, with increased competition from for-profit companies in fields like hospice and home health care — services once dominated by nonprofits, says Melanie Ramey, CEO of The Hospice Organization and Palliative Experts (HOPE) of Wisconsin.

Ramey has spent much of her career heading a nonprofit.

“Slightly more than half of the hospices in the U.S. are for-profit,” she said. “Many of them are parts of national chains or are owned as a division of a national corporation. Their reimbursement is the same, but they have the advantage of centralized purchasing power, issuing stock, and the other opportunities of a for-profit business.”

Rapid technological change is also pressuring nonprofits, she said.

For example, hospices, regardless of size, have been forced to collect a lot of data in the last few years to file claims for reimbursement and to comply with other Medicare requirements.

“Every time a new rule or regulation comes out, and they have been numerous in the last few years, they generally require a change in software to accommodate the information being required,” Ramey said.

“This has been a serious financial burden on hospices and again with no commensurate increase in reimbursements to help cover it. In my opinion, this has contributed to the increase in mergers and even closures as a smaller stand-alone hospice just can’t absorb these costs.”

Ramey just received the 2014 Joseph G. Werner Meritorious Award at Madison’s Downtown Rotary for her service.

Q: Is it hard to run a non-profit organization?

A: The job of a hospice CEO or executive director has become especially demanding, leading to considerable turnover and burnout. The inability to keep up competitively with salaries and benefits has been a particular challenge.

In hospice, there are regulations that require certain staff with specific skills. These include doctors, nurses, counselors, nursing aides and others who are professionals requiring certain salary levels.

I really believe that if one can run a nonprofit well, he or she could probably run the country well. Most nonprofits exist on the membership dues, grants and reimbursements from some governmental source or donations.

These sources of revenue are not flexible and do not allow for any increases in the various costs involved in running any business such as salaries, utilities, building maintenance, and other customary costs.

For example, hospices are reimbursed by Medicare and Medicaid with a rate established by the federal government that has no relationship to many of the costs involved in providing care. The reimbursement is based on wage and hour data in the various states.

A hospice serving a largely rural area incurs a lot of expense in serving patients who may live an hour or more away as the staff must spend at least two or more hours getting to the patient and then have time to deliver care.

At the same time, that hospice has provided all of the medical equipment the patient may need such as a hospital bed, bedside commode, etc., and the medications needed by the patient. All for a set rate that is, on average, about $150 a day.

Q: What do you do?

A: My job consists of the daily running of the organization, working with staff to develop ongoing educational programs for hospice professionals, giving technical support to our members when they need it, following all state and federal legislation that involves healthcare and, specifically, hospice. I also attend meetings and interact with the state regulators that monitor and survey hospices and work with the fiscal intermediary that pays all of the hospice claims.

Q: What’s the next big challenge in the hospice industry?

A: Hospice in the U.S. is a just over 35 years old, and it has come a long way from starting out as an organization run by volunteers to now being a highly regulated Medicare benefit requiring delivery of care by professionals. There has been growth, but much more outreach needs to be done. In Wisconsin, we are serving about 44 percent of eligible people. We are about 18th in the nation in the numbers we serve. The biggest challenge, in our opinion, is that there needs to be an extensive effort undertaken to educate the general public about hospice.

It is considered the gold standard of healthcare, it saves the government money, and it is a paid benefit under Medicare and Medicaid and many insurance providers. The family is the unit of care in hospice, not just the patient. And very importantly, people need to know they do not need to be referred by a physician.

To spread the word about hospice, Hope of Wisconsin is launching “Climbing for Hospice” (

The director of the Agnesian Hospice Hope in Fond du Lac, Andy Land, will climb Mount Everest in March through May 2015. He is a hospice nurse whose climbing has been inspired by the patients he has cared for. We are using this event to build awareness about hospice and to also raise money to launch an ongoing public awareness campaign. We need to get people to understand hospice, especially as the population ages.

Q: Will hospice care organizations become swamped as the population gets older and has more need?

A: We will be swamped as the baby boomers age and need services. There are presently some research projects underway testing out various ideas for delivering care more efficiently and effectively. Wisconsin is really a model of hospice care. We always rank high in the various areas where we are compared with other states. We work very hard to be sure all hospices understand the regulations and comply with them. As we serve more people, we will be able to build on the good foundation that we have laid to deliver quality care. To find hospices in Wisconsin and to learn more, go to

Q: Some people have a rule they live by. Do you?

A: I have always kept in mind an admonition from my mother that we should “brighten the corner where we are.” Do the best you can right where you are and don’t waste a lot of energy wondering about where the grass is greener.

Read the original Wisconsin State Journal story


The HOPE of Wisconsin is a proud member of:

       Community Hospice Partnership       National Quality Forum       The Hospice and Palliative Care Organization       Wisconsin Nonprofits      

Copyright 2016 by The HOPE of Wisconsin   |  Privacy Statement  |  Terms Of Use