Monday, May 21, 2018

What Is the #MyHospice Story Bank?

If you don’t already know, My Hospice is a campaign to reinforce the value of the Medicare hospice benefit among policy and healthcare decision makers to foster a policy environment that will support patient access to high quality, comprehensive hospice and palliative care.

Whether you are a loved one of a person who received hospice care or a member of the hospice Interdisciplinary Team – and that includes dedicated volunteers – we believe that your story deserves to be shared and is essential to showcasing the purpose and value of hospice care. Write about your hospice experience and what hospice means to you, then submit it in the My Hospice Story Bank.  If selected, your story could be:
  • Shared in HAN and/or NHPCO social media messages using #MyHospice
  • Featured in HAN blog posts
  • Shared in NHPCO’s NewsLine or NewsBriefs
  • Featured in your local newspaper
  • Featured in an NHPCO video
If you’re interested in sharing your story, click here.  You can also learn more about the My Hospice Campaign.

Tuesday, May 15, 2018

A Unified Theory of Home-Based Care

You may not know this, but I am fascinated by quantum physics.  No, I don’t actually understand it, nor can I do the math involved, but I am like a curious two year-old when it comes to the idea that the laws governing small particles and large planets are actually the same.  It turns out that the visuals our science teachers taught us about electrons orbiting nuclei were not exactly right from a scientific perspective but a really helpful way to think about this.

So, as usual, what does any of this have to do with hospice or home-based care in general?  Well, we are consumed these days by large celestial bodies that are going to reshape health care.  Walmart, Amazon, Google, are all vying for a piece of the health care pie.  This is both tantalizing and a little scary.  But what if the laws that apply to these large bodies are the same as the laws that apply on the ground? Think about it. While Amazon completely disrupted the business model of traditional brick-and-mortar retailers, it created huge opportunity for smaller, nimbler organizations like delivery services and the specialty realtors who contract with Amazon for those more niche products. A similar evolution in health care could actually play to hospices’ strengths.

I think that when all of the hoopla dies down, and we deal with reality, we will see that this is exactly right.  You see, no matter how much buying or technology power an entity has, people still covet and receive health care (if done right) in a personal, local and convenient manner.  While we can bring the efficiencies and technology of large bodies to health care, and we should, we will not replace that crucial fact.  Even in the Jetsons, neither Rosie the Robot, nor the food eracacycle, delivered health care.

A unified theory of home-based care, just like a unified theory of physics, has been elusive.  Over the coming months, you’ll hear much more about my theory.  For today, suffice it to say that it will be person-centered, interdisciplinary, and will leverage the best of our past with the scale, technology and efficiency of the future.  We’ll be less chopped up by geography or tax status, or even Medicare benefit category.  A unified theory demands that we focus on the one core truth that helps inform all we do.  That part is easy.  It’s about people. No matter the scale, people need care from other people. 

By Edo Banach, JD
President and CEO

Tuesday, May 8, 2018

Happy Nurses’ Week!

It’s hard for me to believe I have been a nurse for over 30 years; however, in my heart, I have been a nurse much longer. Even as a little girl I knew I wanted to become a nurse.  I grew up in a time where there were strong role model nurses on TV shows which fueled my conviction.  

Nursing is an art and a science. The possibilities open to nurses are amazing! From the hospital, to the clinic, to the home, or the laboratory or the classroom, we make an impact on people’s lives every day. And in giving we get so much more back in return.

Like most new grads, my career started in the hospital. I worked on the medical surgical floors before gravitating to oncology which then merged with telemetry, offering me another skill set. Then, I moved to a relatively new bone marrow transplant unit which included adult and pediatric patients. After a move and a second child, I found a part-time job as an outpatient nurse for a drug and rehab center. Another important skill set was learned.  

When I moved out to the country, which I lovingly called the middle of nowhere, I thought my nursing career was over. Little did I know I was about to find my niche.

Responding to an ad for a hospice nurse at a satellite branch of a large community-based hospice opened my opportunities to the full scope of nursing practice. The hospice model, which is holistic, person-centered and interdisciplinary, blew my mind. I wondered why all health care wasn’t built on this model? When I called a primary care physician about their patient, they wanted to know what I recommended. Wow!  I quickly realized I needed to always be prepared and have current evidence to back up my recommendations. I also hoped the hospice model of care would move upstream in care delivery during my lifetime.  

As a nurse leader, I am engaged in that very work today.

In hospice nursing I also honed the art of listening. Listening first is so very important to giving high quality care. While I have built a wealth of skills throughout my career, from bedside nursing, operating complex devices, tackling electronic documentation optimization, developing operational budgets and new programs, managing and leading teams, the single most important skill I have learned is listening.

Great nurses listen with an open heart, to the individual, their family, their co-workers, and their community. These nurses see a person, not a patient.  Nurses dare to care with empathy, understanding this individual before them could be their loved one or themselves.  Great nurses don’t assume, they listen, and because they do, they learn more than any algorithm or protocol can provide. 

I am a nurse who believes in the value of technology. I look for ways to leverage technological advances in providing care to the seriously ill. But I also know that technology can never replace human caring. And human caring starts with active listening.

To all my fellow nurses, happy Nurses’ Week! Please continue to advance your skills and education because you make a difference in the lives of others every day. And never forget the great art of listening.

Lori Bishop, MHA, BSN, RN, CHPN
Vice President of Palliative & Advanced Care

Thursday, May 3, 2018

FY2019 Hospice Wage Index Proposed Rule

On Friday, April 27, 2018 CMS posted the FY2019 Hospice Wage Index Proposed Rule. Staff at NHPCO analyzed the proposed rule and published a Regulatory Alert on April 30, 2018 that provided more detailed information for the membership. Some highlights of the proposed rule include:
  • Hospice rates will increase by 1.8% for FY2019.  The cap amount has also increased by the same percentage to $29,205.44.  
  • Physician assistants will be able to serve as a hospice patient’s attending physician, effective January 1, 2019. NHPCO has worked in collaboration with the American Academy of Physician Assistants for their inclusion in the statute. Hospice patients will have additional choices for their attending physician once this provision is effective. 
  • CMS has reduced regulatory burden for hospice providers by allowing drugs and durable medical equipment to be reported in the aggregate on the claim form, rather than the extremely burdensome per drug or per equipment reporting that currently exists. CMS estimates that the elimination of this burdensome reporting will reduce the number of line items reported on claims by 21.5 million, in the aggregate.   
  • There will be no new hospice quality measures in FY2019. 
  • Data points from the hospice public information, currently available in the Provider Use File and posted by CMS, will be added to an “information” section in Hospice Compare, so that Medicare beneficiaries and their families have information that will assist them in selecting a hospice that meets their needs. 
CMS published a data trend analysis of hospice claims and cost report. Concerns continue to be raised about the number of patients who did not receive a skilled visit in the last seven days of life, the number of drugs paid for by Part D after the patient has elected hospice, and the lack of completeness in the hospice cost report. It's essential that hospice providers be aware that there is likely to be increased focus on these areas in the future.

Comments on the proposed rule are due to CMS no later than June 26, 2018. NHPCO submits a comment letter and encourages all providers with feedback to share that with CMS.

NHPCO members will find more detailed analysis in its Regulatory Alert (04/30/18). 


Friday, April 27, 2018

NHPCO Introduces My Hospice Campaign to Highlight Value of Hospice Care

At their annual Management and Leadership Conference, the National Hospice and Palliative Care Organization today launched a new advocacy campaign to reinforce the value of the Medicare hospice benefit among policy and healthcare decision makers to foster a policy environment that will support patient access to high quality, comprehensive hospice and palliative care.

As Medicare’s first coordinated care model, hospice is one of the few sectors that demonstrates how healthcare can – and should – work at its best for its patients, offering a successful model for expanding access to person-centered, integrated care to all patients with serious, advanced and life-limiting illness, and their caregivers.

The campaign, My Hospice, aims to demonstrate what hospice means to each unique individual and family it serves. Through the My Hospice campaign, NHPCO will highlight how critically important hospice and palliative care are to Americans across the country, while educating policymakers that hospice is an integrated care program that works and a high-quality benefit that matters.

“Hospice truly is Medicare’s first coordinated care model – and it works,” said Edo Banach, President & CEO of NHPCO. “In an increasingly fragmented and broken healthcare system, hospice is one of the few sectors that demonstrates how healthcare can – and should – work at its best. Through My Hospice, we will demonstrate how our coordinated and person-led approach to care protects choice and access to individualized services based on a person’s unique care needs and wishes. It is a system that works for patients, families and the Medicare program, alike.”

The My Hospice campaign is founded on three main principles:
  • Hospice is an integrated care program that works.
  • Patients and families must continue to have timely access to high quality, comprehensive hospice care.
  • Future health reforms should build upon the successful hospice model by expanding access to comprehensive, coordinated care and person- and family-centered care to all patients with serious, advanced and life-limiting illness.
To patients, My Hospice represents their choice to receive the care that they want, while to family members and caregivers, it means joy, purpose, calling, privilege, passion, teamwork, mission, comfort and support. Through the My Hospice campaign, NHPCO will be bringing together the hospice community to share experiences to help policymakers, healthcare influencers and others better understand the tremendous benefits of hospice care.

Continued Banach: “We are not just an industry - we are about person and family-centered care that honors, uplifts and supports. Now is the time to come together to protect hospice as we know and love it today, and to make sure more people get the high-quality care that we offer, earlier.”

To learn more about the My Hospice campaign, please visit

Tuesday, April 24, 2018

Coordinated Care Is More Than a Buzzword for Hospice Providers

As much as we talk about “coordinated care” in health care today, it is regrettable that most people still contend with an uncoordinated, inefficient and stressful system at the end of life.

Often, health care professionals are singularly focused on eliminating illness and find themselves ill-equipped to provide the comfort and guidance needed when a person’s illness requires care rather than, or in addition to, a cure. Families who don’t know that there’s an alternative stand helplessly by as the last months of life get swallowed up by costly, sometimes unnecessary treatments that can hurt more than they help.
A grassroots movement that began over 50 years ago, the success of the hospice model led to its adaptation into Medicare in 1982 — a mere four years after it began as a demonstration program. Today, an estimated 1.7 million Americans receive hospice services each year, with 1.4 million Americans choosing to utilize hospice through their Medicare benefit.

Expert medical care, pain management, emotional and spiritual support services are all provided and tailored to the patient’s and family’s needs. Hospice caregivers represent a comprehensive, interdisciplinary team of physicians, nurses, social workers, chaplains, volunteers and other professionals that ensures the patient is cared for beyond just his or her medical needs. Hospice respects the dignity of the patient’s life, honors his or her choices and provides a care plan reflective of a patient’s values. This philosophy of care is illustrative of hospice’s legacy and commitment to the best care for every hospice patient.

It’s a system that thrives because hospice providers understand how to balance the patients’ wishes with their health care needs – and coordinate care accordingly. This investment in care actually saves Medicare money – by one estimate, as much as $2,300 per patient — not at the expense of the patients, but rather by allowing the patients and their caregivers to guide decisions that can reduce their use of hospital-based treatments, resulting in fewer complications and side effects.

Despite more than 35 years’ success in the Medicare program, inevitable changes in our health care system could threaten hospice’s effective, original system of coordinated care. A rash or untested policy shift could lead to care delays, limitations on patients’ ability to select their preferred provider or a loss of autonomy for the hospice medical directors.

Change is inevitable and can often be good, but it must be incremental change that does no harm and respects patient and caregiver choice for more, rather than less, options for addressing serious illness.
While the goal of hospice care is not to save lives, it is still often called “lifesaving” by patients’ families. After experiencing the confusion and frustration of fragmented care, many are overwhelmed by the quality, compassion and personalized service that hospice care delivers. The hospice model exemplifies these principles of quality, compassionate and personalized care that beneficiaries, payers, policymakers and their constituencies want.
No patient or family should suffer needlessly at the end of life – and that includes either physically or emotionally. America is getting older, but members of the hospice and palliative care community are prepared to meet the growing need for more hospice care. And we are ready to do so in a way that is driven by our patients and their families.

Doing so demands that any health care reform allows hospice to continue to build on our successful foundation – and expand our patient and family-centered model across the care continuum. Protecting that continuity is essential to care for all patients with serious, advanced and life-limiting illness.
Rather than just trying to make hospice more like the rest of the health care system, how about making the rest of the health care system more like the original coordinated care model? Coordinated care should be more than a popular health care buzzword. It should be the driving force for all health care everywhere – just as it currently is for hospice.

It’s the model and philosophy that have driven hospice’s success and changed lives for the better. It is a model that we will continue to fight for and for policies that support peace, comfort and quality at the end of life.

By Edo Banach, JD
President and CEO
National Hospice and Palliative Care Organization

Monday, April 16, 2018

National Healthcare Decisions Day is Here!

Advance Care Planning: Reminder for YOU to Have the Conversation.

The scenario generally plays out the same. A person becomes ill…too ill to make decisions for themselves…too ill to communicate with the attending medical staff. Nearby family rush to the hospital bedside. The physician explains what’s happening to the family. Things aren’t looking good or the medical terminology is not easy to understand. After some time, the family is left to make decisions for their seriously ill loved one. Decisions that have not been discussed or thought about prior to this point. What do we do? Who has the final say?  Things normally go downhill from here. You’ve seen it. I’ve seen it. Medical staff dread it. No one wins.  Making healthcare decision at the hospital bedside is not the right time.  These conversations need to happen before the crisis, not during.

Speak Up
As a mom, sister, daughter, past and future caregiver, I understand the importance of having conversations about my future healthcare decisions with my family and friends. These conversations can be hard to begin. However, there are many resources, tools and games that help families have these talks in creative ways. Over the years, I have facilitated several talks on how to plan and communicate your future healthcare decisions.  One of my personal favorite resources is the Speak Up video. This video is one of the tools I consistently use when explaining why it’s so important to have the conversation and complete an advance directive.  I encourage you to post and share this video with your family and friends on Facebook. They’ll thank you later. The message is short and simple.

As we advocate for more families to participate in advance care planning, keep it simple. I remind my family and friends that advance care planning is much more than completing a form. It really is more about the conversations you have before and after any document is completed.

Lead By Example
April 16 is National Health Care Decisions Day (NHDD) and this year’s theme is, “It always seems too early, until it’s too late.” NHDD is a call to action for EVERYONE to:

→Think about your beliefs and values,
→Write them down,
→Choose a healthcare proxy (someone who speaks for you if you are not able),
→Complete an advance directive, and
→Share with your healthcare proxy, family and doctors.

The purpose of NHDD is to inspire, educate and empower the public and providers about the importance of advance care planning – and most importantly, to encourage people to express their wishes regarding healthcare and for providers and health care organizations to respect those wishes, whatever they may be. As someone in the health care field,  be sure to complete your advance directive and encourage your colleagues and loved ones to do the same. Practice what you preach.

 For more information and resources on advance care planning, visit the National Coalition for Hospice and Palliative Care member organizations websites.

By Cozzie King
National Coalition for Hospice and Palliative Care

National Consensus Project