Friday, December 6, 2019

Survey Finds Californians Seek Support Around Serious Illness and End-of-Life Care

Nine in 10 would want as much information as possible about what to expect if they faced a serious illness.

Living with a serious illness impacts all facets of a person’s life. Results from a statewide survey released by the California Health Care Foundation (CHCF) show that the vast majority of people with serious illness want the kinds of supportive services provided by palliative care, which focuses on providing relief from the symptoms and stress of serious illness and can be provided alongside curative treatment.

Californians also express a desire for as much information as possible about what they can expect with their illness now and in the future. This sentiment poses a challenge to the current health care system, where such conversations are not the norm and the majority of people with serious illness do not receive palliative care.

Help Wanted: Californians’ Views and Experiences of Serious Illness and End-of-Life Care reports selected findings from the new survey and highlights key differences by race/ethnicity and income level. The survey is a follow-up to the foundation’s influential Final Chapter report released in 2012.

“Californians overwhelmingly want their health care provider to address the physical, emotional and practical stresses of serious illness,” said Sandra R. Hern├índez, MD, president and CEO of CHCF. “While many people do receive services, like palliative care, it tends to happen toward the end of life. These services could make a much bigger difference if they were delivered earlier.”

Monday, November 25, 2019

Education Developed for the Hospice and Palliative Care Professional

The annual webinar series offered by the National Hospice and Palliative Care Organization provides professionals – individuals and teams – with education to help develop professional skills and keep providers up to date on current practices in the field.

Each webinar topic and faculty are carefully curated by NHPCO Committees and Councils and incorporates feedback from the provider community.

The webinars reflect the most current and pressing needs of the hospice and palliative care field. Here are some of the 2020 topics:
  • Strategies for Engaging Referral Sources
  • Caring for Difficult Patients and Families
  • Implementing the Hospice Election Statement Addendum
  • Dashboards and Metrics to Communicate Outcomes
  • Pain Management for Patients with Addictions
The NHPCO webinar series is one of the most economical ways to offer training to professionals in the field.  Webinar packages are available and increase the savings available to professionals and organizations.

Continuing education/CME may vary by webinar but is generally available  for the following disciplines: Counselors, Nurses and Physicians (a $5 processing fee is required). To determine which credit is available for specific webinars, visit the NHPCO website and click on each webinar description. In addition, NHPCO webinars offer a Certificate of Participation for non-physician healthcare professionals, learn more about CE/CME provision.

See the full list of 2020 topics and order a package on the NHPCO Website.

Wednesday, November 13, 2019

6 Ways To Prepare Your Hospice For The Primary Care First Application

Setting yourself up for application acceptance and ongoing success
by Jeremy Powell, CEO of Acclivity Health

The Centers for Medicare & Medicaid Services’ Primary Care First (PCF) model is rolling out in 2020, and applications will become available in a matter of weeks. The Seriously Ill Population (SIP) model under PCF is designed to improve care for high-need, high-risk patients who currently receive fragmented or inadequate care. To do this, CMS will assign SIP patients to participating hospice programs, paying the providers to coordinate their care and avoid unnecessary hospitalizations.

There are numerous benefits to hospices participating in the SIP program, but first, your application must be accepted. Hospices interested in participating should take time to adequately prepare for their application based on what is known about the PCF program’s criteria and past CMS applications.

1. Begin drafting responses to narrative applications now.
While the application has not been released yet, because Primary Care First is based on CPC+, the applications are likely to be similar. As with all Alternative Payment Model (APM) applications, it will likely feature a combination of check boxes and narrative answers about your organization, asking how you’ll meet the eligibility requirements and drive success in the program. By preparing responses to narrative questions in advance, you give yourself time to have them reviewed by experts on APMs and improve them as needed.

2. Prepare to analyze patient data provided by CMS.
Although CMS has not announced what types of patient information will be available to participating hospices — which will likely come once the application is approved but before signing the participation agreement — hospices will need a way to make sense of that data. A data analysis platform can provide a glimpse into what 2020 will look like for your hospice, including estimates of the number of patients being assigned to you, their acuity, their prognosis, and more.

3. Determine staffing needs based on the new influx of SIP patients.
By participating in the SIP program, hospices should be able to earn 20 to 25% net profit margins caring for SIP patients. To achieve this, plan for staffing adjustments required to meet the demands of the SIP program. Hospices already employ a multidisciplinary staff to meet patients’ needs; you may only need to redistribute your staff to reflect the forthcoming patient population in your care.

4. Review your technology against PCF’s criteria, including EHR, analytics, and reporting requirements.
To participate in the SIP program, CMS requires a hospice to make use of technology to support care delivery. From certified EHR platforms, to Health Information Exchanges (HIEs), to analytics capabilities, hospices will need to prove to CMS that they are able to make data-driven decisions about a population. Most hospices have never faced this requirement before and may find themselves without a clear path to success, so identifying these gaps as soon as possible is crucial.

5. Reach out to potential community partners to fill care delivery gaps (if any).
Hospices in the SIP program must prove they have a network of providers in the community that can help meet the needs of their patients. While many hospices already offer care coordination, those who currently do not should start engaging in those relationship-building conversations with other providers in the community. This will ensure patients have access to the right care, at the right time, in the right place.

6. Prepare for discussions with Medicare Advantage payers who opt into the program.
With the hospice carve-in looming, hospices need to start thinking about how they will interact with Medicare Advantage payers. SIP is a great first step. Because CMS has made PCF and SIP a multi-payer model, Medicare Advantage payers are invited to participate. Consider how you will hold meaningful discussions with these payers about partnering with them on SIP. Even though the Medicare Advantage payers’ version of the SIP program will be similar to CMS’s, there will be differences, and you’ll need a plan about how you negotiate the details.

For more information about how to prepare for the application, or how Primary Care First’s SIP program can benefit hospice programs, visit

  • NHPCO Members: SIP Webinar from Edge Business SeriesJoin NHPCO for a free webinar on Friday, November 15 at 2:00 pm EST focusing on the recently released Request for Applications for the Primary Care First – Seriously Ill Population model. We will provide a detailed overview of the RFA and how hospices and palliative care organizations can be best prepared to apply and participate. We will also explore hospices’ readiness to provide SIP programming as well as the specific areas for providers to address to take advantage of this opportunity. NHPCO members are invited to register online.

Wednesday, October 30, 2019

November 1 is Social Media Action Day!

A Day of National “Hospice Awareness” Friday, November 1, 2019

#HospiceMonth   #HospiceAwareness #hpm

In recognition of National Hospice and Palliative Care Month, NHPCO encourages all member organizations, professionals and supporters to participate in our annual social media action day, traditionally the first Friday in November – this year, it’s Friday, November 1, 2019.

NHPCO wants the hospice and palliative care community to flood social media with images that promote awareness of hospice and palliative care. This guiding theme, My Hospice: A Program that works. A Benefit that Matters, will allow participants to share a wide range of photos, images or videos – all to help people better understand the value of hospice and palliative care.

Social media posts on November 1 should feature photos, graphics or short videos provided by hospice and palliative care organizations/professionals or individuals that capture hospice and/or palliative care at its best – the specific post we leave up to you!

Spread positive messaging on November 1 - and all month long in recognition of National Hospice and Palliative Care Month.

Download NHPCO's Social Media Action Day tip sheet (PDF).

Monday, October 21, 2019

Birdie's Heart for Hospice

As I walk into the Malone, New York office of Hospice of the North Country, I’m reminded of all the memories I have from working at the organization. I started my career in hospice and communications there twelve years ago.  Every day I was amazed at the work my clinical colleagues were doing. I wasn’t at the bedside, but occasionally, I got to go into patient’s homes and interview them and their families. It was the highlight of my job. I looked forward to lunches spent with the nurses, who would talk about the different events of the day. They never stopped thinking about their patients…even at a lunch break where they could easily use the time to talk about the latest episode The Bachelor (okay we did that sometimes!).

Now that I work at NHPCO, I am more aware of what is going on with hospice care on a national level. Regulatory changes, reimbursement cuts, and new payment models are just some of the things we are currently facing as a community. Healthcare in this country is constantly evolving and hospice is facing many challenges. The reality is that hospice will probably look different in five years. We are seeing a greater need for providers to be innovative when it comes to care delivery all while preserving the mission of hospice care.

Naturally, it’s easy to get wrapped up by these issues. They are so important to our community and at NHPCO, we must do everything we can to guide providers through these challenges. However, I wanted to get back to the basics, back on the ground meeting with those who are doing the work at the bedside. So, I went back to HONC and interviewed an amazing human being and hospice volunteer – Birdie Leavitt.

Birdie is a person I will remember for the rest of my life. She checks off all the hospice volunteer criteria – because her husband and family member received such quality hospice care, she felt she needed to give back and signed up to volunteer. She is willing to visit with anyone at any time, go into any living situation, and drive miles upon miles on country roads, sometimes in a snowstorm, to get to her patient’s home. She will come into the office and stuff envelopes, shred paper, and cuddle the office cats Alice and Tommy.

Birdie and one of the hospice cats.
I talked with Birdie about her experience as a hospice volunteer and I was so pleased to learn that she had the same passion, if not more, for hospice and volunteering now as she did when I worked with her seven years ago. Birdie has a binder that is full of memorabilia from her time at HONC. It’s a lot thicker today than it was the last time I looked through it. Since 2004, she has collected thank you notes, messages, obituaries, and mementos of the patients and families she cared for.

She reminisced about the range of activities she has performed as a hospice volunteer – making breakfast, doing dishes, picking up a few items at the grocery store for a family after their loved one died, singing along as a patient performed her daily comforting activity of playing the piano, and visiting with a patient and family on Thanksgiving Day.

Birdie told a story about a nursing home patient who didn’t have any family to provide support and companionship. This person had only the staff charged to care for them. The team at HONC made a commitment to staff five volunteers daily so the patient wouldn’t be alone in their final days. Birdie visited the patient and would wheel them out to the courtyard to look at the flowers and plants. It was one of the only times this patient left their room since being admitted weeks before. The patient’s disease had made it difficult for them to speak but, during one of Birdie’s visits, they communicated by grabbing Birdie’s hand and placing it against their cheek. Birdie had made an impact on this patient and they remembered her through the dementia and loneliness.

Many people don’t understand that hospice teams will go into any home and living condition to ensure that a patient is cared for. Birdie talked about two patients she was volunteering for. One of the patients lived in a beautiful home with a gorgeous chandelier. The other patient lived in a trailer with a hole in the floor. When Birdie sat down, a chipmunk peeked out its head. Her comment to this contrast in living situations, “With hospice, no matter how you live where you are, you get the same care as the next person.”

When I asked Birdie if she gets attached to her patients, she said without hesitation, “You do get attached to them. I can tell when the time is getting short, when it’s getting close.”

I learned that HONC is taking steps to provide emotional care for their volunteers, to ensure that they understand and recognize the symptoms of grief that they might feel after losing their patients. Bereavement coordinators will be providing a seminar for all the volunteers in the organization this fall. Volunteers are encouraged to attend and have been told they can bring friends along because hospice cares for the whole community, not just those receiving hospice care.

Finally, I asked Birdie what hospice meant to her. She answered, “It means everything. It means doing something for somebody else. It means more for me than I could ever do for them.”

Birdie is the model hospice volunteer. But she’s so much more than that...just like hospice is more than just a piece of the United States healthcare system. There are thousands of hospice volunteers, like Birdie, across the country and they are one of the reasons hospice care is so unique. We often hear that volunteers are the “heart of hospice.” They are also the foundation of hospice, as this movement was started by volunteers. They are an integral component of the interdisciplinary model of care that makes hospice special. 

You will not find this type of care in any other part of healthcare in this country. I didn’t need to go back to HONC to understand why hospice is so important because I was already a believer and advocate for our community. But it’s always good to be reminded that people like Birdie are out there, willing to sit with your dying loved while you take a much-needed break, do the dishes that are piling up because you are more focused on caregiving, or sit by your side as you take your final breath.

Hospice might look very different five years from now. Let’s preserve and protect that pieces of  hospice care that make it so special. Let’s make sure the Birdies out there can continue to make house calls to patients and families who need a little extra help.

By Amanda Bow
Senior Director, Communications and Digital Strategy

Thursday, September 26, 2019

OIG Virtual Town Hall for NHPCO Members

NHPCO will host a free Virtual Town Hall for members on Thursday, October 24, 2019 from 1:00 – 2:00 p.m. ET with the Office of Inspector General for the Department of Health and Human Services.

As providers are likely to remember, in July 2019, two OIG reports were released (PDF) that identified concerns with the large number of hospices with survey deficiencies and examples of hospice patients in immediate jeopardy for harm. These two reports have received media and policymaker attention since their release.

This virtual town hall offers members a unique opportunity to learn more about the OIG's specific findings and the suggested reforms OIG is recommending for both CMS and Congress to undertake.

Participants will have the opportunity to learn and ask questions with the authors of the reports including Assistant Inspector General Erin Bliss, Assistant Inspector General for Evaluation and Inspections at HHS Office of Inspector General, Nancy Harrison, Deputy Regional Inspector General Office of Evaluation and Inspections in New York and Jodi Nudelman, Regional Inspector General for the Office of Evaluation and Inspections in New York.

Prior to registering for the Virtual Town Hall, members should review the OIG talking points (PDF) prepared by NHPCO.

Members will find a registration link in NewsBriefs issued September 26, 2019 and available online.

Wednesday, September 18, 2019

NHPCO Hospice Ambassadors on Capitol Hill

Hospice providers from NHPCO are on Capitol Hill, September 17 and 18, to advocate for reforms that would increase access to hospice and palliative care in America’s rural towns and improve hospice care quality.

“All Americans should be given access to quality hospice care, no matter their zip code,” said Sandy Kuhlman, Executive Director of Hospice Services of Northwest Kansas and one of NHPCO’s visiting My Hospice Ambassadors.  “For this reason, we are bringing our message to Washington and asking our representatives to improve and reform hospice and palliative care policies that will increase access, refine oversight, advance education and improve transparency for providers and consumers alike.” 

Hospice advocates are urging lawmakers to support the Rural Access to Hospice Act of 2019 (H.R. 2594), bipartisan legislation introduced by Representatives Ron Kind (D-WI) and Jackie Walorski (R-IN) that will allow Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) to receive payment for serving as the hospice attending physician. If passed, the legislation would fix a technical glitch that currently prevents terminally ill beneficiaries in underserved and rural communities from utilizing the physician of their choice when entering hospice care.

NHPCO members will also talk to lawmakers about the organization’s Program Integrity Initiative, which overviews provider supported reforms and opportunities for proactive collaboration with Congress and federal regulators to increase oversight, education, and transparency.

“We look forward to working with the Administration and Congress to simplify and streamline the hospice benefit and compliance process to ensure taxpayer resources are spent wisely,” noted Kuhlman. “More oversight of new and poor-performing hospice providers would protect the most vulnerable, while easing unnecessary governmental red tape on honest and law-abiding hospice providers so they can continue to provide high-quality, person-centered care.  Accountability leads to credibility. Our goal is to ensure patients and their families have the utmost confidence in their hospice program.” 

Learn more about the My Hospice Campaign.

My Hospice Ambassadors with members of the board at NHPCO offices on September 17.