Friday, August 18, 2017

The Interdisciplinary Thought Behind IDC 2017

By Joan Harrold, MD, MPH, FACP, FAAHPM
Medical Director/Vice President of Medical Services
Hospice & Community Care, Lancaster, PA
Chair of NHPCO’s Professional Education Committee

In selecting the content for the 2017 Interdisciplinary Conference, we’ve pulled together an incredible group of people from the field of hospice and palliative care to answer some of the questions that are especially difficult for many programs. How to approach chronic pain in cancer survivors (especially in hospice when cancer is not an active diagnosis)?  How to manage addiction issues? What do studies really say about cannabis use? The IDC17 will offer variety of different sessions that really matter how we deliver care to people. 

While I know that it can be a sacrifice for programs to send people to an onsite educational program like this, it is incredibly valuable for both the individuals who attend and for the organizations that send them. First, an onsite program can gather many more people from different disciplines, cover a broader range of session topics, and offer many more presenters—all in a very short period of time. So while it may seem like it takes more time and money, it’s actually very efficient. Even more so if you plan beforehand to have your staff come home with handouts, other resources, and information to share with their colleagues.  The education shouldn’t stop with a handful of staff who attend the conference in person. 

Second, people who gather “in person” have the opportunity to follow up on what they learn.  Not just the questions you might ask during a presentation, but even more in depth conversation following a session. I’ve presented NHPCO webinars and been happy to answer questions that were emailed afterwards. I can often help more, however, when someone approaches in person and says, “I’m doing something like that, and I want to pick your brain.” You can often make time for a concentrated conversation about what matters to that person right then and there.

I think we can be a little blasé about “networking” at conferences and the benefits that offers. However, it goes beyond meeting other people from other places and having a good time; it’s actually taking the educational elements and figuring out very quickly how they apply to your program. Taking resources that matter to you. Having an intensive conversation with a presenter—or other attendee—about issues that really matter to your program. And if people go with this idea in mind, that they’re going to bring information back, it really can enrich their program.  

One of the things we’ve done for years at my organization is divvy up the sessions before the conference begins. After all, this is not like swimming after eating—you don’t need a buddy at every session! If you send three people and they’re all attending different sessions, they can come home with much more information than you would get in the same amount of time listening to webinars or reading articles. And this is an interdisciplinary conference, it’s not just for one discipline. It’s not just the docs; it’s not just the nurses. The psycho-social, spiritual, bereavement staff, volunteers, regulatory and quality professionals and interdisciplinary team leaders are such an integral part of our teams. They need to get the same kind of experience and bring it back. I think this is incredibly valuable way to learn. 

I’m so proud of the work that NHPCO’s professional education committee and conference planning committee members have done to create this very special event, the 2017 Interdisciplinary Conference. I hope many people from across the field will join us in San Diego this September.
2017 Interdisciplinary Conference:
Strengthen Your Organization: Care, Compliance, Quality

San Diego Marriott Marquis and Marina, San Diego, CA
Education Programs and Preconference Seminars: September 16-17, 2017
Main Conference: September 18-20, 2017

Register today – team discounts available.

(Look for a special registration discount on Monday & Tuesday, August 21 & 21 only!)


Tuesday, August 15, 2017

Stronger Together: A Message from Edo Banach

The last few days have been trying ones for our country. The events and protests that began in Charlottesville, Virginia this past weekend and are echoing across the nation have been difficult and hit close to home for many of us. As a Jew and the grandson of two holocaust survivors, messages of intolerance and hate associated with recent protestors are hard to hear and understand in the year 2017. Additionally, staff members at NHPCO attended the University of Virginia and have ties to the Charlottesville community, as do I, since my wife grew up close to that city which has become a focus of great debate in recent days.

This year, while we mark 50 years of hospice since the creation of St. Christopher’s in London and the pioneering work of Dame Cicely Saunders, we also note that Dr. Martin Luther King died almost 50 years ago; the wounds of WWII and Selma are still raw; the protests of Stonewall still reverberate for many who continue to feel disenfranchised in our nation.

As hospice and palliative care professionals and advocates, it is part of our philosophy of care to honor and celebrate the dignity of every individual. While events of this weekend are not connected to hospice per se, the approach we bring to the compassionate care we provide has the capacity to be a unifying force in the communities in which we serve. As a unified provider community, we find our strength is our ability to engage in respectful discourse that recognizes a wide range of perspectives.

These are the times that try and hopefully define the noble vision of our republic. There is no room for hate, bigotry, or racism in America. I hope that we will all redouble our efforts to engage in constructive dialogue, to meet hate with love, and to continue moving our country forward in a positive direction.

As we know so well, at the end of life, we are all simply people with hopes and wishes who share a unified humanity. Thank you for what you do; I am proud to work alongside you to help advance the care of the countless patients and families that you serve with compassion, dignity and respect every single day.

Edo Banach, JD
President and CEO

Monday, August 7, 2017

All Other Ground is Sinking Sand

This week, I had the honor of visiting with a music therapist, Georgia, from Seasons Hospice in Columbia, MD.  I came away with a renewed belief in the value of hospice, and the important role that music therapy can play in an interdisciplinary team.  I was also deeply moved by the connection and spirituality that I witnessed during my visit.  As a musician, I believe in the power of music to transcend words and connect people; yesterday, my faith in music, hospice and people was reaffirmed.

I have been disabused of any notion that music therapy is simply about strumming a guitar.  In the hands of a skilled music therapist like Seasons’ Georgia, the guitar and voice are spiritual and deeply connected tools that can be extremely meaningful to a patient that is in pain, or family that is in need of healing.

Georgia, her colleague Anne and I visited two patients at one of Seasons’ inpatient unit.  One, Ms. A, requested Johnny Cash songs initially.  I sang along to “I Walk the Line” and a few others.  We then learned from Ms. A’s nephew that she led a church chorus for 50 years.  The songs shifted to spirituals. As Georgia strummed the guitar, Ms. A confided that she was ready to go, ready to relieve the burden on her family.

Ms. A was sure that she was ready, but she did have a song request, “My Hope is Built on Nothing Less.” I hadn’t heard this song before, but I was so moved to see and hear Georgia and Ms. A harmonize beautifully, with Ms. A repeating the last line—“All other ground is sinking sand”—twice.  Ms. A sang these lines with a certainty and conviction.  We all knew, somehow, that Ms. A would soon die.  As I leaned in to speak with Ms. A, she asked me why I didn’t sing with her.  I told her that I didn’t want to mess up her beautiful two part harmony.  She smiled, as if she knew that I didn’t really know the words.

Two hours later Anne and Georgia let me know that Ms. A died.

I was so moved by this experience, and so aware that this experience plays itself out every day in countless rooms and homes across the nation.  Music therapists—and all members of the hospice interdisciplinary team—help provide peace to patients and families at the end of life.  As President and CEO of NHPCO, I stand on the solid foundation that our professionals provide each and every day.  Thank you to Georgia, Anne, and all of our amazing hospice and palliative care teams.   

By Edo Banach, JD
President and CEO

Wednesday, August 2, 2017

FY 2018 Updates to the Hospice Wage Index and Payment Rates

On August 1, CMS issued a final rule that updates FY 2018 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries, and also updates the hospice quality reporting requirements. Section 411(d) of the Medicare Access and CHIP Reauthorization Act of 2015 amends section 1814(i) of the Social Security Act to set the market basket percentage increase at 1 percent for hospices in FY 2018. Hospices will generally see a 1.0 percent ($180 million aggregate) increase in their payments for FY 2018. As mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014, the cap amount for accounting years that end after September 30, 2016, and before October 1, 2025, must be updated by the hospice payment update percentage, rather than the Consumer Price Index. The cap amount for FY 2018 will be $28,689.04 (2017 cap amount of $28,404.99 increased by 1 percent).

The final rule also includes:
  • Hospice Quality Reporting Program, including submission exemption and extension requirements for the FY 2019 payment determination and subsequent years 
  • Hospice CAHPS® Experience of Care Survey 
  • Public reporting 
  • Quality measure concepts under consideration for future years 
  • New data collection mechanisms under consideration: Hospice Evaluation & Assessment Reporting Tool

 For More Information:
Final Rule (CMS-1675-F)

See the full text of this excerpted Fact Sheet (issued August 1).
(Information from CMS.) 

Tuesday, July 18, 2017

From the Road - New York

As summer sets in, we find ourselves in my home town of New York City. As I stroll familiar streets,  I am reminded of old and new friends, old and new memories, and filled with promise for the future of our industry and those who we care for. I am also filled with emotion.

Last night we strolled by the September 11th memorial, and I was reminded of the time that I spent at the old World Trade Center, of the friends that I lost that day, and of the majestic view of those Twin Towers from the Brooklyn Bridge.  As Manhattan rises up and recreates itself (as it always has) I am also reminded that change is constant, and evolution—sometimes forced, sometimes innate—is a part of life.  I no longer recognize some blocks in New York, but I always recognize its spirit of reinvention. From Alexander Hamilton (who is buried at Trinity Church, near Ground Zero) to yours truly, New Yorkers have often come from elsewhere and have evolved to meet the needs of their City, state and nation.  Changing, but not forgetting our roots


 I am so grateful for the opportunity to lead NHPCO at this important time.  Despite the challenges of our time, I am hopeful that we will continue to make progress toward creating a better and kinder health care system.  As much as hospice needs to evolve, the rest of the health care system needs to evolve in a way that is more person-centered, interdisciplinary, compassionate, and non-acute.  Like Hamilton, we must evolve but must not forget our roots—it is what has gotten us this far.  Onward!

Edo Banach and Don Pendley of the New Jersey Hospice and Palliative Care Organization.
Have a wonderful rest-of-summer with your friends and family.  I will see you on the road.   


Monday, July 17, 2017

Honoring Those Who Fought for Our Freedom

My first honor flight experience was one I will never forget. One hundred and ten Veterans from the Korean and Vietnam Wars arrived in Washington, D.C. on a gloomy, overcast morning. However, the weather could not dampen their spirits as they proudly exited the plane to a mass of cheers and welcome. As I stood there clapping, smiling, and welcoming the Veterans off the flight, I took a moment to consider how things had changed since the last time they were welcomed off a plane in such a manner. I wondered if all of them had been so deservingly honored with a welcoming home from their service. The smiles on their faces and tears in their eyes – most of them would only admit to allergies or “sweaty eyes” – told me that this moment was unlike any other for the honored guests of the capital.

For most of the Veterans, it was their first time in Washington, D.C. and the guided bus tour provided their first glimpse at the Washington Monument, Lincoln Memorial, and more. Having lived in D.C. for only a month, the monuments became just objects disrupting the D.C. horizon to me instead of the wonderful testaments to American freedom. The Veterans’ marveling and appreciation for the monuments and memorials provided me a renewed significance of the grounds. 

The honor flight experience added context to the importance of my work with the We Honor Veterans program this summer. After learning of the many challenges that Veterans face in terms of health and mobility, the opportunity for the Veterans to visit the nation’s Capitol that they sacrificed and fought so valiantly for became much more significant. In fact, many of the Veterans that required wheelchairs to get off the plane chose to stand and walk through the memorials instead of being assisted. Their perseverance and respect for their fallen brothers in arms was admirable and inspiring.

 It was an honor to help the Veterans locate a friend’s name on the Vietnam Memorial wall or even just listen to their stories. I had the fortune of being present for the reunion of two Veterans who had not fought in the war together, but worked at the same gas station in the years after the war. The two talked about the feeling of significance that they felt in their work during the war and the lost sense of purpose upon returning. Hearing the conversation reaffirmed the need to honor and respect Veterans regardless of one’s position on war. 
Welcoming and walking alongside the Veterans from the honor flight renewed my respect for Washington, D.C. and its symbol of freedom. Additionally, the experience helped me understand the need to continue to show respect to our Veterans of all wars for their service and dedication to protecting the independence of our country that we just celebrated on the Fourth of July. I cannot express my sincere gratitude enough for the National Hospice and Palliative Care Organization and the Honor Flight Network for the amazing opportunity.

By Kevin Curwick
Kevin is an intern working with NHPCO’s Access Team and We Honor Veterans program. He recently graduated from St. John’s University in Minnesota with a Bachelor of Arts in Integrative Health Science.  Kevin has done a lot of work at the Mayo Clinic, both as an undergraduate research assistant in their Pain Rehabilitation Center and as an undergraduate research fellow in their Department of Critical Care.

Every summer, NHPCO welcomes student interns who are involved in a wide range of projects for the organization and its affiliates. This summer, our three interns participated in an Honor Flight event in DC and we asked them to share their experience. This is the third in the series of three blogs from our interns.  See blog the previous blogs: "Some Wounds Never Heal"  and "Honoring American's Heroes."

Wednesday, July 12, 2017

Honoring America’s Heroes

Smiling faces, heavy hearts, and American patriotism was what I saw and felt as the honor flight Veterans emerged from the gate at the Ronald Reagan National Airport. I clapped, said “welcome to DC,” and waved my flag as I greeted the men who fought tirelessly for my freedom, and for the freedom of those around me. Watching them walk in, some more solemn then others, I couldn’t help but wonder what exactly was going through their mind as they stepped off that plane. How were they feeling about their time serving our country? Did they lose friends in the war? How did it cause them to suffer?  Some of their smiles, their waves, and their pride that radiated from their faces made my eyes fill with tears. I was filled with thankfulness as I honored their lives and their time spent serving our country. 

My favorite part of the day was spent at the Vietnam veteran’s memorial wall.  As I walked with the Veterans, I continued to think and wonder what was going on in their minds as they viewed the names of those who died, and the names of those who were not found. I couldn’t imagine the memories that the memorials were provoking and I thought about the bravery that it took for the Veterans to be there. Looking at their memorial was like looking their past, their service, and their dedication to our country in the face. Some may have thought of fond memories, while some could have thought of the worst memories of their life. I honored them as they faced whatever memories the war brought them as they walked beside the memorial wall. 

My heart was full as we continued the walk when one of the Veterans asked me to help him find the names of two of his friends who died in the war.  I pulled out my smart phone and found the location of his friends’ names on the wall and we found both of them. He shared with me the few memories he had with them, where they died, and why he wanted to see their names. I took a picture of him beside his friends’ names and I continued to be in awe of the bravery that it took to look the war that you served in, in the face.  I couldn’t fathom having to find my friends’ names on a wall that represented their death, and my survival. 

The honor flight experience placed me at a very reflective spirit. I left feeling grateful, inspired, and proud of those who served our country so well, and those who sacrificed so much so that the rest of us could live in freedom and in peace.

By Hannah Winters
Hannah is an intern working with NHPCO’s communications team this summer. She is a junior at Ball State University in Indiana working toward her Bachelor of Science in English Studies, with minors in Political Science in Professional Writing.  

Every summer, NHPCO welcomes student interns who are involved in a wide range of projects for the organization and its affiliates. This summer, our three interns participated in an Honor Flight event in DC and we asked them to share their experience. This is the second of three blogs that will run this week.  See blog #1, "Some Wounds Never Heal."