Monday, August 22, 2016

New Quality Reporting Requirement for Hospice Providers

The Centers for Medicare and Medicaid Service’s (CMS) posted the FY2017 Hospice Wage Index final rule on August 5, 2016 with updates to quality reporting for hospice providers that will be effective in 2017.

The FY2017 Hospice Wage Index final rule will bring some new and interesting changes to Medicare hospice quality reporting. While there will be no changes to the seven hospice item set (HIS) measures, CMS confirmed that two new quality process measures will be implemented in 2017. The two new measures include:

1.  Hospice Visits When Death is Imminent

This is a process measure pair that assesses hospice team member visits to patients and their family in the last week of life. The first measure of the pair assesses the percentage of patients who received at least one visit from either/and a registered nurse, physician, nurse practitioner, or physician assistant in the last three days of life for the purpose of case management and clinical care provision.  The second measure of the pair assesses the percentage of patients who received at least two visits from either/and a medical social worker, chaplain or spiritual counselor, licensed practical nurse, or hospice aide in the last seven days of life. This second measure in the pair allows providers flexibility to provide care that is individualized for the patient/ family’s preference and measurable goals of care. The process measure pair data will be collected as four new items on the HIS discharge record beginning April 1, 2017.

2. Hospice and Palliative Care Composite Process Measure

This quality process measure uses the current seven HIS measures as its components and calculates the percentage of patients for whom HIS admission records contain data on all seven HIS quality measures. The individual component of the composite measure is assessed separately for each patient and is then aggregated into one score for each hospice.

Final Reminders for Hospice Providers:

  • Providers who do not submit data to CMS per regulatory requirements will be subject to a two percentage point reduction to the market basket percentage increase for that fiscal year.  This includes failure to report HIS data and/or CAHPS data.
  • CMS confirmed the following compliance thresholds for the submission of HIS records in the final rule:
    • January 1, 2016 to December 31, 2016 - 70 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2018 payment
    • January 1, 2017 to December 31, 2017 - 80 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2019 payment
    • January 1, 2018 to December 31, 2018 - 90 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2020 payment
Members of NHPCO will find a comprehensive Regulatory Alert looking at the Final Rule available online.

By Jennifer Kennedy, MA, BSN, RN, CHC
NHPCO Senior Director, Regulatory and Quality

Wednesday, August 17, 2016

AHA releases Appropriate Use Compendium offering 5 Toolkits

The American Hospital Association’s Physician Leadership Forum and Hospitals in Pursuit of Excellence initiative has released a compendium to help hospitals, in partnership with their clinical staff and patients, to closely examine the appropriate use of medical resources for five hospital-based procedures or interventions.

The compendium offers a toolkit on each of the five areas:  blood management, antimicrobial stewardship, ambulatory care sensitive conditions, elective percutaneous coronary intervention, and aligning treatment with patient priorities for use of the ICU.

The toolkits are an outgrowth of the AHA white paper, “Appropriate Use of Medical Resources,” which recommends a way forward that will place hospitals at the forefront of innovative change for reducing the use of specific non-beneficial services while improving health care overall.

AHA collaborated with a broad group of national organizations and content experts that included National Hospice and Palliative Care Organization to produce each toolkit.

The new compendium is available at

Tuesday, August 16, 2016

New Edition of NHPCO's Pediatric E-journal Now Available

Communications with children and families is the theme of the new edition of the pediatric e-journal produced by NHPCO's Children's Project on Hospice/Palliative Services. This resource is available free of charge online.

These articles included in this edition of the e-journal offer suggestions for and examples of engaging in this important aspect of providing pediatric palliative/hospice care.

In the introduction, the e-journal editors write, "We appreciate that a single issue on this subject will not do complete justice to this very broad subject area, but we hope that the articles in this issue will spur increased awareness and discussion of this subject and we note that all communication is a cooperative enterprise with children, adolescents, their family members, the professionals, the volunteers, and the organizations involved in their care. We welcome communications from anyone who has more to offer on these subjects."

Download the PDF.

An archive of past editions of the pediatric hospice and palliative care e-journal is available also.

Monday, August 8, 2016

World Hospice and Palliative Care Day 2016

"Living and dying in pain: It doesn’t have to happen" is the theme of World Hospice and Palliative Care Day being celebrated on Saturday, October 8, 2016.

World Hospice and Palliative Care Day is a unified day of action to celebrate and support hospice and palliative care around the world. This year, World Hospice and Palliative Care Day theme tackles the critical issue of access to essential medicines for pain management and palliative care worldwide, and resonates with the advocacy work being done in the lead up to – and beyond – the United Nations General Assembly Special Session on the World Drug Problem.

According to the International Narcotics Control Board (INCB), 75% of the world’s population (5.5 billion people) does not have adequate access to controlled medications for pain relief.

As a result, millions of people suffer from pain which is avoidable and could be managed with proper access to the correct medications. Various barriers prevent people in need from accessing these essential medications. This year’s World Hospice and Palliative Care Day campaign will focus on three major barriers for access to pain relief:
  1. overly restrictive national regulations
  2. poor education of healthcare providers in relation to opioid medications; and
  3. economic barriers to availability of these medications.
Between the launch of the theme and World Hospice and Palliative Care Day itself, the WHPCA will provide case studies, advocacy resources, and examples of good practice to help you address these issues in your country and region.

You can find out more and access the Key Messages for this year on the World Hospice and Palliative Care Day webpage. Follow World Hospice and Palliative Care Day on the WHPCA Facebook page, as well as on Twitter. Join the conversation using the Twitter hashtag #WHPCDay16

Friday, July 29, 2016

"Hot" Topics Regulatory, Quality & Compliance Webinar

This has been a year of unprecedented activity on the regulatory and quality fronts for hospice providers.  NHPCO's Webinar on August 23 will help hospice providers stay up to speed on the latest burning issues in quality, regulatory and compliance.

Register for this Webinar, "Hot Topics: Sizzling News for the Field," to hear the latest news about the “hot” topics that are keeping U.S. hospice providers up at night starting with the Final Hospice Wage Index Rule for FY 2017.(See the proposed FY 2017 Rule on the CMS website.)

Hosted on Tuesday, August 23, 2016, 2:00-3:00pm ET, Webinar presenters will be NHPCO Vice Presidents and content experts Judi Lund Person, MPH and Carol Spence, PhD.  Judi and Carol will discuss the final rule’s rate increase and cap adjustments as well as provide updates on the new quality measures and data points for HIS. This Webinar also provides participants with an opportunity to ask NHPCO experts questions on the presentation. Additionally, this Webinar offers CE/CME Credit. 

Learning Objectives:
  • Discuss the Final Hospice Wage Index Rule for FY 2017
  • Describe rate increase and cap adjustments in the final rule
  • Identify the new quality measures and data points for HIS
Visit the NHPCO website to register today.

Thursday, July 14, 2016

Feature Your Program Successes at MLC 2017

NHPCO returns to the Washington Hilton for the 2017 Management and Leadership Conference from May 1 – 3. NHPCO is seeking proposals from hospice and palliative care experts designed to advance the knowledge, competence and performance of hospice and palliative care managers and leaders.

NHPCO’s 2017 Management and Leadership Conference learning objectives:

  • Strengthen executive leadership and management skills; 
  • Discuss innovative strategies to respond to changes in the regulatory, health policy and healthcare landscapes;  
  • Develop strategies to adapt to current reimbursement for hospice care and discuss options being considered for the future;  
  • Examine reimbursement options/models for palliative care service provision;
  •  Create organizational systems and processes to adapt to changing circumstances;
  •  Provide tools to ensure the provision of quality, evidence-based, ethical, effective and efficient end-of-life care;
  •  Analyze innovative approaches to improve access to hospice and palliative care by underserved and marginalized populations; 
  •  Highlight exceptional quality assessment and performance improvement practices.
Over 60% of MLC participants have 11+ years of professional experience in the hospice and palliative care field. Thus, proposals to be considered for this conference must be geared toward the expert (advanced) or proficient (intermediate) levels for seasoned hospice palliative care executives and leaders; preference will be given to these proposals. 

Advance leadership in the hospice and palliative care field by submitting a presentation proposal by Wednesday, August 17, 2016; MLC 2017 Proposals.

NHPCO returns to Washington, DC for the 2017 MLC.

Thursday, July 7, 2016

Community-Based Palliative Care

By K. Jeanne Dennis, MSW
Associate Consultant, NHPCO Edge

When the winds of change in health care blew our way many of us in hospice cheered, our time had come! Hospice was the one provider that was hitting the triple aim: better quality of health for a population of patients, better health care and at a lower cost. But are the health care providers and payers in our communities flooding our phone lines and email boxes to partner with us, learn from us, contract with us? In some cases perhaps, but mostly we are hidden in plain site, fighting for a seat at the table (with ACOs, DSRIPs, Medicare Advantage plans, PCMHs, etc.) What happened? Why is the hospice model of care not promoted as the solution to the problem of improving quality of care and saving health care dollars? Consider two reasons: Internal barriers and external competition. 

Internal Barriers: 
  • Unprecedented Changes in the core hospice business that require significant operational focus and resource allocation.
  •  Funding: with no distinct palliative care benefit, and the options of Medicare B and/or fund raising lacking the promise of a breakeven bottom line, the financial case is too hard to make.
  •  Infrastructure: Although a community-based palliative care service is anchored in the hospice model, it requires an investment in recruitment and education of staff, an EMR, policies and procedures, a marketing plan, and more.
  •  Strategic Positioning: with some notable exceptions, hospice programs did not have the planning and palliative care program structure ready to go.
  •  Value Proposition: participation in the new shared saving and risk sharing opportunities demands data that demonstrates value. Pulling this information is a challenge for many hospice providers.
External Competition: The lack of distinct Medicare Conditions of Participation or a benefit structure opened up the opportunity for palliative care innovation by other providers and by payers. For example:
  • Large health care systems are already creating post-acute services designed to manage patients in the community and reduce re-admissions
  • Physician groups (often part of a large system) are now expanding home visit and tele-medicine services
  • Major health insurance companies are implementing care management programs with the ability to scale beyond the usual boundaries of most hospice programs
  • New entrants in the field like Aspire Health, a for profit company founded in 2013, now providing community based palliative care in 11 states and the District of Columbia. Aspire has the advantage of a well-known Board Chair, Bill Frist, MD, former Senate Majority Leader and $21m in venture capitalist funding.

The good news is that it’s not too late to succeed. Community-based palliative care is in our DNA, and the opportunity to shape the future of care for a vulnerable population is now. The innovation in palliative care that’s happening among hospice providers is encouraging and exciting. For hospice leaders this service is emerging as a top strategic priority. Hospices are now taking action aimed at clearing the barriers. Record-breaking attendance at NHPCO’s Palliative Care offerings at the recent MLC is evidence of the energy and interest in adapting the hospice principles, practices and proficiencies to meet the care needs in the community and the mandates of the new value based payment models.
NHPCO is committed to leading these efforts and NHPCO Edge is here to provide support and consultation.

This post was written by K. Jeanne Dennis, NHPCO Edge Associate Consultant. NHPCO Edge is proud to count Jeanne among our expert consultants, as she brings decades of experience in hospice leadership. For more info, see NHPCO Edge online.

See our previous NHPCO Edge blog, "Using Metrics for Marketing."