Wednesday, August 27, 2014

Children with Medical Complexities: Free e-journal

A new edition of the free e-journal published by NHPCO's Children's Project on Palliative/Hospice Services is available online. Children with Medical Complexities, Part One (Issue #36; August 2014) is a free e-journal published by NHPCO’s Children’s Project on Palliative/Hospice Services. This new edition is a collection of articles focused on caring for children with medical complexities. This is the first of two editions looking at this important topic.

As noted in the introduction of one of the articles, “Medically complex and fragile children with progressive diseases present unique and complex challenges for their medical management that require coordination, flexibility, and consistent community…between the family, hospice and medical teams.”

Alison Kirkland, a mother who wrote the article “After the Unexpected Happens,” shares her personal insight: “Despite the heartache and stress, parenting a child with medical complexities can be one of the most joyful and rewarding experiences of your life.”

Additional articles in this issue include:
•    Caring in Uncertainty: Children and Families with Genetic Conditions
•    The Partnership between Palliative Medicine and Children with Medical Complexity
•    Complex Care Coordination
•    Pediatric Palliative Care and Pediatric Surgery: Common Issues
•    Staff Bereavement in Palliative Pediatric Care

Visit the archive page of the ChiPPS e-journal/e-newsletter page on the NHPCO website for access to previous editions of this publication.

Tuesday, August 5, 2014

New Legislation Introduced to Promote Appropriate Hospice Oversight

Legislation requiring more timely surveys of Medicare-certified hospice care programs was introduced on Friday, August 1, before the House of Representatives adjourned for the August recess.  Led by Congressmen Tom Reed (R-NY) and Mike Thompson (D-CA), the Hospice Opportunities for Supporting Patients with Integrity and Care Evaluations (HOSPICE) Act, HR 5393, is being well-received by the hospice community.

The National Hospice and Palliative Care Organization enthusiastically supports this new legislation and applauds the work of Congressmen Reed and Thompson who are strong champions of hospice care.
The HOSPICE Act would require that hospices be surveyed no less frequently than every three years and authorizes funding for CMS to contract for the additional oversight.

The Office of the Inspector General (OIG) examined hospice survey frequency in 2007 and 2013 and found that the existing intervals and resources were inadequate.  The mandatory survey frequency in HR 5393 is consistent with the OIG recommendations.

Additionally, the new bill will make a technical correction to allow for implementation of existing law requiring CMS to conduct a medical review of hospice programs that reach to be determined threshold of patients under care for more than 180 days.  The threshold would be established by CMS.  NHPCO has supported this provision since it was originally recommended by MedPAC in 2009. 
“These are two important program integrity provision that have long-been supported by NHPCO.  The hospice community is very serious about compliance and protecting the quality of care that is promised by the Medicare Hospice Benefit,” said J. Donald Schumacher, NHPCO president and CEO.

This new bill builds on a provision from the HELP Hospice Act (HR 2302/S 1053) that addresses mandating hospice surveys as a critically important program integrity piece.

Friday, August 1, 2014

2014 Circle of Life Award® Presented

National Hospice and Palliative Care Organization and the National Hospice Foundation honor the recipients of the 2014 Circle of Life Award®.  Presented on July 21 at the American Hospital Association’s annual summit held in San Diego, the award celebrates innovation in end-of-life care and highlights programs that demonstrate superior vision, depth, and scope. 

The 2014 Circle of Life Award honorees are:
  • Baylor Health Care System Supportive and Palliative Care Services, Dallas, Texas
  • Lehigh Valley Health Network, Allentown, Pennsylvania
  • Yakima Valley Memorial Hospital and Foundation, Yakima, Washington
In announcing the honored recipients, AHA emphasized that the programs share overriding themes of creating and championing the role of palliative care through the community.

In addition to the three award winners, AHA presented a Citation of Honor to the Center for Palliative and Supportive Care, Ambulatory Program, University of Alabama at Birmingham.

“These programs serve as models for us all as we move forward in our shared goal of providing the highest quality of care for all those we serve,” said J. Donald Schumacher, NHPCO and NHF president and CEO. “We are proud to celebrate those care providers that are leading the way in innovation and quality care delivery.”

Since 2000, the Circle of Life Award has honored programs that demonstrate excellence and innovation in palliative and end-of-life care. Further information about the honorees and the Circle of Life Award is available at the AHA website.

The National Hospice and Palliative Care Organization and the National Hospice Foundation are major sponsors of the 2014 award, as is the American Hospital Association and the Catholic Health Association of the United States.

Left to right: Dr. Jonathan Perlin, American Hospital Association Board; Dr. Elizabeth Kvale, University of Alabama Birmingham; Diane Patterson, Yakima Valley Memorial Hospital; Donna Stevens, Lehigh Valley Health Network; Dr. Robert L. Fine, Baylor Health Care System; Mary Starmann-Harrison, AHA’s Executive Committee.

Friday, July 18, 2014

New CMS Guidance Issued on Part D and Hospice

Since March, the National Hospice and Palliative Care Organization has been working with the hospice community and many Congressional champions to halt implementation of a Medicare Part D policy that resulted in dying patients unable to get necessary medications under their Part D benefit. These efforts have been successful.

Today, the Centers for Medicare and Medicaid Services issued revised, interim guidance for hospice providers and Part D sponsors pertaining to Medicare beneficiaries who are receiving hospice care and are also enrolled in Part D.  The intention of the Medicare Part D policy is to prevent the federal government from paying for medications under Part D that are related to the terminal illness and should be the responsibility of the hospice.

This new Part D guidance substantially modifies guidance first issued on March 10, 2014 which generated confusion and concern for hospice providers and Part D sponsors, and most importantly, prevented hospice patients from accessing needed drugs.

An NHPCO survey of hospice professionals found the policy often left Medicare beneficiaries without needed medications unrelated to the terminal illness once they had elected their Medicare hospice benefit. Other dying patients either revoked or refused the hospice benefit, foregoing this compassionate care, in order to maintain access to medications unrelated to their terminal prognosis.
Since the March implementation, dying hospice patients and their family caregivers found themselves caught in the middle of the policy which many in the hospice community called well-intentioned yet misguided.

The revised guidance instructs Part D sponsors to use prior authorization only on four categories of drugs that are generally used to treat symptoms of pain, nausea, constipation and anxiety commonly seen in hospice patients. Prior authorization requirements on other categories of drugs will no longer be required from Part D sponsors.

The modified guidance was issued after months of intense discussion with CMS, Congress, and other stakeholders on the problems with the March guidance and a request from NHPCO to temporarily suspend the guidance until the issues could be resolved.
“We are pleased that CMS has taken this step to revise the March 10 guidance in keeping with the 2012 OIG report.  It will reduce the confusion for hospice providers and will allow patients to get their medications when they need them,” said J. Donald Schumacher, NHPCO president and CEO.
“As frontline caregivers, the hospice community led the effort to educate Congress and engage with stakeholders to halt the policy.  With this change, patients and their families will no longer be caught in the middle of troublesome policy and stakeholders can implement an interim solution that can more easily be understood by all providers,” Schumacher added.

NHPCO does not dispute hospices’ responsibility in paying for all medications and care related to patient’s terminal prognosis and will continue working to educate the hospice community on better navigating this intersection. 
CMS and all stakeholders will continue working to identify a more permanent solution to this Part D and hospice intersection.  Added Schumacher, “We remain committed to working collaboratively with all stakeholders to ensure that hospice patients receive the medications they need for comfort and quality of life and do not have to experience confusion and delay as they are facing the end of life.”

Tuesday, July 1, 2014

Focused Advocacy and Congressional Sign-on Letters Further Highlight Part D Issue

July marks the entry into the third month of implementation of the damaging policy involving Medicare Part D and hospice patient medications.  In response, the National Hospice and Palliative Care Organization reports a surge in advocacy activity to halt the negative consequences on dying Medicare beneficiaries
The poorly conceived policy issued by the Centers for Medicare and Medicaid Services, with a May 1, 2014 implementation date, was designed to prevent duplicate payments on medications for hospice patients. The unintended result of this policy is causing many dying Americans to forgo necessary medications that should be covered under Medicare Part D.
Through the efforts of Hospice Advocates across the nation, both Congress and CMS have heard what this misguided policy is doing to the patients and families being cared for by hospice providers.
“Coordinated advocacy efforts have brought some positive results but not a halt to the implementation of this policy,” said J. Donald Schumacher, NHPCO president and CEO. “Yet, even one patient at the end of life who suffers needlessly from this policy is one too many. It’s heartbreaking that CMS has failed to recognize the urgency of protecting these vulnerable patients.”
Congressional sign-on letters circulated by Senators Rockefeller and Roberts (PDF) and Representatives Reed and Thompson (PDF) emphasized the call for CMS to act.
The letters were signed by 75 Senators and 202 Members of the House of Representatives. Nineteen out of 24 Members of the Senate Finance Committee, which has jurisdiction over hospice in the Senate, and 26 out of 39 Members of the House Ways & Means Committee, which has jurisdiction over hospice in the House of Representatives, signed on to these letters.
Additional measures calling on CMS to stop implementation of the Part D policy include:
Additionally, last week, even the Medicare Payment Advisory Commission (MedPAC) commented on the guidance, and suggested that the guidance be suspended until a streamlined process, that does not impact the Medicare beneficiary, can be implemented.
For more information on this issue, please visit the Hospice Action Network’s Hospice & Part D webpage at

Tuesday, June 17, 2014

Call to Action: Contact your legislators to support hospice care!

Today, you can make a tangible difference for hospices across the nation. Hospice Action Network and the National Hospice and Palliative Care Organization are encouraging all hospice supporters to call their Members of Congress and voice their concern about the Hospice & Medicare Part D issue.

On June 17, over 240 of your fellow Hospice Advocates, representing 47 states and districts, and every discipline in the IDT, are in Washington, DC, visiting more than 300 Congressional offices to call for support of hospice.

Advocates on Capitol Hill will request that Congress ask CMS to temporarily suspend the Part D implementation for hospices- and Americans across the national are needed to convey this same message from their homes.  

The Hospice Action Network has created an easy to use online "Click to Call" Campaign that will help people understand the issue and then connect them to their Congressional representatives. The whole process should take no longer than 30 minutes, start to finish- that’s all it takes for you to make a difference.

To watch our video, which explains the Part D policy changes, and how the calling system works to connect you to your Members of Congress, visit this special page of the Hospice Action Network website.


Monday, June 9, 2014

CMS Part D policy hurting hospice patients and families

A hospice patient in Oklahoma City is being denied his medications to treat his COPD, while coping with a diagnosis and treatment for tongue cancer.  In Cadillac, Michigan a patient struggling with colon cancer is being denied insulin to treat his diabetes and is in danger of diabetic shock.

Due to a recent and poorly thought out Medicare Part D Prescription Drug policy, dying patients are revoking hospice services to maintain access to other necessary prescriptions for diseases unrelated to their terminal illness that Part D have paid for until recently. 

Patients’ families are left at the pharmacy counter with no refill of medications, after the pharmacist announces that because the patient is on hospice, the pharmacy is no longer allowed to fill their prescriptions – which in not accurate.  Or they are going days, sometimes weeks, without the necessary medication to manage symptoms that were present before they elected the hospice benefit due to unnecessary complications in approving prescriptions under Part D.

The intention of the new Medicare Part D policy implemented by the Centers for Medicare and Medicaid Services is to prevent the federal government from incurring duplicate costs for medications of hospice patients. 

The National Hospice and Palliative Care Organization has strongly opposed the inadequate and haphazard implementation of this guidance. 

NHPCO agrees that hospice providers should be held responsible for all drugs that are related to the terminal diagnoses and those drugs that are unrelated should be billed to Medicare Part D.  

NHPCO acknowledges that there have been instances of Part D payment for drugs that should have been covered by the hospice provider under the Medicare hospice benefit. 

NHPCO continues to encourage CMS to halt the implementation of the Part D guidance and convene key stakeholder groups to collaborate and create a strategic and uniform process.  An effective solution can be reached so that Part D providers, pharmacists, hospice providers and beneficiaries have developed a coherent process together and hospice patients are not denied the medications they need at the end of life.