Congress Supports Hospice Community Regarding Part D issues.

Yesterday (12/16/13), Congressmen Tom Reed and Mike Thompson sent a letter to Marilyn Tavenner, the Director of the Centers for Medicare and Medicaid Services (CMS). The letter urged CMS to slow down on their recent initiatives regarding Part D and hospice (read this letter online).

This is a direct result of the Hospice Advocacy from the our provider community. The letter contained signatures from 42 Members of Congress from the House of Representatives. Of those 42, two were physicians, and most notably 14 were on the House Ways & Means Committee.

Why does this matter? The Ways & Means Committee has jurisdiction over Medicare issues, including hospice. Ways & Means members can be reluctant to sign on to letters of this nature, but your grassroots relationships coupled with the seriousness of the issues surrounding hospice and Part D were enough to overcome that/ Congratulations are in order for the entire hospice community.

What happens next? The hospice community has now very publicly weighed in on this issue, and (with your help) so has Congress. CMS is currently accepting comments on their draft memorandum through January 6, 2014. NHPCO is collecting case studies of how this guidance would affect hospices. If you are an NHPCO member, please submit comments to regulatory@nhpco.org.

NHPCO and its affiliate organization, the Hospice Action Network, is monitoring several year-end issues here in DC including the ‘SGR’ packages, the budget agreement, and this Part D issue, among others.

Our  work as the voice of hospice on Capitol Hill will continue, and we - along with Hospice Advocates and our supporters - will keep fighting for increased access to hospice care in the United States.

2014 Innovation Forum: Discuss challenges and solutions with EOL peers!

NHPCO's 2014 Innovation Forum is a special event being held in Miami on January 21-23, 2014 that will allow participants to discuss challenges in the field, look at issues of relevance and explore possible solutions and practical models.  The intimage nature of the forum will allow a lot of discussion and networking with other participants.

Also, it's an ideal time to escape the winter weather and enjoy the Florida sun while networking with professional colleagues and discussing end of life care.

You now have until December 15 to register for the Innovation Forum at the early-bird registration rate.

Featured speakers include:  John R. Brandt; Nicholas A. Christakis, MD, PhD, MPH; Joe Flower; Donald Schumacher, PsyD; and William H. Thomas, MD.

Learn more about the Innovation Forum: http://www.nhpco.org/education/2014-innovation-forum

Growing Minority of Americans Say Doctors Should Do Everything Possible to Keep Patients Alive - Pew Research Reports

At a time of national debate over health care costs and insurance, a Pew Research Center survey on end-of-life decisions finds most Americans say there are some circumstances in which doctors and nurses should allow a patient to die. At the same time, however, a growing minority says that medical professionals should do everything possible to save a patient’s life in all circumstances.

The information release by PEW Research looks at a wide range of issues including Physician Assisted Suicide, patient self-determination and the impact religion can play on end-of-life choices.

Learn more: http://www.pewforum.org/2013/11/21/views-on-end-of-life-medical-treatments/

New Showtime Documentary "TIME OF DEATH"

TIME OF DEATH debuts on Showtime, Friday November 1 at 9:00pm ET/PT. It shares stories of real people face to face with their own mortality.

What are the final weeks, days and very moments of life really like? TIME OF DEATH offers an unflinching, intimate look at remarkable people facing their own mortality. Cameras follow these brave, terminally ill individuals as they live out the end of their lives, supported by family, friends, and dedicated healthcare and hospice workers who gently guide the process.

This groundbreaking documentary series provides a tangible, hopeful reminder of the finite nature of our time here on earth.

Learn more at http://www.sho.com/sho/time-of-death/home.

There Is Treatment: What Chronic Pain Sufferers Need To Know

An Op-ed by J. Donald Schumacher, PsyD

Today and every day, 56 million Americans try to get by in a condition of chronic pain. That's more than one of every five adults.

Yet in many cases, their suffering is undue. Those with chronic pain often do not receive medication or treatment that could safely alleviate their pain.

The simple truth is that pain can be relieved in most cases. Afflicted patients and their families should insist that their healthcare providers control and treat their pain accordingly.

The vast majority of those with chronic pain are not terminally ill. Some suffer from severe back or neck pain or from debilitating migraines. Others may have arthritis, multiple sclerosis, fibromyalgia, shingles, or nerve damage.

The afflicted are of all ages. Those most affected by chronic lower back pain, for instance, are typically between 30 and 50 years old.

And chronic pain isn't just physical. Patients also have to grapple with feelings of despair and isolation.

Despite the scope of the pain epidemic, many doctors are wary of dispensing medication because they fear that patients will become addicted. Some point to the fact that one in five Americans reports misusing a prescription drug at least once in his or her lifetime.

But their fears are overblown. Just 4.5 percent of those without a predisposition toward alcohol or drug addiction who were prescribed painkillers developed a dependency.

Doctors also tend to look at pain as a symptom of an underlying problem -- thinking that if they can find and treat that problem, the pain will go away.

But according to a recent report from the Institute of Medicine, chronic pain itself can be the problem. Such pain can cause changes in the nervous system that worsen over time -- even after the original source of the pain has gone away.

Because many doctors are not properly trained in the study of chronic pain, patients often suffer unnecessarily. One study of nursing home residents with chronic pain found that 44 percent were not getting any treatment at all.

In some cases, the need for pain treatment may not be obvious. Older patients, especially those with dementia, often struggle to communicate their needs.

Yet according to a report from the Hartford Institute of Geriatric Nursing at New York University, the burden to communicate with patients who may be in pain does not rest with the patients. Clinicians must take on that duty. They can do so by learning to identify non-verbal behaviors, such as "agitation, restlessness, aggression, and combativeness," which "are often an expression of unmet needs."

Old age must not become an excuse for the failure to pursue effective treatment for pain.

Of course, patients must assume some responsibility for treating their pain, too. Approximately 50 percent of patients do not take their medication as prescribed. Many mistakenly wait for pain to recur before administering another dose. Such on-again, off-again treatment just results in cycles of pain -- rather than preventing it altogether by maintaining adequate levels of medication in the bloodstream.

Patients should also educate themselves about available treatment options and the risks of possible drug interactions. And they must talk candidly with their doctors about their needs and the effects of the treatment they are receiving. Too often, patients settle for a little bit of pain relief when more is possible.

Patients who are not getting adequate relief should ask their doctors about palliative care or availability of pain clinics, where specialists may be able to suggest more effective treatment options. Many patients have benefited from keeping a pain diary to which they and their doctors can refer when devising a treatment regimen.

Whatever the condition causing the pain, the person best equipped to take the lead in finding the proper treatment is the sufferer. People know their own bodies, and they can judge when medications are inducing unwanted side-effects.

No one deserves to be incapacitated by chronic pain. The means to alleviate it are available. All that's required is the will to find the right treatment.

J. Donald Schumacher is President and CEO of the National Hospice and Palliative Care Organization.

Nominations Now Open for REAL Awards

The REAL Awards is a first-of-its kind awards platform that honors frontline healthcare workers who are providing life-saving care around the world.

Created by Save the Children and the Frontline Health Workers Coalition, the goal of the Awards
is to demonstrate the universal and urgent need for more trained workers since, by some estimates, the world is short more than 5 million!

While the award categories change from year to year, hospice care was a featured category in 2012
— and Carri Butcher from Hospice of the Ozarks was honored.

Nominations are now being accepted for the 2013 Awards. As a proud supporter, NHPCO encourages all members to take a closer look and consider making a nomination in the hospice category.  Please note: The deadline for submissions is coming up - it's October 25, so act fast!

Visit: http://therealawards.com/.

Virtual Conference: Loss, Grief and Bereavement

A Conference that Comes to You and Fits Your Schedule

The National Hospice and Palliative Care Organization's Virtual Conference: Loss, Grief and Bereavement will bring nationally recognized experts in the field of loss directly to your organization or community via live Internet broadcast.The online event will offer all the benefits of an in-person conference without the added time and expense of travel.

The focus is on the loss, grief and bereavement needs of patients, families and communities.

Registered sites have access to the recorded conference content for three months allowing you to take advantage of the conference when it suits your schedule. Invite community partners and other stakeholders to your organization or meeting center and share the components of the conference that resonate most strongly with those you are caring for and working with.

The conference includes:

• Live-broadcast plenary sessions featuring national recognized speakers
• Concurrent sessions featuring leaders from the field
• Ignite sessions (Quick, succinct and “to the point” presentations)
• Networking opportunities
• Virtual exhibit hall featuring national vendors

November is National Hospice and Palliative Care Month - a great time to reach out and host some educational outreach events!

Join thousands of hospice and palliative care professionals who will be a part of this national event from the comfort of your own office.

Registration is now open!

There is a special registration category for non-profit and for-profit community organizations. Visit the conference website for more information.

Vincent Mor Receives NHPCO Distinguished Researcher Award

Vincent Mor, PhD, MED, professor of Medical Science, Heath Services, Policy & Practice at Brown University was awarded the National Hospice and Palliative Care Organization’s 2013 Distinguished Researcher Award.

 

Many in the U.S. hospice community are familiar with Mor’s work from the mid-1980’s when he headed the National Hospice Study – the initial evaluation of the impact of hospice care under the then new Medicare hospice benefit – on the cost and quality of life outcomes experience by terminal care patients.  He continues to influence policy maker’s decision-making for hospice today.

 

Most recently, Mor and his Brown colleagues have documented large regional variation in hospitalization rates, including end-of-life transitions and the use of hospice and palliative care.

 

He has led contracted government projects related to aging and long term care such as patient outcomes in nursing homes and a national study of residential care facilities. Mor was one of the authors of the Congressionally mandated Minimum Data Set for Nursing Home Resident Assessment.

Mor has been principal investigator of nearly 30 NIH-funded grants as well as awards from the Robert Wood Johnston Foundation, The Commonwealth Fund, and other private foundations.

 

Mor was presented with the Distinguished Researcher Award by NHPCO President and CEO J. Donald Schumacher, PsyD, at the Friday morning conference plenary session where more than 1,000 hospice and palliative care professionals are gathered to explore innovation and excellence in clinical end-of-life care delivery.

“For thirty years, Vincent Mor’s research has focused on the impact of health care services on quality of care and outcomes for frail and chronically ill patients and his many contributions have improved the care many people have received,” said J. Donald Schumacher, NHPCO president and CEO. “One of the most important things we as a professional community can do is to shine a light on individuals who have contributed much to the work we are doing to care for those at life’s end.” 

 

The Distinguished Researcher Award was created by NHPCO to recognize an outstanding body of research that has contributed to the enhancement of hospice and palliative care.

 

Dr. Vincent Mor (R) Receives the Distinguished Researcher Award from NHPCO's Don Schumacher.

 

Dispelling Myths about Pain during Pain Awareness Month

The misconception that pain is a natural part of aging or illness and those who suffer must live with it is a common myth that leaves millions of people in pain every day. There is almost always a reason why a person is experiencing pain and in most cases physical pain can be managed.  

Hospice and palliative care professionals—experts in helping patients and families cope with pain—know from experience that pain can take away peace of mind, comfort, enjoyment, and most of all hope.

September is National Pain Awareness Month and helping people learn the truth about pain and what can be done to manage pain is the focus of the National Hospice and Palliative Care Organization’s campaign, LIVE Without Pain.

“When someone is in pain, it can be impossible to think about anything else,” said J. Donald Schumacher, NHPCO president and CEO. “Pain can make it difficult for you to work, sleep, maintain relationships with friends and loved ones and participate in simple activities.”

Physical pain is only one aspect of suffering.  Emotional and psychological suffering is also an important factor that must be considered. 

 “Good pain management improves quality of life and in most cases it is possible to manage pain and that’s why we want to increase public awareness about the issue,” explained Schumacher.

Some advice from professionals who help patients and family caregivers deal with pain:

·         In order for the doctor or other healthcare provider to determine the best way to control pain, they rely on what patients and family caregivers tell them, so communication is important.

·         Pain in older adults, just like pain in any other age group, is the body’s way of saying that something needs attention. Pain is a signal that it is time to talk with a doctor or other caregiver and seek help.

·         Pain associated with a life-limiting illness or at the end of life requires special attention and can best be treated by a palliative care or hospice provider.

LIVE—Without Pain resources are available free-of-charge from NHPCO’s Caring Connections at  www.CaringInfo.org/pain. You can learn about different kinds of pain, caring for someone in pain, talking with your physician, managing medications and more.

Royalties from New Book by Judith Fox to Benefit Hospice

On September 3, a new book was released by the award-winning photographer and author, Judith Fox. One Foot Forward: Stories and Faces of Widows and Widowers explores the poignant stories and portraits of 20 widowed women and men who have grieved and persevered in the face of losing their spouses to sudden death and chronic illness.

Fox is donating 100 percent of her royalties from this book to the National HospiceFoundation.

Fox comes to this topic from deep personal experience. She lost her first husband, Jerry, to an aggressive cancer in 1992, and for the past 15 years has cared for and advocated on behalf of her second husband, Dr. Ed Ackell, who was diagnosed with Alzheimer’s disease just three years after they married.

In 1998, after a successful career as a business leader and entrepreneur in both New York and Virginia, Fox returned to an earlier career in photography. Her first book, I Still Do: Loving and Living with Alzheimer’s, focuses on both her and her husband’s experiences with the disease and caregiving.

She explains the impetus for creating One Foot Forward:  “Because I was widowed before, it’s difficult not to think about the pain that I know is ahead of me when Ed dies. Writing One Foot Forward was a way to find some personal comfort as Ed’s life is coming to an end. I wrote the book that would have helped me and I hope will help others.”

“Death is an inevitable—and very difficult—part of life. But if we are fortunate enough to love and to have a significant relationship, one of the individuals in the relationship is eventually going to be widowed. So we might as well learn to talk about death and grief, and understand what it’s like to live through,” said Fox.

Fox selected NHF as the recipient of her royalties because she believes in the hospice and palliative care mission and wants to support work at the national level. She notes further, “Both my parents benefited from hospice care and my husband is currently being helped—as am I—by compassionate people at The Elizabeth Hospice in San Diego.”

“We are overwhelmed at Judith’s generosity and commitment to support the work of the National Hospice Foundation,” noted J. Donald Schumacher, NHF president and CEO.

To learn more about Judith, her new book, One Foot Forward, and her other works, visit www.judithfox.com.

To order her book and support NHF, see One Foot Forward on Amazon.com.

Outcome Resources Helps Bring Advocates to the Intensive

Outcome Resources, a Pharmaceutical Benefit Manager (PBM) exclusively serving hospices, has helped many of NHPCO’s programs over the past five years.

Most recently, they have offered their support to the Foundation of Hospices in Sub-Saharan Africa’s “From San Diego to Africa” event as well as the National Hospice Foundation’s Run to Remember and the annual Gala. Their financial support for these events has allowed hospice patients and their families in both Africa and the United States to receive quality hospice care.

Dr. Martin McDonough founded Outcome Resources in 2000 to provide expertise to hospices on pain and symptom management. The firm helps hospices in reducing costs and increasing the quality of patient care. They have served as a very useful resource for NHPCO and our member hospices around the country. As Autumn Spence said in her opening remarks at the HAN Advocacy Intensive, everyone at Outcome Resources has a professional commitment to helping hospices succeed. This dedication shows in the satisfaction of customers nationwide.

This year, thanks to the generosity of Outcome Resources, ten advocates whose hospice programs would otherwise be unable to afford it were able to attend the Hospice Action Network’s Advocacy Intensive. HAN and NHPCO are incredibly grateful for their sponsorship.

The stories these advocates had to tell to their congressmen on the Hill, like all hospice stories, are very important, and if not for Outcome Resources, these stories would have gone unheard.

Penelope Gatlin from Outcome Resources with HAN Scholarship Recipients.

 

CMS Publishes Final Hospice Wage Index Rule - Many Provisions Included.

On Friday, August 2, the Centers for Medicare and Medicaid Services (CMS) posted the final FY2014 Hospice Wage Index rule.  This rule provides critically important information to providers on the following:

 1. Guidance on how hospices are to report multiple diagnoses on hospice claims
 2.Guidance on the discontinuation of the use of “debility” and “adult failure to thrive” as primary diagnoses
 3.Directives to MACs to begin the “Return to Provider” RTP process on and after October 1, 2014 for claims submitted with “debility” or “adult failure to thrive” as primary diagnoses
 4.Guidance on changes to coding for dementia diagnoses
 5.Guidance on changes in the requirements for hospice quality reporting, including discontinuation of data collection and reporting for the QAPI structural measure and NQF #0209
 6. Implementation of a Hospice Item Set (HIS) with seven National Quality Forum (NQF) endorsed measures, beginning July 1, 2014
 7.Implementation of a Hospice Experience of Care Survey beginning January 1, 2015
 8.Update on hospice payment reform

NHPCO members will find a comprehensive Regulatory Alert posted online.

Sens. Warner & Isakson Introduce Bipartisan Care Planning Act of 2013

WASHINGTON – U.S. Sens. Mark R. Warner (D-VA) and Johnny Isakson (R-GA) introduced legislation today designed to give people with serious illness the freedom to make more informed choices about their care, and the power to have those choices honored. The Care Planning Act of 2013 creates a Medicare and Medicaid benefit for patient-centered care planning for people with serious illness. It will reimburse a team of healthcare professionals for providing a voluntary, structured discussion about the patient’s goals, illness, and treatment options. A written plan will reflect the informed choices made by patients in consultation with their health care team, faith leaders, family members and friends. The Care Planning Act also provides resources for public and professional education materials about care planning.

“When faced with a serious illness, you want the freedom to control how you will live. The Care Planning Act will help align the care you receive with the care you want – no more, no less,” Sen. Warner said. “People don't like to talk about sickness or death, and families tend to put off confronting what might happen if individuals become seriously ill or unable to make decisions about their own medical care. This patient-centered approach will help your doctors and your hospital know about the choices that you and your loved ones have made. If a patient prefers to explore every possible treatment option, that choice should be respected. And if an individual prefers a different approach after informed consultations with their health team, their family and others, those choices should be documented and honored, too.”

Read the full release on Senator Warner's website: http://www.warner.senate.gov/public/index.cfm/bloghome.

Make the Voice of Hospice Heard on Capitol Hill Today

The Hospice Action Network's Advocacy Intensive is in full swing.

Today is the day that more than 320 Congressional offices will meet with Hospice Advocates, hear their stories, and be asked to protect and support hospice! But before Hospice Advocates storm Capitol Hill, they will be energized at a Pep Rally featuring Congressman Tom Reed of New York, Congressman Chris Van Hollen of Maryland, and others! You can view the Pep Rally live at 8:45am ET by following this link.

Don’t forget: you can take part in the Advocacy Intensive from home! You can extend the reach of the message of the hospice community, by submitting an email to YOUR Members of Congress. The meetings Members of Congress will have today, combined with your email support of the same message, will together make our voices heard and stories remembered. Click here to send an email now!

Remember: HAN staff will be sharing updates throughout the day on Facebook and Twitter @HospiceAction, hashtag #AdvocacyIntensive! Cheer on your friends and colleagues, see how the day is going!

CMS Final Rule on Hospice Care in Nursing Homes

On Thursday, June 27, 2013 CMS published the final rule regarding requirements for long term care facilities when they enter into an agreement with a hospice to offer hospice services to residents of the facility.

This final rule is the long awaited companion to §418.112 of the Hospice Conditions of Participation, published in June 2008, that set forth the requirements for hospices when hospice care is provided in a SNF/NF or ICF/MR. This newly published final rule outlines the parallel regulations for long term care facilities (LTC facilities) when hospice care is provided to a LTC facility resident. CMS intent was to make the facility rule (§483.75(t)) as consistent with the hospice rule (§418.112) as possible to provide “regulatory clarity for both providers to eliminate duplication of and/or missing services.”

CMS states that the purpose of this rule is to “ensure the coordination of care for LTC facility residents who elect hospice services. The coordination of care is anticipated to result in better outcomes related to quality of care and quality of life for residents. With appropriate coordination of care, we anticipate improved outcomes through more efficient coordination of care between the LTC facility staff and hospice staff, a decrease in duplication of services provided, and improved resident care.”

Resources about the new rule are available from CMS:

• Nursing Home Surveyor guidance in Appendix PP for F309, Quality of Care.
• Survey and Certification Letter 12-48 NH
• Nursing Home Surveyor guidance in Appendix PP for F155, Advance Directives

Members of the National Hospice and Palliative Care Organization will find additional resources to help providers ensure compliance with the new rule.

2013 Advancing End-of-Life Care Access Award

NHPCO's Advancing End-of-Life Care Access Award recognizes provider initiatives that have significantly increased the type, scope, or range of services offered to and used by a traditionally underserved population.

Eligibility:  This award is open to NHPCO Provider Members.  The program to increase access must be fully implemented for more than 12 months and there must be data to demonstrate concrete outcomes.  Further, the program should be based on a project plan that defines the target population, objectives, strategies, outcome measurement, and intended impact.

Learn more on the NHPCO website.
http://www.nhpco.org/membership/2013-advancing-end-life-care-access-award

CMS Health Care Innovation Awards - Round Two

CMS has announced a second round of funding under the Health Care Innovation Awards. CMS will spend up to $1 billion for awards and evaluation of projects from across the country that test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program enrollees.

In this second round, CMS is seeking proposals in the following categories:

• Models that are designed to rapidly reduce costs in outpatient and/or post-acute settings.
• Models that improve care for populations with specialized needs.
• Models that test approaches for specific types of providers to transform financial and clinical models.
• Models that improve the health of specific populations.

Applicants must submit a non-binding letters of intent to apply by June 28, 2013; 3:00pm EDT.

More information on CMS Grants Notice CMS-1C1-14-001 is available online at the grants.gov website.

Devastation in Oklahoma: A Message from Don Schumacher

The destruction caused by the violent tornado that hit Oklahoma earlier this week – and in the violent storms occurring due to the severe weather conditions in our nation’s heartland – is overwhelming. Particularly heart wrenching is the devastation and loss of life seen in Moore, Oklahoma.

As the full impact of the devastation continues to unfold, NHPCO extends its thoughts and prayers to all those whose lives have been affected.  As hospice and palliative care professionals, we recognize the significance of loss within a person’s life, we also understand how those not directly affected may identify with victims and struggle with their emotions. Ultimately, tragedy can show people they have more resiliency and strength then they realized.

For those programs and professionals providing care, we offer our respect and admiration for the challenges faced in continuing to provide the compassionate services that are the hallmark of hospice palliative care. And to all hospices and palliative care programs forced to reach beyond their previously known limits, we salute you. We honor your dedication to serve beyond what could ever be expected.  Your commitment and courage reflect positively and shine a bright light on all those providing and receiving care. 

I also salute the first responders who were on the ground as soon as the tornado lifted to help those in need. There are many moving examples of neighbors coming to the aid of neighbors and the broader community. While we cannot stop the forces of Mother Nature, we learn that the care and support of family and friends is essential. 

NHPCO is reaching out to the state organization and other contacts in the region to get an assessment of how the hospice palliative care community has weathered this disaster. The needs of those who have been hurt and the extensive damage done to homes and businesses will take time to address, and those needs will be significant.

When our country suffers a disaster like this, all attention seems to focus on the devastation and loss. At a time like this it is so important that we monitor how our children may be affected by what they may be seeing on television or news reports. And even for those of us who are fully grown, it’s important that we take note of how the images of destruction might be impacting each one of us.

NHF Disaster Relief Fund Some of you may be aware of the Disaster Relief Fund created by the National Hospice Foundation to support the hospice palliative care community when disaster overwhelms regularly-available resources.  NHF works to make funds available to our state organizations as they respond to recovery efforts of providers at the local level.  In the past, funds have also gone to support grief and bereavement programs to foster community healing following traumatic events. We welcome your support of the disaster fund and to enhance NHF’s ability to care for the hospice palliative care community.  To donate, please visit www.nationalhospicefoundation.org/DonateDisaster

 J. Donald Schumacher, PsyD
President and CEO
National Hospice and Palliative Care Organization

Comments on CMS Proposed Payment FY2014 Update for Hospice

On Monday, April 29, The Centers for Medicare and Medicaid Services released a proposed rule which would update the fiscal year (FY) 2014 hospice reimbursement rates.  The CMS notice claimed that hospices would receive a 1.1 percent market basket increase in their reimbursement.

NHPCO's official comment letter to CMS will be submitted as instructed; however, J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization offers the following public comments on the proposed rule.

Beyond the policy considerations, the numbers just do not add up. For CMS to characterize hospices as receiving a positive update, much less an $180 million dollar increase, without factoring in the impact of the sequester is disingenuous.  The truth is, under current law, CMS’ proposed payment update would mean a -.9 percent decrease for the nation’s hospice community.

Hospices are already struggling with an increased regulatory burden and productivity cuts associated with PPACA.  For the hospice community, which has a high proportion of Medicare/Medicaid patients (almost 90 percent) and an average margin of 4.6 percent – without even taking into account the impact of sequestration – any proposed negative update could be catastrophic.

This is a time when access to hospice should be encouraged, not threatened.  Virtually every responsible policy maker acknowledges that more end of life care patients should have access to the high quality and compassionate services offered by the nation’s hospice programs.  

New research out of Mount Sinai’s Icahn School of Medicine, published in the March 2013 issue of Health Affairs, (affirming previous cost saving research from Duke University) found that hospice enrollment saves money for Medicare and improves quality from Medicare beneficiaries by reducing emergency room stays, ICU days and hospital readmissions.  And yet, we’re already seeing layoffs and consolidation in the hospice community.  The proposed negative update sends a message to the hospice community to expect more of this disturbing trend.

J. Donald Schumacher, PsyD
President and CEO
National Hospice and Palliative Care Organization

 

e-hospice-USA is a New Resource for Healthcare Professionals Powered by NHPCO

Designed to Help Hospice Referral Sources Better Understand End-of-life Care Options

ehospiceUSA, a new resource designed to help healthcare and other professionals that care for patients and families facing serious and life-limiting illness, was unveiled at the opening plenary session of the National Hospice and Palliative Care Organization’s leadership conference on April 25, 2013.

Powered by NHPCO, ehospiceUSA is a free resource created specifically for hospice referral sources, such as physicians, hospital discharge planners, and other professionals who will benefit from a comprehensive understanding of the ways that hospice care will help their patients. 

“Any professional caring for or supporting patients and families who may be appropriate for hospice will find useful information on ehospiceUSA,” said J. Donald Schumacher, president and CEO of NHPCO.

“One of the most frequent comments we hear from the families we care for, is that they wish they had known about hospice earlier. ehospiceUSA will help clarify what hospice is and how it can help people, with the goal of ensuring more timely access to the services hospice offers,” added Schumacher.

In addition to the resources for professionals, ehospiceUSA also offers information on hospice and advance care planning that can be shared with patients and family caregivers.

ehospice recognizes the potential to connect people working in hospice and palliative care using the technology available today.  ehospice is available as a free iPhone app, as well as a mobile web app, which is compatible with most modern smart phones.  There is also an updated iPad app launching today. 

In addition to ehospiceUSA, there are 10 other country and regional editions covering the latest news, commentary and analysis from around the world. Available editions include England, Canada, South Africa, Kenya, India, Australia and others.

 

The brainchild of the UK-based organization, Help the Hospices, the goals of ehospice are to improve patient care through access to information, to foster a sense of community in hospice and palliative care worldwide and to give a voice to people associated with hospice and palliative care, whether as professionals, volunteers, patients or family caregivers.

“ehospiceUSA does not replace the NHPCO website, rather, it’s our hope that hospice and palliative care providers in the U.S. will share ehospiceUSA as a helpful resource with the referral sources in their communities that might benefit from a better understanding of how hospice works and the many benefits it would offer patients under their care,” noted Schumacher.

Find this new resource at:  http://www.ehospice.com/usa.

Policy Symposium: Conversations Before the Crisis

NHPCO and Hospice Action Network will host a Policy Symposium, "Conversations Before the Crisis: The Intersection of Family, Faith and Policy," on Tuesday, April 23, 2013.

What role does federal policy play in advance care planning? What opportunities are there for congress to act on the issue? What obstacles stand in their way? NHPCO is proud to announce that several members of congress will join Conversations Before the Crisis to tackle these issues.

Featuring:

Senator John Isakson, GA

Senator Ron Wyden, OR

Congressman Phil Roe, TN

About Conversations Before the Crisis:
Communities, families and individuals need to have access to the proper tools in order to have conversations about care needs, wishes and values earlier and throughout the course of a lifetime. The time for a robust and open dialogue by policymakers, care providers, hospice experts, opinion shapers, journalists and religious/spiritual leaders has come. There is no better time than now to start these conversations.

 

Learn more on the HAN website. The event is offered free-of-charge.

 

Join the discussion on twitter: #CB4C

Comments from NHPCO's Don Schumacher on the Tragedy in Boston

It’s April 16, National Healthcare Decisions Day, and people across the nation are focused on the unpredictability of life and the world around us in a way we could not have foreseen. A senseless act of violence in Boston yesterday afternoon at the Boston Marathon has left us horrified, angry, frightened and confused. Very rarely can such violence be explained in any manner that makes sense to rational people.

Our thoughts and prayers go out to all those affected by the bombings in one of America’s most historic cities.

I began my hospice career as CEO of Hospice West in Boston more than 30 years ago. My daughter, Amelia, son-in-law and two granddaughters live in Boston and I am a frequent visitor. Many of the supporters of our National Hospice Foundation’s Run to Remember program have also participated in this great event in past years. In fact, Amelia and the two girls were watching the marathon waiting for a friend to pass by and had left the race only a short time before the bombing. My fondness for this city runs deep, hence, my urge to share some thoughts with you.

Upon reflection of Monday’s events, I am reminded of the courage and skill of our nation’s first responders and law enforcement. I am touched by the acts of kindness by many who came to the aid of the seriously injured and frightened. I am also reminded of the resilience of the American people.

The world is a different place than when I lived in Boston but our humanity has not changed. Issues involving national security are part of our normal lives. Increased security and awareness are not intended to put us on edge but, rather, to help us to live our lives without feeling controlled by terror or violence.

Today, many of you will care for someone who will end their life’s journey. You will be there for them, and comfort their families as they say a final goodbye and grieve their loss. I know you will care for them with the professionalism and compassion that are hallmarks of hospice care. Your mission to serve others will not be diminished or hampered.

 

Yet, yesterday’s events do affect us. We should allow ourselves time to process what we are seeing and hearing via ongoing newscasts. We are reminded to be attentive to our children and monitor what they may be seeing on the news or on the Internet. Let us also support those heroes who respond in such emergencies and lend an ear to our friends and neighbors who may need to share their fears or concerns without judgment. It’s also an important time to take an extra moment to tell those near to us that we love them.

As we mark National Healthcare Decisions Day, I encourage all of you who are able to consider donating blood in the weeks ahead. The tragedy in Boston demonstrates the importance of this simple act. Let this be one way we honor those who have died or have been injured as we continue to live free from the shadow of terror.

I consider myself blessed to be part of this community.

Don

The 2013 Innovation Intensive is a Special Part of April's MLC

NHPCO's Mary J Labyak Institute for Innovation is proud to present the 2013 Innovation Intensive - an exclusive educational event within the 2013 Management and Leadership Conference.

 

Healthcare is changing every day. New alliances are being formed between health systems, providers, payors and community organizations. NHPCO is offering you a unique opportunity to learn how to participate in alliances, partnerships and contractual agreements designed to meet the needs of the chronically and seriously ill.

The 2013 Innovation Intensive, which is an exclusive event held during the MLC, will focus on how hospices can develop strategic business alliances and partnerships to provide hospice palliative services to people much earlier in their disease process/life.

Faculty will come from outside the hospice community to offer a fresh perpsective on strategic thinking regarding end-of-life care.

Registration for this event within the MLC is only open to NHPCO members who are registered for the Main Conference.  :earn more about this unique offering: http://www.nhpco.org/mlc2013/intensive.

Call for Proposals - 2013 Clinical Team Conference

NHPCO’s 14th Clinical Team Conference and Pediatric Intensive will explore the care continuum, interdisciplinary team, medical, clinical, psychosocial, spiritual, bereavement and team innovation and excellence – in all their myriad facets, ideas, forms and outcomes.

Join colleagues from across the country that are committed to innovation and excellence by submitting a proposal that demonstrates significant work and achievement for the 14th Clinical Team Conference and Pediatric Intensive to be held from September 26 – 28, 2013 in Kansas City, Missouri. The Conference Planning Committee is particularly interested in proposals for advanced (for the expert) topics. The deadline for proposals is March 25, 2013.

To learn more and submit a proposal, please visit: http://nhpco.confex.com/nhpco/CTC2013/cfp.cgi.

We hope to have you join us in Kansas City this September!

New Research Validates That Hospice Saves Medicare Dollars

Research out of Mt. Sinai shows hospice patients have lower Medicare costs, reduced use of hospital services, and that hospice can improve care quality

 

New research published in the March issue of Health Affairs found that hospice enrollment saves money for Medicare and improves care quality for Medicare beneficiaries with a number of different lengths of services.

The National Hospice and Palliative Care Organization applauds this study that adds to a growing body of research demonstrating the value of hospice care both in terms of high quality and cost savings.

Led by Amy S. Kelley, MD, MSHS, from the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mt. Sinai, researchers looked at the most common hospice enrollment periods: 1 to 7 days, 8 to 14 days, 15 to 30 days, and 53 to 105 days. Within all enrollment periods studied, hospice patients had significantly lower rates of hospital and intensive care use, hospital readmissions, and in-hospital death when compared to the matched non-hospice patients.

The study reveals that savings to Medicare are present for both cancer patients and non-cancer patients. Moreover, these savings appear to grow as the period of hospice enrollment lengthens with the observed study period of one to 105 days.

Study authors suggest that investment in the Medicare Hospice Benefit translates into savings overall for the Medicare system. “If 1,000 additional beneficiaries enrolled in hospice 15 to 30 days prior to death, Medicare could save more than $6.4 million,” they note.

Furthermore, the authors write, “In addition, reductions in the use of hospital services at the end of life both contribute to these savings and potentially improve quality of care and patients’ quality of life.”

“We know that hospice care addresses so many critical issues involving quality of care at the end of life and that hospice brings dignity and compassion when they are needed most. This new study reaffirms other reasons why hospice is the best solution for caring for the dying in a way that provides patient-centered care and is cost effective for the Medicare system,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

This study builds on the valuable work of the 2007 Duke University study by providing further proof that hospice care saves the federal Medicare system money.

Added Schumacher, “For many years, hospice professionals have known through firsthand experience, that the interdisciplinary care they provide to patients and family caregivers coping with life-limiting illness significantly improves quality of life and allows people to focus on living as fully as possible even as life draws to a close. Now the broader healthcare community, regulators and legislators understand more fully the many benefits of hospice care.”

NHPCO reports that more than 44 percent of dying Americans were cared for by hospice in 2011. Among these patients, 84 percent of hospice care was paid for through the Medicare hospice benefit.

 

“We have an example of a care delivery model that not only scores high in patient and family satisfaction, reduces hospital services, and promotes the dignity of every person cared for but also can be cost effective with regards to federal spending,” Schumacher noted.

Based on the study’s findings, the researchers questioned recent aggressive efforts, including the Office of the Inspector General’s investigation of hospices that enroll patients with late-stage diseases but unpredictable prognoses.

“Our finding suggest these efforts maybe misguided,” write the researchers. “Rather than working to reduce Medicare hospice expenditures and creating a regulatory environment that discourages continued growth in hospice enrollment, CMS should focus on ensuring that patient’s preferences are elicited earlier in the course of their disease and those who want hospice care receive timely referral.”

NHPCO has consistently supported earlier discussions of care options once a person receives a diagnosis of a serious illness.

 

NHPCO and Hospice Action Network offer some key messaging points about the study; additionally, a link to the study is available on the HAN website.

 

Choosing Wisely® Campaign Promotes more Informed Healthcare Decisions

The National Hospice and Palliative Care Organization applauds new recommendations released as part of the Choosing Wisely^® campaign to promote more informed healthcare decision making. 

The American Academy of Hospice and Palliative Medicine and the American Geriatric Society have both developed lists  identifying five specific tests, procedures or medication therapies  that physicians and patients should question – all part of the Choosing Wisely^® campaign.

• Read the AAHPM Recommendations
• Read the AGS Recommendations

NHPCO encourages physicians to review this new information, particularly in areas that are relevant to people coping with serious and life-limiting illnesses, specifically:

• Don’t recommend feeding tubes for patients with advanced dementia; instead offer to assist with feeding.
• Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.
• Don’t leave an implantable cardioverter-defibrillator (ICD) activated when it is inconsistent with the patient/family goals of care.

NHPCO has been a strong advocate for earlier access to hospice palliative care services. Additionally, the organization has a position statement on the Care of Hospice Patients with Automatic Implantable Cardioverter-Defibrillators (PDF) available online.

 Choosing Wisely^® is a national campaign launched in April by the ABIM Foundation and Consumer Reports that promotes conversations between physicians and patients about utilizing the most appropriate tests and treatments and avoiding unnecessary care.

For more information on Choosing Wisely, visit:

• http://consumerhealthchoices.org/campaigns/choosing-wisely/
• or choosingwisely.org.

For information on advance directives, and helpful information on end-of-life care, visit NHPCO’s consumer website, Caring Connections at: www.caringinfo.org.

Call for Proposals - 2013 Clinical Team Conference & Pediatric Intensive

Join colleagues from across the country that are committed to innovation and excellence by submitting a proposal that demonstrates significant work and achievement for NHPCO’s 14th Clinical Team Conference and Peditaric Intensive. The deadline for proposals is March 25, 2013.

The theme for NHPCO's 14th Clinical Team Conference and Pediatric Intensive underscores a drive for the hospice and palliative care field to innovate and pursue excellence in all endeavors. The conference will explore care continuum, interdisciplinary, team, medical, clinical, psychosocial, spiritual, bereavement and team innovation and excellence – in all their myriad facets, ideas, forms and outcomes.

The CTC will be held September 26 – 28, 2013, in Kansas City.

Whether you provide care to patients and families directly through interdisciplinary practice, manage interdisciplinary team staff, lead quality efforts or are responsible for related practices and processes, you need to keep pace with evidence-based practice, adapt and respond to impending changes in the field, work in partnership with your community to meet patient and family needs across the care continuum and ensure that every component of the care and services you provide is excellent.

Visit the Call for Proposals page online.
http://nhpco.confex.com/nhpco/CTC2013/cfp.cgi

Hospice Medicare Rates Impacted by Sequestration

Most Americans are aware that Congress took action in January to avoid the fiscal cliff that would impact just about every aspect of federal spending. While most individual income tax increases were avoided, Congress provided only short term relief from dramatic spending cuts within the federal budget. Indeed, absent a more considered alternative, “across the board” spending cuts will be made effective on March 1, 2013. These forced spending cuts are a process called sequestration – and in most cases, legislators want to avoid sequestration because the cuts are done with such a broad brush that they negatively impact just about everyone.

As March 1 approaches, NHPCO wants to provide more detailed information on the implementation of sequestration, which will involve a 2% cut in Medicare payments, effective for services provided on or after April 1.

What does this mean?
 1. Hospices will continue to bill at the FY2013 rates.
 2. For services provided on or after April 1, 2013, the MAC will deduct 2% from the reimbursement before paying the claim.  The hospice will NOT bill at the 98% rate.
 3.The sequestration cuts will continue for 10 years, unless there is Congressional action to discontinue them.

NHPCO issued a Regulatory Alert (02/12/13) for members that provides links to some additional information, including a wage index chart and rate calculator.

NHPCO Brings 100 Hospice Leaders Together to Create Future Care Delivery Models

More than 100 hospice and palliative care senior level managers and leaders gathered in Florida to identify and explore innovative approaches to bring the benefits of hospice care to people with advanced or chronic illness. 

Creating the Hospice Palliative Care Continuum: A Futuring Forum was the first official event hosted by NHPCO’s Mary J. Labyak Institute for Innovation at the Westin Diplomat Hotel, January 22 – 24, 2013. The focus of the Futuring Forum was to identify and create innovative approaches to bring the services hospice provides – including pain and symptom management, care coordination, home safety assessments, emotional and spiritual support and caregiver education and services -- to individuals and family caregivers coping with serious and chronic illness.

The Futuring Forum built upon participatory experiences with forum attendees engaging with presenters during five master classes and working in small groups to explore new ideas.

Master Classes featured guest speakers from outside of the hospice palliative care field. They included Tom Szaky, founder and CEO of TerraCycle; Clement Bezold, PhD, founder and chairman of the Institute for Alternative Futures; Jennie Chin Hansen, executive director of the American Geriatrics Society; Jim Kinsey, senior consultation services specialist for Planetree; and Steve Gross, chief playmaker and executive director of Life is Good Foundation.

“The opportunity for us to tap into the great minds of a number of dynamic innovators from many different fields fostered a spirit of creativity that allowed many of us to think in new ways and reframe the traditional hospice model as a series of services or products that individuals with serious illness so desperately need,” said J. Donald Schumacher, NHPCO president and CEO.

Added Schumacher, “Some of the common themes that repeatedly came up as our guest presenters interacted with Forum attendees centered on the dedication and passion that motivates hospice professionals. The hospice field was created by those striving to innovate how the dying were cared for over 30 years ago – the need to tap back into this creativity came up repeatedly during the Forum.”

NHPCO plans to share ideas from the Futuring Forum at its upcoming Management & Leadership Conference (April 25-27, 2013, at the Gaylord National Harbor Convention Center, National Harbor, MD) and via other member platforms to prompt further discussion and collaboration of new ideas and innovations.

New Pediatric Concurrent Care Report Emphasizes Need for Collaboration

Affordable Care Act Provision Expands Access to Pediatric Palliative Hospice Care

 Children living with life-limiting or life-threatening conditions and their families need the expertise that hospice and palliative care professionals can provide throughout the course of a serious illness.

 A pediatric-focused report, Pediatric Concurrent Care Briefing, has been released by the Mary J. Labyak Institute for Innovation, a program of the National Hospice and Palliative Care Organization based at the National Center for Care at the End of Life.

 It’s important to remember that the care provided to a child with serious illness is different from the care that we would give to an adult,” said J. Donald Schumacher, NHPCO president and CEO. NHPCO is the organization that created the Mary J. Labyak Institute for Innovation in 2012.

 Children aged 0-19 years accounted for 1.9 percent of all deaths in 2009. Slightly more than half of childhood deaths occur in infancy.

“While the numbers of children that die from each year from a serious illness in the U.S. are low, we have a responsibility to compassionately care for each of these children and their families,” Schumacher added.

 Effective management of pain and symptoms together with psychosocial and spiritual care that are sensitive to developmental, personal, cultural and religious values and practices are critically important. The need for such care begins at diagnosis and continues throughout the entire course of a child’s life and for their families beyond the child’s death.

 For many years, children facing such illnesses had few options for Medicaid coverage when children were very seriously ill. Parents in all but a few states were faced with forgoing curative treatments for their children to be eligible for hospices services – considered to be the gold standard for end-of-life care. The patient Protection and Affordable Care Act (ACA) changed that situation.

 Under the ACA all state Medicaid programs are required to pay for both curative and hospice services for children under age 21 who qualify. This is covered by a provision, Section 2302, termed the “Concurrent Care for Children” requirement.

 The Pediatric Concurrent Care Briefing shares examples from states that have implemented options to provide pediatric palliative and hospice care services and outlines eight implementation strategies that can help ensure that providers are serving the children and families in the community that may be in need of the unique services hospice and palliative care brings.

 The goal of the briefing is to foster the necessary collaboration among providers and advocates within each state to ensure that the most medically fragile children and their families have the quality care they deserve and desperately need.

 NHPCO encourages the formation of statewide pediatric palliative and hospice care advocacy coalitions to work towards improved options of care.

 This new report joins other materials created by NHPCO such as the Concurrent Care for Children Requirement: Implementation Toolkit and a series of seven online learning modules on Pediatric Palliative Hospice Care that will soon expand to a series of 10 modules. 

Download the Pediatric Concurrent Care Briefing (PDF) free of charge from the NHPCO website and learn more about available resources for pediatric palliative care at www.nhpco.org/pediatrics.