Read Past the Headline

Despite an unfortunate and misleading headline that appeared in Politico yesterday, “Hospice in crisis,” the article is actually a thoughtful look at what we as a provider community face in caring for people at the end of life. For those who may have seen this headline in your news tracking or social media feeds, I’m sure you were immediately concerned, as was I. However, I encourage you to read past the headline.

The article explores how demographic, competitive and public policy changes are challenging the hospice industry. The author Joanne Kenen – who NHPCO spoke with for her reporting – is not pointing an accusatory finger towards hospice, but is instead exploring the changing environment in which we must provide care.  (As an aside, it should be noted that Kenen did not write the headline, that was done by editorial staff at Politico.)    

A better headline would have been “Hospices Navigate Changing Environment.”  Unfortunately, crisis sells and our challenges do not.  

While it is true that hospices are challenged by changing demographics and patient needs, the crisis is most acutely felt by patients and their families. As providers, we know that when people wait until they are actively dying to access hospice, our patients and family caregivers are unable to fully utilize and benefit from the wide range of services that we provide.  Those of you on the frontlines know this best.

Part of our job is to innovate while we continue doing what we already do so very well. NHPCO is eager to work with Congress, the Administration and other stakeholders to enact policy changes that allow patients to receive palliative care earlier, expand access to concurrent hospice care, and support the delivery of other services that improve care for individuals with serious and advanced illness near and at the end-of-life.  

In fact, we are supporting legislation that our affiliate the Hospice Action Network is championing on Capitol Hill that would likely help more Americans access quality hospice care in a timelier fashion. If you are not familiar with our two major legislative priorities, the Patient Choice and Quality Care Act and the Rural Access to Hospice Act, I hope you’ll visit  the links to learn more on the HAN website.

We are pleased that Kenen took the time to interview me as part of her research and I trust this conversation will be ongoing.  We had a thorough conversation about the realities of caring for the dying, which we are encouraged could lead to additional reporting on the important work NHPCO is doing on behalf of the hospice community.

Thank you for your continued work towards providing high quality care to an ever increasingly complex population in an evolving health care landscape. I can attest to the amazing work I have seen firsthand from one corner of the country to the other and I am proud of the dedication, compassion and understanding I see among the hospice community to adapt to the world around us.

By Edo Banach

President and CEO

Research Published by American Geriatric Society Suggests People Begin Hospice Too Late

New research published in the current issue of the Journal of the American Geriatrics Society states that individuals who access hospice care often do so too late to fully benefit from this holistic model of care. National Hospice and Palliative Care Organization, the oldest and largest leadership organization working on behalf of hospice and palliative care providers applauds the research and attention it brings to issues involving when to best access hospice care.

A team of researchers from the Yale University School of Medicine looked at hospice enrollment for decedents from a cohort of 754 persons aged 70 and older who were enrolled in a larger longitudinal study.  Of the 562 patients who died during the study, more than 40 percent utilized hospice care in the last year of life; however, the median time spent under the care of hospice was less than two weeks.

Study researchers wrote, "In summary, hospice services appear to be suitably targeted to older persons with the greatest needs at the end of life, although the short duration of hospice suggests that additional strategies are needed to better address the high burden of distressing symptoms and disability at the end of life.

NHPCO’s current Facts and Figures Report indicates that 34.5 percent of patients died or were discharged within seven days of admission. In fact, the report shows that 61.5 percent of patients received care for 29 days or less, which may prevent patients and family caregivers from taking full advantage of the full range of services that the hospice team can offer.

NHPCO stresses that hospice care is best suited for the final months of life, not just the final days.

Hospice is more than pain relief and symptom control. Hospice also provides emotional and spiritual support, training for family caregivers, and bereavement services to family for a year following the death of a loved one under hospice care.

Remarked Edo Banach, president and CEO of National Hospice and Palliative Care Organization, "Hospice and palliative care professionals have long known the importance of earlier access to the high-quality, interdisciplinary care that hospice makes available to those facing life-limiting illness.”

“Helping the public and the broader health care community – particularly physicians caring for patients with a non-cancer diagnosis – understand the many benefits of timely access to hospice care is an ongoing initiative at NHPCO. This study will certainly help raise important awareness and we offer our appreciation to the researches who have shared this important work,” Banach added.

Previous research has found that earlier access to hospice and palliative care services can prevent emergency department visits, hospitalizations, and stays in the intensive care unit – all of which can be distressing for those coping with serious and life-limiting illness.

Additionally, hospice works to help patients stay in the home if possible, which is the place that eight out of ten Americans would prefer to be at the end of life.

Timely access to hospice care can increase quality of life for patients and family caregivers. NHPCO suggests discussions of hospice care should take place earlier in the course of a serious illness, before hospice care might be necessary.

“Individuals must also ask their medical professions about hospice care and whether it’s appropriate and when the best time to think about accessing services should be,” explained Banach. “A question people can ask their physicians is: ‘Would you be surprised if I were to die within six months?’ – if the physician feels that this is a possibility, then a discussion about hospice should begin immediately.”

Resources to help people learn about hospice care are available on NHPCO’s CaringInfo.org website and via information, videos and tools from NHPCO’s public engagement campaign, Moments of Life: Made Possible by Hospice, at momentsoflife.org.

September 11: A Message from Edo Banach

It is hard to believe that it has been 16 years since the tragedy of September 11, 2001. As some of you know, I grew up in New York City and many friends and family were impacted by the tragic events of that day. I’m sure that lots of us have similar stories and memories. Many years later, I have the most vivid memories of how we pulled together as a country after that day. 

I’m further reminded of that as I see how we are pulling together in Texas, Florida and across the nation to deal with natural disasters. It is interesting to see how people of all walks of life can come together during these moments and then retreat back when the imminent danger subsides and memory fades.  

I’m proud to be working with and on behalf of a community that does not retreat—dealing with crisis, often personal crisis, is a part of our collective jobs. I think we have lots to teach the rest of the nation and world about how to stick with it and to continue to help each other get through the rough times that are inevitably thrown our way.  

Thanks for what you do every day.  

Edo

NHPCO Suggestions for Regulatory Relief

In response to a request from the U.S. House of Representatives Ways and Means Committee, the National Hospice and Palliative Care Organization has submitted a series of recommendations (PDF) that would provide regulatory relief to hospice providers. 

The recommendations were developed by the NHPCO regulatory committee and echo concerns raised in NHPCO’s comments to the Centers for Medicare and Medicaid Services regarding the FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements; Proposed Rule. 

In summary, NHPCO highlighted areas where Congress and CMS could reduce regulatory burden around payment policy, staffing requirements, audits, and data collection and reporting.  NHPCO also called for Congress to enact legislation that would loosen requirements around Face-to-Face, and allow both Rural Health Clinicians and Physician Assistants to serve as the hospice attending physician. 

NHPCO President and CEO Edo Banach wrote in the letter to Congress, “In recent years, hospices have been faced with substantially increased regulatory burdens, based on new regulations and sub-regulatory guidance, changes required by hospice payment reform, additional quality reporting obligations, and increased audit activity. While some of these changes are positive, hospices report that they are facing many regulatory burdens that take valuable staff time away from patients and are not increasing the quality of care provided.”

NHPCO leadership, staff, and members are eager to work with Congress on these issues, as well as other policy changes that will ensure that all Medicare beneficiaries can access the high-quality, compassionate end-of-life care offered by hospice providers across the nation.