NHPCO Update on PTAC

On Monday, March 26, NHPCO attended the Physician-Focused Payment Model Technical AdvisoryCommittee (PTAC) in Washington D.C. to publicly support the need for the Centers for Medicare and Medicaid Services to test a model to address the continuum of care needs for the seriously ill population. The first proposal for discussion was the American Academy of Hospice and Palliative Medicine’s proposal for a Patient and Caregiver Support for Serious Illness (PACSSI) model. AAHPM representatives did an excellent job answering questions from the PTAC. Several PTAC members expressed the urgency for a care model for the seriously ill and their families. The PTAC members recognized a gap in care exists and expressed the importance of creating a distinction between palliative care and hospice while encouraging close collaboration between both services. The PTAC voted to “Recommend to the Secretary limited scale testing of this model”. The PTAC’s vote reflected support for 8 of the 10 criteria. 

Several stakeholders expressed support for the PACSSI model. As NHPCO’s Vice President of Palliative and Advanced Care, I was proud to provide public comment on behalf of NHPCO to emphasize three main points:

1. The PACSSI survey used to obtain patient reported outcomes and experience of care builds on the existing Hospice CAHPS survey, which is designed to measure and assess the experiences of patients who died while receiving hospice care, as well as the experiences of their informal primary caregivers. Use of these NQF-endorsed measures supports seamless care delivery for seriously ill individuals and their families experiencing PACSSI and hospice care.
2. The process measures align with the domains of care recommended by the NCP Clinical Practice Guidelines for Quality Palliative Care (3rd edition) and support access to an interdisciplinary team that includes physicians, nurses, social workers, therapists, home health aides, spiritual caregivers, bereavement counselors, and others as needed, for seriously ill individuals and their families.
3. Hospice is the gold standard in evidence-based care for terminally ill individuals. 
   Existing palliative and advanced care programs demonstrate that seriously ill individuals experience more timely access to hospice care. We would expect a model that closely coordinates care between the model and hospice, with the goal of improving the length of stay in hospice. Using the hospice median length of stay, currently at 17 days, may be a better reflection of a quality measure.  Furthermore, for those concerned with long lengths of stay in hospice, the PACSSI model offers an alternative that addresses a current gap in care and support service. We would expect a shorter length of stay in hospice for long stay patients, where patients in the model may be referred to hospice later in their disease trajectory. 

Additional speakers included Sandy Marks representing the American Medical Association, she expressed support of the PACSSI model. Dr. Diane Meier provided public comment on behalf of the National Coalition for Hospice and Palliative Care.  Betty Ferrell spoke on behalf of HPNA. Dr. Martha Twaddle and Dr. Dana Lustbader also provided comments based on their experience in the field. Betty Ferrell and Dr. Martha Twaddle have co-chaired the revision of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, 4^th edition, expected to be out in mid-2018. Dr. Lustbader is co-presenting an NHPCO webinar pn April 12 on Advances in Telehealth forPalliative Care and Hospice. 

The Coalition to Transform Advanced Care (C-TAC) followed the AAHPM presentation with the second round of their proposal, Advanced Care Model, focused on the same patient population. The PTAC also voted to “Recommend to the Secretary limited scale testing of this model”.  

The PTAC expressed their desire to urge CMS to develop a model as soon as possible that recognizes the strengths of both models rather than recommend either model for implementation. After much deliberation, the PTAC determined they would combine their letter of recommendation for PACSSI and ACM because they saw pros and cons to both models. They encouraged ongoing collaboration between all stakeholders to develop a palliative care model for the seriously ill.  You can find more information on the PTAC website. 

NHPCO is actively collaborating with the National Coalition for Hospice and Palliative Care, AAHPM, CMS, and other stakeholders to offer our expertise in providing care for the seriously ill and ensuring that patients and family members are an integral part of the care plan. NHPCO encourages members to be ready to participate in a CMS model, if available. To prepare our members for this tremendous opportunity, NHPCO is working on creating resources to help operationalize and sustain palliative care programs regardless of whether a model is launched by CMS or not. The NHPCO Palliative Care Council reconvened on March 23, to assist in these efforts. NHPCO members can join the Palliative Care community on my.nhpco.org and also participate in a member survey on palliative care, coming out in May (look for news of the survey in weekly NewsBriefs).  

Lori Bishop, MHA, BSN, RN, CHPN
Vice President of Palliative & Advanced Care
National Hospice & Palliative Care Organization

Lori Bishop at the PTAC meeting.

 

Right-sizing your hospice facility: Finding the Goldilocks point for hospice beds

I spoke to a colleague a few days ago and mentioned that I’d recently consulted to a hospice that plans to open a new hospice facility later this year. “Are people still doing that?” she asked me.

There’s been so much ink spilled about the financial risks of hospice facilities (some of it written by me, I admit) that you too, might be surprised to learn how much activity there is in the U.S. around building, expanding and re-formulating hospice facility beds. But hospice beds continue to be a critically important part of the provision of quality hospice care.

It's true that successfully planning a hospice facility is more complex than in years past. Whereas in the 1990s many hospice facilities opened to greater than expected demand and high occupancy rates, these days a provider must be very careful to calibrate the likely demand to the number of beds built and staffed.

But there are still very good reasons to grow or increase the number of hospice beds in many markets. Among the reasons you might consider adding beds to your capabilities:

• For defensive competitive reasons, to keep another competitor from stealing hospice market share
• High-acuity hospitals in your market are seeking a partner to whom they can discharge high acuity end of life patients
• Your existing facility is always full and you’re turning patients away (yes, this is happening in several markets)
• You have an opportunity for partnership with another provider that may be a consistent source of new referrals
• You see an opportunity to add to your overall patient volume by gaining a reputation for expertise in managing complex illness and challenging patients

The real question is, how can your hospice best plan to meet the needs of your community responsibly? And consider, too, that perhaps the root of the problem isn’t the number of beds, but how they’re configured. Cost structures for hospices vary widely, depending on how beds are housed. Many providers are finding that while freestanding structures are high-cost, high-risk, beds located within a dedicated hospital or nursing facility wing have much lower fixed cost burdens.

On April 22, I’ll be speaking at the upcoming NHPCO Management and Leadership Conference, leading a special half-day session for hospices interested in the latest strategies around right-sizing hospice facilities.  I’ll be sharing the latest news and planning tools from the many innovative programs in the U.S. that are finding new ways to achieve the best and highest use for hospice beds in their markets. (Online registration is available through April 2 and onsite registration will be available on April 22.)

This will be an interactive workshop with limited attendance to allow participants to share individual problems, ideas and opportunities with their peers and with me.

by Sue Lyn Schramm, MA
Principal
Schramm Consulting LLC

 

NPR Host Ari Shapiro to be Opening Speaker at MLC

National Hospice and Palliative Care Organization is proud to announce that Ari Shapiro, host of NPR’s weekly news magazine All Things Considered, will be the opening plenary speaker for its upcoming Management and Leadership Conference & Advocacy Intensive, April 23- 25, hosted at the Washington Hilton. 

Shapiro has reported from above the Arctic Circle and aboard Air Force One. He has covered wars in Iraq, Ukraine, and Israel, and he has filed stories from five continents. In 2015, Shapiro joined Kelly McEvers, Audie Cornish and Robert Siegel as a weekday co-host of All Things Considered. He is a frequent guest analyst on television news programs, and his reporting has been consistently recognized by his peers. He will lend his keen insight to leaders from across the nation’s hospice and palliative care community. 

Ari Shapiro

 During the first two days of the MLC, hospice and palliative care leaders and managers will explore innovations within the field, define excellence, foster more effective engagement with staff and communities, and enhance quality throughout the care continuum.

On Wednesday, the focus shifts to advocacy. Participants start off with a morning plenary and instructional sessions at the Washington Hilton and move to Capitol Hill in the afternoon to meet with their legislators. The day of advocacy will be capped off with a Congressional Reception on the Hill.

On Tuesday evening the celebration continues as the National Hospice Foundation hosts its annual gala, also at the Washington Hilton.

Online registration for the 2018 MLC & Advocacy Intensive is available through April 2 at https://www.nhpco.org/mlc2018. Onsite registration will be available at the Washington Hilton beginning Sunday, April 22 at the NHPCO conference desk (Capitol Hill advocacy visits cannot be arranged for onsite registrants). 

NHPCO thanks the following organizations who are providing educational grants and support for the Management and Leadership Conference.

•         Platinum Level: Enclara Pharmacia;
•        Gold Level: Simione Healthcare Consultants;
•       Silver Level: Consolo, Hospice Cloud, Kinnser Software;
•       Bronze Level: ACHC, brighttree, Complia Health, TwinMed, Wizard Creations, Inc.;
•       Copper Level: Home Healthcare Solutions, a Cardinal Health Company; hospicemed, Optum;
•     Pewter Level: Hospice Source, KanTime Healthcare Software, Maxwell Healthcare Associates, and Prevail by First Quality.

Leadership and Advocacy Come Together

This April 2018 two premiere events are coming together that unites the NHPCO Management and Leadership Conference and the HAN Advocacy Intensive.

As palliative care and hospice leaders and managers, it’s important to recognize that 2018 will continue to be a pivotal time for the future of hospice and palliative care, as well as healthcare in general. It is critical that members and partners of the National Hospice and Palliative Care Organization - as well as the broader U.S. hospice and palliative care community - be active participants in charting the future course.

To meet this need, NHPCO and its affiliate organization the Hospice Action Network has made a change to the annual Management and Leadership Conference and the Advocacy Intensive, bringing the two events together, April 23-25 in Washington, DC, at the Washington Hilton Hotel. 

On April 23 and 24, hospice and palliative care leaders will take advantage of educational offerings focused on timely topics and new approaches to successful leadership and program management. More than 60 concurrent sessions and numerous networking opportunities are part of the three day conference experience.

On Wednesday, April 25, the focus shifts to advocacy, starting off with a morning plenary and concurrent sessions at the Washington Hilton Hotel and moving in the afternoon to Capitol Hill for participants to meet their legislators. The three days will be capped off with a Congressional Reception at the historic Russell Senate Office Building adjacent to the Capitol.

An array of preconference offerings, that include the Hospice Manager Development Program’s Foundational Course, are being offered on April 21 and 22 that may be taken alone or as part of the full conference experience. Adding to the excitement of the conference is the National Hospice Foundation’s Gala hosted at the hotel on April 24 (please note, separate Gala tickets are required).

Visit the NHPCO conference website for more information. Online registration is available through April 2. Onsite registration will begin at the Washington Hilton on April 21. An additional participation form is necessary for those who wish to attend meetings on Capitol Hill.

MLC 2018

The Mindful Leader: Thrive In Just Minutes A Day

By Heather Stang, MA

There is no doubt that our work in the hospice and palliative care industry contributes to the greater good. But when we feel rushed, overwhelmed, and driven to distraction, it is easy to lose touch with our passion for care. And while on-the-job stress is common in any industry, those of us who dedicate our lives to serving others are particularly susceptible to stress overload and compassion fatigue.

If you are a hospice and palliative care leader caught in this downward spiral, you know how hard it can be to make clear, creative and wise decisions on the fly. You may even find it harder and harder to treat yourself and others with heartfelt compassion. Left unchecked, this distress can lead to mistakes, burnout, and even a stress-related illness, but the good news is that there a way to help yourself get unstuck, or better yet, prevent this scenario from unfolding in the first place.

One way to reduce stress, improve your health and cultivate leadership excellence at the same time is mindfulness. Mindfulness is more than navel gazing on a cushion, I like to think of it as the right kind of mind control. Far from a passive activity, cultivating mindfulness requires focusing and refocusing your attention on what is arising in the present moment while maintaining an attitude of heartfelt objectivity.

You have likely heard of the wide range of health benefits in brief mindfulness interventions, including reducing anxiety and migraine headaches, improved immune functioning, and even decreased psoriatic lesions. But what you may not know is that there is a growing body of evidence supporting that mindfulness has a positive impact on leadership.
 
And aren’t we all leaders? Whether your job title states it or not, you influence a wide range of human beings, not the least of which is yourself!

I hope you will attend The Mindful Leader: Thrive in Just Minutes a Day, the pre-conference workshop offered at the 2018 Management and Leadership Conference that will show you how to be the best leader you can be. We will review the principles of mindfulness, survey the current research, and even test-drive several key meditation techniques so you can only cultivate self-care – which is important – but experience how mindfulness can help you become a better leader and develop the Four Foundations of Leadership Excellence.

You can even start your MLC days off right and deepen your mindfulness training by joining me for morning meditation from 6:45 -7:45 am on Monday and Tuesday. Monday you will experience Mindfulness Meditation for Resilience and Self Care, and Tuesday we will learn how to Overcome Work/Life Challenges using meditation. This is open to all MLC attendees, whether you attend The Mindful Leader pre-conference session or not.

There is still time to register for The Mindful Leader on Sunday, April 22nd.  I can’t wait to share these Mindfulness & Leadership tools with you!

50th Issue of Pediatric E-Journal Now Available

“Celebrating the Past and the Future of Pediatric Palliative/Hospice Care," is the theme for the landmark 50th Issue of the ChiPPS pediatric palliative hospice care e-journal from NHPCO’s Children’s Project for Palliative/Hospice Services.

In his article acknowledging the work done on behalf of pediatric palliative and hospice care, NHPCO President and CEO Edo Banach writes in part:

I am proud to share the 50th edition of the ChiPPS e-journal with the field and I extend my deepest appreciation to the many people who make each edition possible. Over the past several years, we have featured hundreds of articles by dozens of experts and thought-leaders from the pediatric palliative and hospice care field. We have also included contributions from family members who have faced the overwhelming loss of a beloved child. And members of our ChiPPS Communication Workgroup have given of their time, talent and insight to make the e-journal a valuable resource offered free-of-charge to anyone interested in this important area.

For those of you reading this article in the ChiPPS e-journal, there is no need for me to tell you how essential it is to have members of the IDT skilled in caring for the unique needs of young people facing serious and life-limiting illness and being able to appropriately care for grieving families. The death of a child is surely one of the great challenges that those in our field face; yet, it is a reality that young people do die and over the years, NHPCO has done its best to provide resources, education, and opportunities to advocate on behalf of pediatric care.

Our Children’s Project on Palliative/Hospice Services began with a two-day meeting in Dallas in November 1998. So as we celebrate this milestone edition of the e-journal, we are just about to mark the 20th anniversary of ChiPPS. 

Since 1998, the accomplishments of ChiPPS have played a vital role in shaping the entire national pediatric palliative care and hospice field and the written word has been a significant part of these efforts. 

Download the 50th issue of the Pediatric E-journal (73-page PDF), or read the issue online.