What Is the #MyHospice Story Bank?

If you don’t already know, My Hospice is a campaign to reinforce the value of the Medicare hospice benefit among policy and healthcare decision makers to foster a policy environment that will support patient access to high quality, comprehensive hospice and palliative care.

Whether you are a loved one of a person who received hospice care or a member of the hospice Interdisciplinary Team – and that includes dedicated volunteers – we believe that your story deserves to be shared and is essential to showcasing the purpose and value of hospice care. Write about your hospice experience and what hospice means to you, then submit it in the My Hospice Story Bank.  If selected, your story could be:

• Shared in HAN and/or NHPCO social media messages using #MyHospice
• Featured in HAN blog posts
• Shared in NHPCO’s NewsLine or NewsBriefs
• Featured in your local newspaper
• Featured in an NHPCO video

If you’re interested in sharing your story, click here.  You can also learn more about the My Hospice Campaign.

A Unified Theory of Home-Based Care

You may not know this, but I am fascinated by quantum physics.  No, I don’t actually understand it, nor can I do the math involved, but I am like a curious two year-old when it comes to the idea that the laws governing small particles and large planets are actually the same.  It turns out that the visuals our science teachers taught us about electrons orbiting nuclei were not exactly right from a scientific perspective but a really helpful way to think about this.

So, as usual, what does any of this have to do with hospice or home-based care in general?  Well, we are consumed these days by large celestial bodies that are going to reshape health care.  Walmart, Amazon, Google, are all vying for a piece of the health care pie.  This is both tantalizing and a little scary.  But what if the laws that apply to these large bodies are the same as the laws that apply on the ground? Think about it. While Amazon completely disrupted the business model of traditional brick-and-mortar retailers, it created huge opportunity for smaller, nimbler organizations like delivery services and the specialty realtors who contract with Amazon for those more niche products. A similar evolution in health care could actually play to hospices’ strengths.

I think that when all of the hoopla dies down, and we deal with reality, we will see that this is exactly right.  You see, no matter how much buying or technology power an entity has, people still covet and receive health care (if done right) in a personal, local and convenient manner.  While we can bring the efficiencies and technology of large bodies to health care, and we should, we will not replace that crucial fact.  Even in the Jetsons, neither Rosie the Robot, nor the food eracacycle, delivered health care.

A unified theory of home-based care, just like a unified theory of physics, has been elusive.  Over the coming months, you’ll hear much more about my theory.  For today, suffice it to say that it will be person-centered, interdisciplinary, and will leverage the best of our past with the scale, technology and efficiency of the future.  We’ll be less chopped up by geography or tax status, or even Medicare benefit category.  A unified theory demands that we focus on the one core truth that helps inform all we do.  That part is easy.  It’s about people. No matter the scale, people need care from other people. 

By Edo Banach, JD
President and CEO
NHPCO

Happy Nurses’ Week!

It’s hard for me to believe I have been a nurse for over 30 years; however, in my heart, I have been a nurse much longer. Even as a little girl I knew I wanted to become a nurse.  I grew up in a time where there were strong role model nurses on TV shows which fueled my conviction.  

Nursing is an art and a science. The possibilities open to nurses are amazing! From the hospital, to the clinic, to the home, or the laboratory or the classroom, we make an impact on people’s lives every day. And in giving we get so much more back in return.
 
Like most new grads, my career started in the hospital. I worked on the medical surgical floors before gravitating to oncology which then merged with telemetry, offering me another skill set. Then, I moved to a relatively new bone marrow transplant unit which included adult and pediatric patients. After a move and a second child, I found a part-time job as an outpatient nurse for a drug and rehab center. Another important skill set was learned.  

When I moved out to the country, which I lovingly called the middle of nowhere, I thought my nursing career was over. Little did I know I was about to find my niche.
 
Responding to an ad for a hospice nurse at a satellite branch of a large community-based hospice opened my opportunities to the full scope of nursing practice. The hospice model, which is holistic, person-centered and interdisciplinary, blew my mind. I wondered why all health care wasn’t built on this model? When I called a primary care physician about their patient, they wanted to know what I recommended. Wow!  I quickly realized I needed to always be prepared and have current evidence to back up my recommendations. I also hoped the hospice model of care would move upstream in care delivery during my lifetime.  

As a nurse leader, I am engaged in that very work today.
 
In hospice nursing I also honed the art of listening. Listening first is so very important to giving high quality care. While I have built a wealth of skills throughout my career, from bedside nursing, operating complex devices, tackling electronic documentation optimization, developing operational budgets and new programs, managing and leading teams, the single most important skill I have learned is listening.
 
Great nurses listen with an open heart, to the individual, their family, their co-workers, and their community. These nurses see a person, not a patient.  Nurses dare to care with empathy, understanding this individual before them could be their loved one or themselves.  Great nurses don’t assume, they listen, and because they do, they learn more than any algorithm or protocol can provide. 
 
I am a nurse who believes in the value of technology. I look for ways to leverage technological advances in providing care to the seriously ill. But I also know that technology can never replace human caring. And human caring starts with active listening.
 
To all my fellow nurses, happy Nurses’ Week! Please continue to advance your skills and education because you make a difference in the lives of others every day. And never forget the great art of listening.
 
Sincerely,
Lori Bishop, MHA, BSN, RN, CHPN
Vice President of Palliative & Advanced Care
NHPCO

FY2019 Hospice Wage Index Proposed Rule

On Friday, April 27, 2018 CMS posted the FY2019 Hospice Wage Index Proposed Rule. Staff at NHPCO analyzed the proposed rule and published a Regulatory Alert on April 30, 2018 that provided more detailed information for the membership. Some highlights of the proposed rule include:

• Hospice rates will increase by 1.8% for FY2019.  The cap amount has also increased by the same percentage to $29,205.44.  
• Physician assistants will be able to serve as a hospice patient’s attending physician, effective January 1, 2019. NHPCO has worked in collaboration with the American Academy of Physician Assistants for their inclusion in the statute. Hospice patients will have additional choices for their attending physician once this provision is effective. 
• CMS has reduced regulatory burden for hospice providers by allowing drugs and durable medical equipment to be reported in the aggregate on the claim form, rather than the extremely burdensome per drug or per equipment reporting that currently exists. CMS estimates that the elimination of this burdensome reporting will reduce the number of line items reported on claims by 21.5 million, in the aggregate.   
• There will be no new hospice quality measures in FY2019. 
• Data points from the hospice public information, currently available in the Provider Use File and posted by CMS, will be added to an “information” section in Hospice Compare, so that Medicare beneficiaries and their families have information that will assist them in selecting a hospice that meets their needs. 

CMS published a data trend analysis of hospice claims and cost report. Concerns continue to be raised about the number of patients who did not receive a skilled visit in the last seven days of life, the number of drugs paid for by Part D after the patient has elected hospice, and the lack of completeness in the hospice cost report. It's essential that hospice providers be aware that there is likely to be increased focus on these areas in the future.

Comments on the proposed rule are due to CMS no later than June 26, 2018. NHPCO submits a comment letter and encourages all providers with feedback to share that with CMS.

NHPCO members will find more detailed analysis in its Regulatory Alert (04/30/18).