A new frontier, and I’m not afraid to stay curious

If Hamlet were a 21st century hospice leader, he might very well ponder the question, “To be (carved-in) or not to be (carved-in)?”  Will the Medicare hospice benefit be carved into Medicare Advantage Plans or not?  We have been discussing the implications of this since March 2014 when I was a CMS staffer and MedPAC discussed the possibility of ending the Medicare Advantage carve-out.  Since then, I’ve left the federal government, but  I am more curious than ever about whether Congress will act on MedPAC’s recommendation.

In the past, MedPAC recommended that Congress include the Medicare hospice benefit as part of Medicare Advantage plans’ scope of services.  MedPAC’s recommendation anticipates that MA plans take on the financial responsibility associated with offering patients high-quality hospice and palliative care services they need as a part of the full continuum of care – under the assumption that this will promote coordination of care resulting in lower Medicare spending.

There was and continues to be vocal protest from many stakeholders including the hospice provider community as well as the managed care plan community against MedPAC’s recommendation, which has likely prevented any action toward implementation. Our members at NHPCO have shared their concerns regarding the possibilities of reduced beneficiary access; reduced quality of hospices services; impact on the interdisciplinary care plan; and financial sustainability.  Some of the concern is based on the hospice experience with state managed care plans which has neither resulted in improved care coordination nor financial stability for hospices.

I do not consider their concerns trivial and I believe we need a deeper dive into the policy goals, technical complexities, and implications for the patient and caregivers.  An article from a March 2018 HealthAffairs blog helps put some of this into context.  Whether the hospice MA carve-in would help hospice providers and end-of-life care is still up for debate.

I am encouraged to see that CMS includes a new policy interpretation of what is considered “primarily health related” in its Calendar Year 2019 Call Letter.  Furthermore, Section 50322 of the Bipartisan Budget Act of 2018 requires the Government Accountability Organization to study the expanded supplemental benefits for the chronically ill, due to publish in 2023.  Both, the legislation and CMS policy, mark a new vision of the changing health care environment to one that recognizes the person-centered care model.

Hospices are uniquely poised in communities across the country to transform a health care industry from a medical model to a compassionate holistic care that accounts for the psychosocial and emotional needs of patients and caregivers.

This fall, NHPCO will partner with Better Medicare Alliance to take an unprecedented step by jointly holding a convening with key stakeholders to discuss the issues MA plans and hospices may face if hospice is included in Medicare Advantage plans.  It’s imperative that we fully engage in thoughtful discussion on this complex issue and remain curious together. 

By Zinnia Harrison, MHS
Vice President, Innovation & Inclusion
NHPCO

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NOTE: NHPCO is working to gather input from its hospice and palliative care membership regarding the MA carve-in and challenges and opportunities for the provider community.  NHPCO members may attend a free Virtual Town Hall on Thursday, October 4 at 2:00pm EST. Registration is required.

NHPCO Participates in Seminal Briefing of the Congressional Palliative Care Task Force

Lori Bishop, Vice President of Palliative & Advanced Care for the National Hospice and Palliative Care Organization, participated in the first-ever meeting of the Assisting Caregivers Today (ACT) Caucus’ Palliative Care Task Force. Hosted on September 14, the bipartisan task force was launched by Congresswoman Jacky Rosen (D-NV) and Congressman Bruce Poliquin (R-ME) and inspired by their personal experiences providing long-term care to loved ones.

While the briefing served to introduce congressional staff to palliative care, the task force will work to enhance palliative care services to improve the quality of life of millions of Americans managing serious illnesses while also raising the public’s awareness and promoting the availability and benefits of palliative care through bipartisan solutions to expand access these services.

“NHPCO wholeheartedly stands behind the efforts of the bipartisan Palliative Care Task Force and is committed to continuing its work to support efforts to educate lawmakers about this important type of care,” said Ms. Bishop. “We thank Representatives Rosen and Poliquin for spearheading this important effort and commend their goal to create bipartisan policies and solutions that address the needs of the palliative care community. We look forward to working with them and other task force members to advance palliative care for all Americans.”

Palliative care helps to prevent and reduce the physical and emotional suffering for patients dealing with serious illness, providing individuals with the best possible quality of life for both them and their families.

In July the House of Representatives passed the bipartisan Palliative Care and Hospice Education and Training Act (PCHETA) which is co-sponsored by both Representatives Rosen and Poliquin and furthers the task force’s goals as the bill would expand access to palliative care services and provide awards, grants, career developmental opportunities, and support to physicians, nurses, hospitals, social work schools, medical schools, and other medical institutions to promote education and research in palliative care.

“NHPCO commends the House of Representatives for advancing PCHETA and urges the Senate to take up the popular bipartisan bill so that Americans with life-limiting illnesses are able to access the hospice and palliative care they need to be comfortable and at-peace alongside their loved ones,” concluded Ms. Bishop.

Launch of Bipartisan Congressional Task Force Championing Palliative Care hosted on September 14.

Grief Support Exemplifies the Value of Coordinating Care

What My Hospice means is different to each individual and family we serve. For Jan Jones, it means supporting families on their hospice journey even after their loved one is gone. As Medicare’s first coordinated care model, we must protect the Medicare Hospice Benefit for programs like Jan’s. 

As the President and Chief Executive Officer of The Elizabeth Hospice in Southern California, Jan Jones, RN, BSN can’t help but care deeply about everyone who walks through her door. Throughout her career, she has seen how the death of a loved one, even when expected, can leave behind deep and painful grief for family and friends. Even though grief is a natural response to loss, grieving is a difficult and emotional process. For Jan and her team, caring for those who are grieving can be a precarious undertaking requiring tact and skill because not everyone processes loss the same way and immediate needs vary. This is where experience combined with sensitivity and compassion proves to be invaluable.

In my experience, the hospice community has the knowledge and specialization to offer care for the bereaved – something many people may not know about the hospice benefit. Hospice exemplifies the principles of quality, compassionate, personalized care that everyone wants and deserves. Anyone who has ever been affected by hospice and palliative care--whether as a patient, loved one, or healthcare professional--understands the immense value of comprehensive and coordinated care models like hospice.

Hospice bereavement services are diverse, and our program includes a number of support groups specialized for spouses, children, parents or caregivers, as well as support for communities processing unexpected deaths, tragedies and natural disasters. While hospice bereavement services can come in the form of groups or outreach, it can also come through yoga, guided meditation, writing workshops, hiking excursions and pet therapy.   

While the details of support may vary, what all these programs share in common is that they are comprehensive in scope. As a care team, we all work together to develop and coordinate a plan for an individual based on their needs, experiences, interactions with our team and their relation to the deceased.

We will all likely experience grief at some point, but it’s a comfort to know that the hospice community has the depth of experience and expertise willing to support individuals and communities through the grieving process. This openness and commitment to care are the cornerstones of the philosophy of care and I cherish the thousands of lives we have been able to touch.

We invite you to keep promoting the power of hospice by joining the My Hospice campaign. Please consider sharing this post with your family and friends on Facebook and Twitter or share your My Hospice story with us.