Integrated Care Management Train-the-Trainer Series for Palliative and Hospice Care Professionals

NHPCO and Sutter Health are partnering on an Integrated Care ManagementTrain-the-Trainer Series specifically designed for clinicians who care for the seriously ill and their families.

This new series focuses on the practices and tools needed to optimally care for the patient with an advanced illness, with an emphasis on communication, symptom management and supportive measures during palliative care and though end-of-life care. Palliative care and hospice clinicians will be equipped with the tools and competencies that facilitate meaningful relationships with their patients and families. Learn how to deliver care that engages patients, identifies their care goals, reduces unnecessary healthcare utilization and promotes high patient and caregiver satisfaction.  

This series is comprised of 8 live, one-hour interactive Webinars and 4 online, self-paced condition-specific modules that will solidify competencies for the successful implementation of the ICM model of care and prepare you to be a trainer within your organization. The first Webinar is January 16, 2019.

Space is limited for this special opportunity. Register by January 14, 2019. 

Perspective

Pictured is Edo Banach's elf (son) Henry

As we mark the final weeks of 2018, the holidays are often a time of extreme contrasts: happiness and stress; parties and diets; family and, well, family.  Let’s be honest—the holidays are not always the stuff of Christmas cards.

That’s why I love the movie Elf.  In the movie, a tall elf named Buddy, played by Will Ferrell, spreads Christmas cheer to the dismay of almost everybody who encounters him.  Buddy is fascinated by the little things that we all take for granted every day—the “world’s best cup of coffee,” running through a revolving door, and “singing loud for all to hear.”  By the end of the movie, we are all singing along with the grumps and doubters.

I’m no Buddy or Will Ferrell, but I do think that the movie helps me—and should help all of us—find some perspective this holiday season. Whether we struggle with depression, challenging family dynamics, or even serious illness, there is so much to be thankful for if we just get some perspective.

One of the wonders of hospice is how it puts life into perspective.  As we near our final chapter, life often takes on more meaning, and the small irritations become inconsequential. A long commute, a barking dog, or even a squabbling sister or dysfunctional family become less significant as the end of life comes into focus.  The small joys—the smell of coffee in the morning, the kindness of a stranger, puppy breath—take on greater significance. Why do we have to be on the precipice of death to keep life in focus?

I do hope that we can all take a lesson from Buddy this holiday season, and sing, drink the world’s best coffee, hug our dad, fall in love, or just live life.   Live as if this is the only life we have, and quite possibly our last day.  Life is precious, and the holidays are a perfect time to reflect and be thankful for what we have.

I wish you a happy and restful holiday season.  I hope that we are all able to get some perspective. 

With gratitude --

Edo  

Free Webinar on New NCP Guidelines

The National Coalition for Hospice and Palliative Care will host a complimentary webinar to present the newly published National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care, 4th edition (NCP Guidelines) on Monday, December 17, 2018 from 2:30 to 4:00pm ET.

The 4th edition has been expanded to improve access to quality palliative care for all people living with serious illness, regardless of setting, diagnosis, prognosis, or age.

Registration deadline is Friday, December 14.  Space is limited and early registration is encouraged to ensure your attendance. The webinar will be offered via computer access only and no phone lines will be available. No CEUs will be provided. 

Learn more and register online.

For additional questions about the NCP Guidelines, please  contact info@nationalcoalitionhpc.org.

New National Guidelines Call for Improved Access to Vital Palliative Care

Many people living with a serious illness, whether heart failure, lung disease, cancer or another illness, don’t have access to palliative care, which can make all the difference in how they feel physically, emotionally and spiritually. The Clinical Practice Guidelines for Quality Palliative Care, 4th edition were released on October 31 and area available for free download.

New palliative care guidelines set out to improve access to this care, which provides relief from the symptoms and stress of serious illness; improves quality of life for both the patient and the patient’s family; and is provided concurrent with disease-focused treatments.

"Palliative care should be provided throughout the community wherever people living with serious illness receive care. To reach that goal, the guidelines promote consistent criteria and encourage continuity of palliative care across settings," Martha L. Twaddle, MD, FACP, FAAHPM, HMDC, Steering Committee Co-Chair, National Consensus Project for Quality Palliative Care.

To improve access to this care, the new guidelines urge clinicians and health care organizations to integrate palliative care into the services they provide all people living with serious illness, regardless of their diagnosis, prognosis, or age. The guidelines also call for palliative care to be available wherever people receive their care, including: outpatient clinics, cancer centers, long-term care facilities, office practices, homeless shelters, dialysis units and at home.

The guidelines include tools, resources and practice examples to help with implementation. They expand on the eight domains of palliative care: structure and processes of care, physical aspects of care, psychological and psychiatric aspects of care, social aspects of care, spiritual, religious and existential aspects of care, cultural aspects of care, care of the patient nearing the end of life, and ethical and legal aspects of care.

So what can you do right now to ensure your patients and their families are getting this vital care:

• Read the guidelines and share with your colleagues.
• Review the eight domains with your health care team and/or organization to assess how you can use the Guidelines to best address the gaps and needs of people living with serious illness and their caregivers.
• Identify specific action steps that your organization can implement to provide quality palliative care and focus on the easily attainable goals first.

The purpose of the guidelines is to improve access to quality palliative care by fostering consistent standards and continuity of care across settings. Please join us in this national effort so that all people living with serious illness and their families will receive the best care possible. Learn more at www.nationalcoalitionhpc.org/ncp.

TRIBES

In my job working on behalf of person- and family-centered care, I am fortunate to travel the country, and I love the opportunity to meet our members and many professionals who are seeing the value of NHPCO and becoming members.  Many things stand out for me— the beauty of America and its people, the caring and compassionate nature of all the folks serving hospice and palliative care patients and families, and the lingering tribalism that, intended or not, undermines the first two things.

You see, we are all on the side of patients and families.  We are all trying to do our best to improve care and to improve our communities.  I see this shared commitment in communities across the country—and I am proud. What’s different is how we talk about ourselves, and how we describe what we do.  Not what we ARE.  Democrat or Republican, small or large, rural or urban, hospice or palliative care, physician, nurse, social worker, chaplain or administrator…and I could go on.  There are so many tribes we all belong to in our personal and professional lives.  Sometimes we allow our tribe to become us and to cause us to question others’ motivations or constitution.  This is natural, but we must resist doing so at all costs.

Whenever I speak about palliative care—and note that the term is not fully or clearly defined—it seems that I am immediately accosted by a dedicated palliative medicine physician that questions my commitment to palliative care.  When I speak about hospice in loving terms, I am immediately told by a well-intentioned provider that a local for-profit entity or large non-profit is not committed to the original model and they are eroding the “heart” of hospice.  When I speak of health care reform, I am accused of being a Democrat, and when I embrace market reforms, I am accused of being a Republican.  I am accused by city folks of being a country dweller (which I am) and by country dwellers of being an out of touch city boy (which I was, sort of).  I am guilty as charged of all of that— but I want to note that what motivates me— and most of us— is that we are guilty of wanting a better life for our communities, our families and our country.

As we enter this elections season, I want to urge all of us to focus on the only tribe that matters— our fellow human beings.  Please, don’t let labels or divisive rhetoric prevent us from uniting around person-centered, interdisciplinary care.  This care is not about our tribe, it is all about putting our tribe aside and doing what’s best for our patients and families and doing so while collaborating with our colleagues, even those who have a different point of view.  That’s the best model I can think of for participatory democracy. I hope that we will show the rest of the country how to put labels aside and just move forward in a decent and productive manner.  And as we move forward, let us never lose the ability to engage with one another in a constructive manner on challenging issues. Only by working together can we build on the success of those who forged our path as both a nation and a provider community.

By Edo Banach, JD
President and CEO
National Hospice and Palliative Care Organization

Opioid Packages Includes Safe Disposal Provision

National Hospice and Palliative Care Organization applauded Members of Congress for including key provisions related to safe disposal of expired or no longer needed medication in the final opioid legislative package that has passed both chambers of Congress with bipartisan support on October 3, 2018. 

“Opioid abuse is truly a national crisis, and one that the hospice community is dedicated to helping prevent and treat,” said NHPCO President and CEO Edo Banach. “In fact, as a key part of this nation’s grief support safety net, hospices are acutely aware of the toll that this epidemic takes on families and communities.” 

A provision in the passed bill will help reduce the number of unused controlled substances at risk of diversion or misuse by allowing qualified hospice employees to safely dispose of these medications on site after the death of a patient, or when the controlled substance is expired or no longer needed because the hospice patient’s plan of care has been modified. 

Granting appropriate hospice professionals the legal authority to dispose of unused medication after a hospice patient’s death would not only alleviate grieving families of this responsibility but also help prevent potential diversion or illicit use of these drugs. 

Opioids play a key role in alleviating pain and suffering for those with advanced illness and at the end of life. Patients admitted to hospice care frequently require intensive medication management of both chronic conditions and symptoms associated with end-stage disease such as pain, shortness of breath, nausea, delirium, and depression. Our nation’s hospice and palliative care providers can be an important part of the care continuum for people with serious pain, including those with serious illness and facing the end of life, and should be looked at as a resource for these populations.

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.