The Moran Data Project: Is your hospice participating?

The participation of all hospice providers across the country is needed for a very important project that has the potential to impact every provider in the U.S. I'm writing about the Moran Data Project.

For those not familiar with the project, last July, NHPCO retained The Moran Company (a healthcare research and consulting firm specializing in payment reform) to conduct our own data collection and assessment project on behalf of the hospice and palliative care field. This is in response to impending work on hospice reimbursement reform that is now required as a part of the new health care reform law and requires CMS to initiate hospice payment reform no earlier than 2014.

I would like to share the video message linked below:




For those unable to access the video, here is some additional information about the Moran Project.

The Moran Data Project

Through data collected and analyzed in the Moran Data Project, NHPCO will develop and present to CMS and MedPAC alternative Medicare hospice payment reform models that fairly reimburse us for the care we provide. This proactive approach allows us to exert some influence on the process rather than relying solely on government regulators and the data they can access. However, in order for our models to be sound, we must have comprehensive, patient-level data—and for that, we need the assistance of all hospice providers.

The data collection phase of this project began in February and there are now about 200 providers which are submitting data—but we need 800 more providers of all sizes, type and from all areas of the country to step up and contribute data.

By coming together to present to MedPAC and Congress comprehensive data from a unified hospice industry, we can help preserve our core values and our revenue streams. NHPCO will fight for this—but we can't do it alone. Working together to collect data, we can make our voices heard. Members can learn more online at nhpco.org/moran or contact Amanda Forys at The Moran Company at aaforys@themorancompany.com.

Thank you for your participation!

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NHPCO would like to thank the software vendors who are participating in this important data collection project:

• Allscripts
• Cerner BeyondNow
• Consolo Services Group
• Delta Health Technologies
• Homecare Homebase
• McKesson Corporation
• HPMS - Mills & Murphy Software Systems, Inc.
• mumms® Software
• Suncoast Solutions

A Closer Look at the Health Care Reform Provisions Impacting Hospice

Earlier this week, NHPCO's Public Policy/Advocacy Team sent you an important update on the passage of the health reform legislation and next steps for the hospice community. NHPCO wants to share what we know about the various provisions impacting the hospice community. In some cases, you will see that there is not yet much information. Many of the provisions will be implemented by the Health and Human Services Secretary, and administered through the Centers for Medicare & Medicaid Services (CMS). But, in order to do that, we believe that the first order of business for the Administration will be to appoint a CMS Administrator to delve into the details of implementation and oversight.

Visit NHPCO's Advocacy page for more information on the provisions that will be significant to hospice.

Health Care Reform Bill Has Moved Through Congress and Signed by President Obama

A Quick Recap

For more than a year, the hospice community has been on the edge of our collective seat, watching the political process that has consumed health care reform. First there were three bills, and then the House and Senate each settled on one version they each wanted to put forth.　 At the end of 2009, we were waiting to see if and when the White House would weigh in and choose a direction to pursue toward passage. At the same time, Republican leadership continually urged for a re-start of the process, from scratch. Along the way, we lost Senator Ted Kennedy, a long time health reform champion and a very good friend of the hospice community. We’ve also had multiple changes in leadership of the committees with jurisdiction over health care reform. To say that this journey has been a winding road is an understatement, but with each curve, Hospice Advocates have been very clear and unified in our messaging to Congress. During this process, we have sent Purple Folder Letters to the White House by the dozen, filled up the White House Comment Line, and contacted Congress (more than 70,000 contacts) so much that they probably recognize you by name!, Now this part of the process is drawing to a close. In the past 24 hours, Congress has moved into the final stages of this round of health care reform.
　
What Passed and What it Means for End-of-Life Care

Sunday night, by a vote of 219-212, the House passed H.R. 3590, the Patient Protection and Affordable Care Act. H.R. 3590 is actually the version of health reform that originated and passed out of the Senate last December. This version of the bill, the one that has now passed both chambers of Congress, softens the productivity cuts to hospice from a proposed $10 billion to $7.8 billion. Here’s an overview of what is in the final package relevant to end-of life care:
　

• Market Basket Cuts & Productivity - Incorporates a productivity adjustment reduction into the market basket update beginning in fiscal year 2013, as well as a market basket reduction of .3 percent for hospice providers from fiscal years 2013-2019.　　Note that these cuts will not take effect until FY 2013.
• Hospice Payment Reforms – (1) This provision would require the Secretary to collect data and update Medicare hospice claims forms and cost reports by 2011.　　(2) Based on this information, the Secretary would be required "implement revisions to the methodology for determining the payment rates for routine home care and other services included in hospice care" no earlier than　FY 2013.　　(3) After January 1, 2011,　a hospice physician or nurse practitioner must have a face-to-face encounter with　each hospice patient to determine continued eligibility for hospice care　prior to the 180th-day recertification and each subsequent recertification, and attest that such visit took place.　 In addition, the Secretary will medically review certain patients in hospices with high percentages of long-stay patients.
• Medicare Hospice Concurrent Care Demonstration Program - Directs the HHS Secretary to establish a three-year demonstration program that would allow patients who are eligible for hospice care to also receive all other Medicare covered services while receiving hospice care. The demonstration would be conducted in up to 15 hospice programs in both rural and urban areas and would undergo an independent evaluation of its impact on patient care, quality of life and spending in the Medicare program.
• Curative and Palliative Care for Children in Medicaid and CHIP - Allows children who are enrolled in either Medicaid or CHIP to receive hospice services without foregoing curative treatment related to a terminal illness.
• Independent Payment Advisory Board - Creates an independent Payment Advisory Board tasked with presenting Congress with comprehensive proposals to reduce excess cost growth and improve quality of care for Medicare beneficiaries as well as the private health system. When Medicare costs are projected to be unsustainable, the Board’s proposals will take effect unless Congress passes an alternative measure that achieves the same level of savings. Congress would be allowed to consider an alternative provision on a fast-track basis. Requires the Board to make non-binding Medicare recommendations to Congress in years in which Medicare growth is below the targeted growth rate.　 Beginning in 2020, requires the Board to make binding biennial recommendations to Congress if the growth in overall health spending exceeds growth in Medicare spending.
• Hospice Value Based Purchasing/Promoting High Value Health Care - Provides the Secretary of HHS the authority to test value-based purchasing programs for long-term care providers, including hospice providers, no later than January 1, 2016.
• Quality Reporting - Requires hospice to report on quality measures determined by the Secretary (endorsed by the new quality measure consensus-based entity) or face a 2 percent reduction in their market basket update. Measures published in 2012 for reporting to begin in 2014.　
• Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-term care Facilities and Providers - Establishes a national program for long- term care facilities and providers to conduct screening and criminal and other background checks on prospective direct access patient employees.
• Advancing Research and Treatment for Pain Care Management - Authorizes an　Institute of Medicine Conference on Pain Care to evaluate the adequacy of pain assessment, treatment, and management; identify and address barriers to appropriate pain care; increase awareness; and report to Congress on findings and recommendations. Also authorizes the Pain　Consortium at the National Institutes of Health to enhance and coordinate clinical research on pain causes and treatments. Establishes a grant program to improve health professionals’　ability to assess and appropriately treat pain.　
• Education and training programs in pain care - Secretary may make grants available to hospices and others to develop and implement pain care education and training programs for health care professionals.　

You may still hear talk of the reconciliation bill over the next week or two. More information on that package and the related legislative process can be found in our previous health care reform update. However, we feel confident that all of the health reform provisions that will impact hospice are contained in the package that passed yesterday and are listed above.
　
We’re Still Fighting
While we appreciate the fact Congress continues to embrace hospice as a vital part of health care at the end of life and we’re pleased to see the provisions included expanding access to hospice, we simply can’t afford to lose $7.8 billion from the national investment in end-of-life care.　
　
We have said it all along; two cuts are too much for hospice. And, we mean it. The productivity cuts on top of the more than 4 percent regulatory reduction associated with the elimination of the budget neutrality adjustment factor (BNAF) we are absorbing over the next seven years, is more than the community can or should sustain. As an aside, you, as a Hospice Advocate, working through NHPCO, were the reason the phase-in of the BNAF cuts went from the previous Administration’s plan of three years, to the current schedule of seven years. This gives the hospice community more time to plan for and manage the implementation of these unwarranted cuts.
　
Accordingly, with Capitol Hill Day 2009 just weeks away, NHPCO will be leading the hospice community in a measured, strategic, and phased fight to further soften the cuts before they go into effect in 2013. We’ve done what we needed to do for this phase of health reform. The hospice community was a resource to Congress during this trying past year. We were heard when we said $10 billion was too much to take from hospice and our policy makers heard us when we asked for increased access to hospice for pediatric patients and concurrent care.　
　
NHPCO will continue to ensure that hospice is "at the table" after the political dust settles and before the community and the patients we serve feel the brunt of the cuts.
　
You may be asking, "Why wait until Hill Day, why does it need to be phased?" To be honest, the health care decision makers on Capitol Hill are going to be burned-out and not ready to revisit the reform legislation for a while…probably not until after the November elections. But, that’s good news for us. With Hill Day, away from all the "noise" of health care reform, we will launch an education effort to reacquaint our federal elected officials with the Medicare Hospice Benefit, who we are as a community, the patients we serve and the invaluable services that are provided by hospice in every community across the nation. A focused and consistent re-education effort is critical to a successful, phased strategy to get additional relief from the cuts.
　
Immediate Next Steps
Obviously, the more people we can get on Capitol Hill on April 21st, the stronger the launch of our re-education effort will be. So, visit the Hill Day 2010 Information Page for more information and to register. And for those of you who cannot join us in D.C., stay tuned for exciting opportunities to participate from home!
　
Most importantly, as a unified community with one voice, we need to get the facts together to show Congress what the cuts will mean to the hospice programs that serve their communities and constituents. The NHPCO Regulatory Team has been hard at work on a comprehensive, easy-to use calculator for programs to use to determine the long-term impact of the combined cuts. NHPCO members should receive an email in the coming days with a link to this interactive tool.　
　
As always, we thank you for your Hospice Advocacy. We may not have the end-result we want yet, but your efforts have come a long way in advocating for the patients and families who depend on compassionate, high-quality end-of-life care. Please let us know if you have questions about any of this information by contacting advocacy@nhpco.org.

Tune In and Tweet Tomorrow for the Health Reform Summit

Tomorrow's Health Reform Summit convened by President Obama will once again bring Health Care Reform to the political forefront and could possibly pave the path forward for the reform effort for the rest of the year. As Hospice Advocates know, the legislative effort toward national health reform has slowed significantly since the political dynamics in the Senate changed with the election of Scott Brown (R-MA).

If health reform regains momentum, the hospice community faces monumental changes in the current reform drafts passed by the House and Senate. While we can't expect the President's Summit to get into the details of how reform would impact end-of-life care, it is important that we understand where the political dynamics are driving the process and what the President and Congress put forth as guiding principles for the effort.

You can witness the bipartisan summit from your television or computer on Thursday, February 25 at 10 a.m. Eastern.

Just tune in to C-SPAN 3 or visit http://www.whitehouse.gov/live to watch Members of Congress and the President have a dialogue on health reform and see how the summit will influence the issue in the coming months. As you watch, share your thoughts with us on Twitter @hospiceaction. Your tweets help us shape our advocacy efforts here in Washington.

For more information on hospice and health reform, visit NHPCO's Health Reform Resource Center.

New to twitter? Email han@nhpco.org for help.

As always, thanks for your Hospice Advocacy!

For more information visit, http://www.nhpco.org

Don's November Message

For more information visit, http://www.nhpco.org

NHPCO Calls for Hospice Community to Make its Voice Heard

More Cuts to Hospice Announced: Hospice Community Responds
with Virtual Lobby Day on July 15

(Alexandria, Va) – The nation’s hospice providers are facing proposed cuts of $2.3 billion over a five-year period and $9.8 billion over a ten-year period in the preliminary estimates of the House of Representatives health reform proposal, released last week by the Congressional Budget Office.

These cuts are in addition to the cuts scheduled to go into effect on October 1 as a result of the elimination of the Budget Neutrality Adjustment Factor (BNAF), an issue the hospice community has been fighting to overturn for some time.

This new development makes the need to stop the BNAF cuts even more urgent for hospice providers. On Wednesday, July 15, NHPCO and The Alliance for Care at the End of Life are sponsoring a nationwide Virtual Lobby Day. All Hospice Advocates are called to join together to protect patient access to compassionate and high-quality end-of-life care.

If the BNAF cuts move forward on October 1, just 80 days from now, the hospice community is potentially facing a 6.4 percent reimbursement cut in federal fiscal year 2010 (October 1, 2009 - September 30, 2010).

“The situation facing the hospice community is clear: we are now facing cuts on top of cuts. When you take these proposed cuts, and place them on top of the BNAF scheduled cuts, it is simply unacceptable,” said J. Donald Schumacher, NHPCO president and CEO.

Here's how Virtual Lobby Day will work:

• On Wednesday, July 15, all Hospice Advocates registered on NHPCO’s Legislative Action Center will receive the Virtual Lobby Day information via email.

• The email with include instructions about who to contact, how to contact them, and specific talking points.

• Participants will call and write throughout the day on July 15.

People who have not previously registered on NHPCO’s Legislative Action Center can sign up now—it’s free and open to any interested individual. Go to nhpco.org/advocacy and click the “Legislative Action Center” box.

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Contact:
Angie Truesdale
Ph: 703-647-5163
atruesdale@nhpco.org
or
Jon Radulovic
Ph: 703-837-3139
jradulovic@nhpco.org

For more information visit, http://www.nhpco.org

The Latest News on Hospice & Health Care Reform

As Congress prepares to depart Washington for the July 4th District Work Period, health care reform activities refuse to wind down. Higher than expected cost estimates by the Congressional Budget Office (CBO) sent Washington into a flurry of activity over the past few weeks, as stakeholders try to rein in the price tag associated with the reform effort. Here’s what’s been going on:

The President
President Obama continues to reiterate his two goals for the overhaul – reducing overall health care costs and covering the uninsured. At the same time, the President has demanded that larger members of the health sector come up with their own savings to pay for the plan, and the pharmaceutical industry responded this week with $80 billion over 10 years.

Senate Activity
The mark-up of the proposal drafted by the Senate Finance Committee, the committee which was previously out in front on health care reform, has stalled due to the lack of a bipartisan consensus. Chairman Max Baucus and the committee staff continue to work around the clock to refine their bill to gain support on both sides of the aisle.
The Senate Health, Education, Labor and Pensions (HELP) Committee was been holding a week-long marathon of a mark-up on its proposal. NHPCO has been asked by Committee staff to comment on proposed amendments that would expand efforts to increase utilization of Advance Directives. This mark-up is expected to continue through the week, and may need to reconvene after next week’s District Work Period.

House Activity
Late last week, the committees of jurisdiction in the House of Representatives released a nearly 900-page draft of the House health care reform proposal. Buried in that draft document is a reduction in the productivity factor, which amounts to an across-the-board rate reduction for all Medicare providers. This is an early draft of one Chamber’s proposal, and we don’t know whether it will come out in the final package. We are still combing through the hefty document to determine if there are other provisions that might impact hospice.
The Ways & Means Committee continues its hearings on health care reform this week, and is expected to begin mark-up of the proposal after the District Work Period. The Energy & Commerce Committee heard testimony from Department of Health & Human Services Secretary Kathleen Sebelius this week and also continues hearings on health care reform.

NHPCO
ABC News hosted a Healthcare Reform Town Hall Meeting on June 24, at the White House. The program was moderated by Diane Sawyer and Charlie Gibson and featured a cross section of Americans asking President Obama questions about healthcare issues as they relate to their personal needs. NHPCO provided information on end-of-life care to ABC News producers, and helped the news team covering this town hall meeting to find additional professional contacts in the field.
NHPCO and the Alliance for Care at the End of Life continue to be in contact with the key Committees of jurisdiction, and try to advance end-of-life care proposals that would pave the pave the way for modernizing the Medicare Hospice Benefit in the future. Check out of the proposals endorsed by NHPCO in recent weeks.
Please stay tuned for future health care reform updates. The President continues to push for passage of bill by the end of the summer and the coming weeks will be full of activity as the various Committees of jurisdiction try to meld their proposals together and pass their bills.

New Health Care Reform Resource Center
Please visit the new Hospice & Health Care Reform Resource Center. There, you can find our current and past updates on health care reform activities. You’ll also find what we are sending to the Hill on hospice and health care reform, and many other valuable resources.
Providers with questions may contact NHPCO's Public Policy Team at advocacy@nhpco.org.

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For more information visit, http://www.nhpco.org

Capitol Hill Day a Success

NHPCO CAPITOL HILL DAY PARTICIPANTS TO CONGRESS: PROTECT ACCESS TO COMPASSIONATE & HIGH-QUALITY END-OF-LIFE CARE

(Alexandria, Va) – More than 500 Hospice Advocates from across the country met with their U.S. Senators and Representatives yesterday, urging them to protect access to compassionate and high-quality end-of-life care for the more than 1.4 million patients and families who depend on hospice each year.

The meetings were part of the National Hospice and Palliative Care Organization’s annual Capitol Hill Day. In addition to the meetings in Washington, D.C., thousands of phone calls were made to Congressional offices by Hospice Advocates, who participated in NHPCO’s inaugural Virtual Hill Day.

Throughout their interactions with Congress, NHPCO Hill Day participants emphasized the value of hospice in their communities, provided state-level data on quality and family satisfaction with hospice services provided, and urged lawmakers to support efforts to stop cuts in Medicare hospice funding that threaten to close the doors of hospice programs around the country.

In 2008, the Centers for Medicare and Medicaid Services (CMS) issued a regulation that eliminates a key component of the Medicare hospice reimbursement formula known as the budget neutrality adjustment factor (BNAF). The phased funding cut threatened 3,000 hospice provider jobs this year, as well as the survival of hospice programs, especially smaller and rural ones, across the country as the cuts were phased in. While a temporary moratorium on the hospice funding cuts was included in the American Recovery and Reinvestment Act of 2009, it expires on September 30 of this year. Just this week, CMS released a proposed FY2010 Hospice Wage Index rule that would incorporate a 75 percent reduction in the BNAF, which is a 3.1 percent reduction in overall hospice reimbursement. This development underscores the urgency in rescinding the CMS rule.

NHPCO Hill Day participants specifically asked Members of Congress to sign on to a bipartisan letter to President Barack Obama and to contact the Department of Health and Human Services about rescinding the 2008 CMS hospice funding cut before it goes into effect on October 1 of this year.

“This is a critical year for the hospice community, so it was important for our advocates to send a strong message to Capitol Hill about the importance of the high-quality services provided through hospice, and the fact that hospice is a cost-saver to Medicare. If these funding cuts are allowed to go forward, they will have a devastating effect on access to high-quality and compassionate end-of-life care,” said J. Donald Schumacher, president and CEO of NHPCO.
In 2007, an independent, Robert Wood Johnson Foundation-funded study by Duke University found that hospice reduced Medicare costs by $2,300 per patient, amounting to more than $2 billion in savings per year.

Hill Day kicks off NHPCO’s annual Management & Leadership Conference, which attracts more than 1,600 members of the hospice community from all over the nation. Two hundred additional members of the hospice community joined the Hill Day participants for a reception honoring Hospice Champions on Capitol Hill at the new U.S. Capitol Visitor Center. Later in the week, the hospice community will also hear from Nancy-Ann DeParle, Director of the White House Office of Health Care Reform, and Elizabeth Edwards when she is recognized as NHPCO’s Person of the Year.

For more information about NHPCO’s Capitol Hill Day, please visit: www.nhpco.org/advocacy.

Media Contact:
Sara Perkins
Manager of Public Policy Communications
Ph: 703-837-3155
sperkins@nhpco.org

Join NHPCO for Capitol Hill Day

Capitol Hill Day Registration Deadline is April 1st

Remember your first day of school? No matter at what level – elementary school or college – most people would say that they felt a combination of excitement and anxiety. There’s the fear of saying the wrong thing, or going to the wrong place. For many, the idea of visiting Capitol Hill for meetings with Members of Congress and their staff can take you back to those first days of school – regardless if it is your first time, or if you are a seasoned veteran.

That’s why NHPCO has a new and improved Capitol Hill Day program planned for this year. We want our members armed and ready to go when they head to the Hill on April 22nd.

The enhanced Capitol Hill Day is designed for everyone, at every level of the hospice community. It is a busy time on Capitol Hill. Congressional offices see hundreds of constituents each week, advocating on behalf of diverse and pressing national issues. That is why it is crucial for us to make sure that we are maximizing our opportunities to emphasize the value of hospice during Hill Day, and throughout the year. The enhanced strategy sessions for messaging and meeting preparation have been designed to give us the unique and unified presence on Capitol Hill that we need to protect compassionate and quality end-of-life care for future generations. Capitol Hill Day promises to be an interactive, educational and fun experience for attendees!

Don’t miss out on Capitol Hill Day - registration ends at midnight on April 1st. There are just two more days left to sign up for this exciting opportunity. For more information on Hill Day, go to http://www.nhpco.org/i4a/pages/Index.cfm?pageID=5809.

If you have questions or need to change your MLC registration to attend Hill Day, please contact advocacy@nhpco.org.

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For more information visit, http://www.nhpco.org

NHPCO Statement on MedPAC Recommentdations to Congress

(Alexandria, VA) – Today, the National Hospice and Palliative Care Organization released the following statement upon the release of the Medicare Payment Advisory Commission’s (MedPAC) March report to Congress. The report includes recommendations to revise the Medicare hospice benefit.

Each year, more than 1.4 million patients and family caregivers seek hospice care. The Medicare hospice benefit is responsible for millions of people living as fully as possible until the end of life. The hospice community is dedicated to not only preserving the benefit, but enhancing it so that hospice is able to continue to appropriately serve the unique and changing needs of dying Americans. Hospice and palliative care providers, through the support that comes from Medicare, are recognized as the leading providers of the interdisciplinary, holistic care considered to be the “gold standard” of end-of-life care.

Hospice care is also cost-effective. As was reported in a 2007 Duke University study, hospice reduced Medicare costs by an average of $2,300 per patient, amounting to a $2 billion savings in a single year.

Statement on MedPAC’s Recommendations for Hospice Reform:

Over the past several years, MedPAC has undertaken a review of the Medicare hospice benefit. While specific reforms and enhanced accountability measures are laudable and should be encouraged, those changes should be framed in the context of a comprehensive review of the various and complex components of end-of-life care, and how the continuum of care can be expanded to increase access for patients and families. Included in this comprehensive review of hospice should be payment methodologies, fiscal constraints review, alternative eligibility criteria, testing of new models of care, as well as any number of other issues. The hospice community is committed to work toward these goals.

Guiding this review ought to be several clear principles. Among them are:

• Advancing hospice and palliative care programs as the recognized providers of end-of-life care;
• Preserving and enhancing the Medicare hospice benefit;
• Recognizing “high quality” as the standard to which all providers must subscribe;
• Ensuring accountability through transparency and fair regulatory scrutiny; and
• Promoting increased access through expansion and collaboration.

Payment policy is one of the areas of the Medicare hospice benefit that needs to stay current, so that payment appropriately recognizes changes on patient demographics and treatment protocols. Updates should be carefully considered and evidence-based to ensure that behavioral consequences are understood prior to implementation. The present payment methodology has served the hospice community and the public well since its inception, virtually without change. Analysis of both current and historical patient level data is necessary to fully understand and predict future behavior and needs, and make changes that continue to provide benefits to patients and to the Medicare system.

As with any payment system, dramatic changes to the hospice benefit from established patterns of reimbursement are sure to produce displacements and unintended negative consequences. Given the nature of hospice referrals and the unique characteristics of the end-of-life patient demographics, unintended consequences of such changes are inherently difficult to predict. Any number of issues might warrant attention, but effectively quantifying such items in terms of behavior changes of patients and providers would be difficult. Payment reforms should be incremental, based on adequate data analysis, and need to be undertaken carefully, with effects on the patient and family in mind.

The hospice community applauds the open and informed process that MedPAC undertook to produce the recommendations, and looks forward to working with the Commission, appropriate oversight agencies, and Congress to ensure that the Medicare hospice benefit continues to serve patients at the end of life in the compassionate and high-quality manner that they deserve and expect.”

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Contact:Sara Perkins
Manager, Public Policy Communications
Ph: 703-837-3135
sperkins@nhpco.org
For more information visit, http://www.nhpco.org