Wednesday, September 28, 2016

Birth of a New CoP for Medicare Hospice, Part 1

After three years of waiting, the final rule for Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers (CMS-3178-F) was finally posted in the Federal Register on September 16, 2016.

The Centers for Medicare and Medicaid Services undertook the architecture of specific emergency preparedness regulations to establish national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers to ensure that they adequately plan for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems.  CMS also wanted to ensure that providers were adequately prepared to meet the needs of patients and families during disasters and emergency situations.  Disasters can disrupt the environment of health care and change the demand for health care services. Regulatory requirements make it necessary that health care providers and suppliers integrate emergency management into their daily operation and culture.

Prior to the posting of the final rule, the federal hospice Conditions of Participation (CoPs) at § 418.110 (c) only included hospice inpatient facilities to have a written disaster preparedness plan that is periodically rehearsed with hospice employees, with procedures to be followed in the event of an internal or external disaster, and procedures for the care of casualties (patients and staff) arising from such disasters.  This final rule has emergency preparedness requirements for both homecare and inpatient hospice providers. Hopefully, most hospice providers have some type of emergency or disaster plan in place right now that contains most of the components in this new CoP which will make the implementation less onerous. Whether your hospice is enhancing your current plan or starting from scratch, including your assessment of your current compliance and development of a plan to become compliant is a must for either a hospice compliance program or quality assessment performance improvement (QAPI) program.

The CoP for hospice providers contains four main standards that specify requirements for the hospice to develop an emergency plan, specific policies and procedures for emergency preparedness, a communication plan, and a program for preparedness training and testing that is based on the emergency plan. The good news for hospice providers is that the implementation date for this new CoP is November 16, 2017.

Next up for discussion (in Part 2) are the hospice emergency preparedness plan and policies/ procedures.

Jennifer Kennedy, MA, BSN, RN, CHC
NHPCO Senior Director, Regulatory & Quality 

Monday, September 26, 2016

Back to School in Baltimore

Learn About Your Options…Before a Health Crisis Hits 

Eight years ago, I stumbled upon the National Hospice and Palliative Care Organization. I was returning to the workforce after being at home with my younger children for two years. Although I did not know much about hospice and practically nothing about palliative care, neither was required for the position I was applying for. I began my journey here as the program assistant to the professional development department. Lots of committee work, lots of conference prep, lots of administrative tasks and tons of processing CE/CME certificates for social workers, counselors, nurses and physicians. At the time, I was more interested in the income for my family’s sake as opposed to the outcomes of work we were doing at NHPCO.  I did my job and I did it well. I listened in on webinars, enjoyed meeting faculty at conferences and I have probably processed ten thousand CE/CME certificates. Fast forward to today.  

Today, I am the senior manager of access programs. Over the past eight years, I have come to realize and am more aware of the work we do and its affect on patients and families. I’m also more aware of the health disparity in our field, as well. My team and I work on programs that allow patients, families and caregivers to access end-of-life care services on a national and local level through our member organizations and vice versa. NHPCO is committed to championing access to the right care at the right time for all people.  Yet, the utilization of hospice and palliative care among African Americans remains disproportionately low.  Of all patients utilizing hospice care in 2014, an estimated 7.6 percent were identified as black or African American, which reflects a slight drop from the previous year. Several studies have shown the reasons for underutilization range from lack of education and awareness about end-of-life care services, religious beliefs and to just not wanting to talk about the subject. 

NHPCO’s strategic plan includes expanding hospice and palliative care access to African American communities where a disparity of care exists. This year through a collaboration between NHPCO and Morgan State University we have worked hard to move this initiative forward. Morgan State University is a HBCU located in Baltimore, MD.  Historically Black Colleges and Universities (HBCUs) are relevant and play an essential part in today's higher education and serve as a hub for gatherings in many African American communities.

This spring, we invited Baltimore area pastors to join us for fellowship and open dialogue with Pastor Corey Kennard who provided guidance and inspiration for addressing the spiritual needs of those dealing with serious illness, end-of-life and grief within the faith community. He also touched on the effectiveness of the faith community and forming healthcare partnerships in this work. We had a great time. We learned a lot.  We were also left with a lot to think about.

The meeting with the local pastors served as a “kick-off” to our 4-Week workshop series on end-of life care. During this series we offered the following free, non-credit courses:
  • Faith and Hope at the End of Life
  • What is Hospice and Palliative Care?
  • How To Plan and Communicate Your Future Healthcare Wishes (my class!)
  • Loss, Grief and Bereavement
Let’s face it, none of these subjects are “sexy” but very necessary.  Making decisions by the bedside is not the right time to discuss any of these topics.  Our goal is to encourage you, your family and caregivers to learn more about your options so you’ll be able to make informed decisions about end-of-life care. Imagine your mom or dad being diagnosed with a serious illness and you and your siblings, and your parent’s extended family trying to make tough decisions during a time when emotions are high. Sound familiar?  I know the feeling.  I’ve been there and don’t want to be there again.  

So, what happened at MSU?  The courses went well. Our faculty members were great. Here are a few of the many participant comments we received about the courses:

“Thank you for this course. Information is power when dealing with myself or a loved-one’s healthcare & end of life decisions.”

“Very interesting, informative and educational.”

“Pastor Corey is a motivational, engaging, informed facilitator.”

“Really like the non-threating approach to difficult subject, varied methods to learning, and practical approach.”

“This course really made me think of how I can be supportive to those who are experiencing grief.”

“It was extremely amazing. I never knew so much went into hospice and that palliative care existed.” 

“I’m glad I came, really informative! Both Kennedy and Coleman were great and knowledgeable about the subject.”

I even learned a little more about each subject. Who knew! I met some great folks in Baltimore. Participants were very engaged in each course; the questions were interesting. Many ideas and family stories shared.

I was blessed to be able to teach the course, How to Plan and Communicate Your Future Healthcare Wishes. This course was all about advance directives and advance care planning. I wanted to leave participants with tools they could use when talking to their families about their personal wishes, including their healthcare provider in the conversation, and choosing a fitting healthcare proxy to be his/her decision maker.  Advance care planning is much more than completing an advance directive. That paper means nothing if you have not had any conversations with your healthcare providers and family. Have you explained to them who your healthcare proxy will be? Does everyone in your family have a copy? Does your healthcare provider have a copy?  Have you asked your healthcare provider questions about the medical treatments you don’t understand?  I covered some serious topics but also played a game and showed videos to keep it fun.

Now what?  Phase II of this collaboration is taking place this fall. These courses will be offered for free to Baltimore families, caregivers and anyone interested in learning more about end-of-life care.  All courses will be hosted at MSU’s University Student Center. Refreshments will be provided. Parking is available. Encourage your friends, family and neighbors to take advantage of this learning opportunity.

You can register yourself, a friend or a group for one or more of the courses. To reserve a spot, REGISTER ONLINE or call 443-885-3155.   When you know better, you do better. Get the conversations started today.  Attend a course, learn about your options and become your own healthcare advocate. Baby steps.  If there is a topic about end-of-life care that you’d like to learn more about, mention it in the comments section of this post. I’d love to hear from you.

Special Thanks to the Infinity Hospice Foundation for providing financial support to Phase II of this collaboration.

Cozzie M. King
Senior Manager, Access Programs
Staff Liaison, NHPCO’s Diversity Advisory Council

Thursday, September 22, 2016

The End of the GIP Building Era

In the early years of my work as a hospice consultant, I spent a great deal of time conducting hospice facility feasibility studies. Many of my clients were freestanding non-profits, i.e., hospices that were not part of a hospital system or larger entity. The common wisdom at that time was that while hospice inpatient facilities were unlikely to break even on the basis of their operating revenue, they nevertheless fulfilled a need for patients and families. In addition, they were seen as visible symbols of service to the community and reliable magnets for fund raising.

One of the biggest questions in these projects was always how big to build it. (Rarely was the question whether to build.) I had a number of rules of thumb in helping clients plan these facilities. While typical hospices without a GIP facility might expect to see 1% to 2% of their patient days at the GIP level of care, hospices with facilities routinely exhibited much higher proportions. Utilization as high as 6% was much more typical, and usually the metric I used to estimate the need for beds in new facilities. In fact, even after using that aggressive planning target, one of my clients reported after an expansion project that their occupancy rate was running far ahead of projections.

My, how times have changed.

These days I find myself advising disappointed clients not to build at all. One client had already lined up donated land and was set to launch the capital campaign. However, when shown the size of the probable operating deficit their proposed facility would carry year after year, the board decided to put the project on indefinite hold.

So what happened? I attribute the change directly to the transformed environment for compliance oversight and increased scrutiny of general inpatient level care. The OIG study released in March this year was titled, “Hospices Inappropriately Billed Medicare for $250 Million for General Inpatient Care.” Only in their document, that title is in ALL CAPS. There is no doubt this analysis is guiding their enforcement action. Since June of this year, two hospices have been assessed civil monetary penalties for misuse (read over-use) of GIP level care. I expect there will be more to come. In addition, we’re hearing from hospices across the country that their MACs are aggressively rejecting claims and requiring much more thorough documentation of the appropriateness of each day of GIP level care.

So what do we do about it? We’ve already built the facilities using a different set of assumptions about their use. If we assume that today’s tight scrutiny is here to stay, how do we ensure that our facilities receive their best and highest use while remaining compliant with Medicare regulations?

I’ll be publishing more about this topic over the coming weeks. In the meantime, I urge you to consider attending our upcoming event devoted to this topic. On October 30, prior to the start of The Intensives conference, I’ll be facilitating the NHPCO Edge Thought Leader Forum. Our focus is “Optimizing Freestanding Hospice Facilities: Stemming Losses in an Era of Shrinking GIP Utilization.” We’ll gather leaders in hospice facility management from around the country to share what works, what doesn’t and how they are adjusting to the new reality. For more information, see the event announcement here

Sue Lyn Schramm, MA
Director, Consulting Services, NHPCO

See the previous NHPCO Edge Blog article, "Community-based Palliative Care."

Tuesday, September 20, 2016


Those of us who are more seasoned as hospice providers, often comment to one another “hospice isn’t what it used to be.”  Usually we are shaking our heads wistfully; sometimes hindsight gives our memories a rosier glow.  Well, it’s not as it used to be.  And it will be different in the future.  Like the rest of healthcare, we will face more chronic illnesses, greater medical complexity in care and treatments, varied cultural values around death and dying, family stresses, and less resources.

Yet I believe wholeheartedly that what we offer and what we do will remain vibrant and valuable. Our challenge is to stay in touch with our roots, our purpose, and have that be the driving force. To quote the Denver Hospice Mission Statement: “To encircle those facing advanced illness with unprecedented levels of comfort, compassion, and expertise.”

To do so with efficiency, we will need to consistently remind one another to shift our perspective and utilize skills with discernment. Often we find ourselves advocating for what we think is best and becoming frustrated as we meet resistance. 

The experience model reminds us to uncover what is hindering the patient/family from identifying and reaching their goals.  Sometimes it is us! We can learn to listen, really listen, to each unique patient/family constellation, allowing what is truly best to unfold and become apparent. Then we step in to support and guide and serve. When our compassion fatigue comes from trying to answer the unanswerable, we will learn to say “I don’t know---but we will walk with you each step of the way.” By taking time for debriefing and extrapolating lessons, particularly from our most challenging situations, we can build resilience, skills and confidence in ourselves and our teams.

As passionate as I am about hospice, I am equally fervent about social workers and recognizing the psychosocial in whole person care.  All members of the team have a role in psychosocial support, just as they do in other aspects of care; we can integrate our interdisciplinary nature so that we blossom and grow as we serve.

Patricia A. Goodwin, ACSW, LCSW, ACHP-SW
Tallahassee, FL

Patricia Goodwin is one of the faculty members for the Psychosocial & Spiritual Care Intensive that is part of NHPCO's new professional development offering, THE INTENSIVES (Oct. 31 to Nov. 2) in Hollywood, Florida.
Register Now: Advance registration ends October 7.

Thursday, September 15, 2016

STAR - Survey of Team Attitudes and Relationships

NHPCO Provider Members: Does your hospice use STAR?

Employees play a fundamental role in the success of any organization and astute administrators recognize the value in a stable and committed workforce.  Research has shown that employees who have higher job satisfaction care about the quality of their work, have higher retention rates, are more productive, and more committed to the organization.  Other sectors of the healthcare industry use job satisfaction surveys tailored to their specific health care environment. STAR is the first and only staff satisfaction survey that reflects the unique needs and work environment of hospice care delivery.  

Utilization of STAR is a benefit of NHPCO provider membership at no additional cost.

Elements of STAR:
  • 45 questions that assess hospice staff job satisfaction (40 items relevant to all hospice staff and 5 questions relevant only to clinical staff).
  • Additional demographic questions.
  • Domains: Work rewards, teamwork, management support, organizational support, workload, global satisfaction.
Administrators find STAR to be a valuable tool for promoting workforce excellence and delivery of quality hospice care. Participation in the NHPCO STAR administration and reporting process provides the information needed to make adjustments to improve staff satisfaction and retention.  Assessing - and improving - staff satisfaction with STAR should be part of each hospice’s comprehensive QAPI program.

How and when to participate:
  • Visit and review the Administrator’s Manual 
  • The first step after reading the manual is to update your hospice’s roster. Email
  • Get started now to have your hospice’s results included in the 2016 National STAR Report! 
  • The annual deadline to complete administration of STAR is December 15
Kristi Dudash, MS
NHPCO Research Manager

Monday, September 12, 2016


A series of blogs on the upcoming event THE INTENSIVES from educational content team members. 

Working with the NCHPP Bereavement Professionals Steering Committee to help develop the Bereavement Intensive for bereavement professionals at first seemed like a daunting exercise. 

Taking into account the NHPCO educational needs assessment, the discussion threads on and our own personal experiences led to a wonderful brainstorming discussion resulting in topics that would advance bereavement services to our grieving hospice families and the community. Finding speakers was the next step and great effort was taken to the find just the right speaker. And we did. We are so excited for this Intensive!

The NCHPP Steering Committee believes that social and cultural implications impact grief reactions. Understanding these are critical for bereavement professionals who all work with clients of diverse backgrounds. The Intensive will cover social complexities as well as the complexities of grief and set the stage for learning about treatment innovations in grief work from EMDR to utilizing digital media. Exciting stuff!

In my community, as well as throughout the country, there has been an epidemic of deaths from heroin overdoses. In our grief center, we are treating a number of parents who have experienced these deaths. In addition, many bereaved are struggling with addiction and recovery.  We have a session designated to this topic which will be helpful to bereavement professionals who have had no previous experience with chemical dependency or substance abuse or could use a refresher on this important topic. 

We also have a session on self-compassion. So many of us have experienced personal deaths or have co-workers who have experienced a personal death. We may even have had a co-worker die. In addition, we are experiencing the death of our patients and listening to the stories of our bereaved families daily. This can be exhausting and takes a toll on our hearts and minds. Learning how to manage personal loss in a professional world is a must not only for ourselves but to help those with whom we work.

The Bereavement Intensive was designed for the advanced professional bereavement and those attending will find it well worth the investment.

Diane Snyder Cowan, MA, MT-BC, CHPCA
Elisabeth Severance Prentiss Bereavement Center
Register Now: Advance registration ends October 7.

Community-Based Palliative Care

A series of blogs on the upcoming event THE INTENSIVES from educational content team members.

It started with a conversation that sounded like the dialogue from an episode of “Mission Impossible.” There was one big difference, however; I don’t remember hearing the words “should you choose to accept this mission…”  The mission was ours; the task was to create an educational program, a Community-Based Palliative Care Intensive about what’s next in community-based palliative care. It was described as “next practices.”  Community – Based Palliative Care 2025 was to be the topic!

“Palliative care outside of the hospital is still fairly new,” we thought, “even though hospice has always been providing it.”  Community-based palliative care is an even more recent addition to the healthcare continuum.  We know the names of some very successful programs but most of these are less than ten years old.  Who could possibly guess where they might be in ten years? 

Suddenly, one of us thought of those little Russian nesting dolls.  Inside every large doll is a series of smaller dolls. One has to peel down to get to the core; to get to the smallest doll.  Conversely the largest doll is built on the others. Our task was to build up!  We already have the kernel.

After discussing the topic with several “experts” in the field, we had some great ideas about what “futuring” might possibly look like for community-based palliative care.  The first bit of advice, however, was not to attempt to look ten years into the future. That was the end of “Palliative Care 2025.”  We were cautioned that change is continually happening – we are in the midst of it –  and trying to predict ten years down the road is likely impossible. 

So we did some research on the topic of “futuring.”   What is it? Why is it important? The authors of Dance of Change warn that futuring, while not easy, is essential for program planning and development.  It challenges us to look forward not just ahead. We analyze internal assumptions, scan the environment and use data to identify emerging issues.  We were convinced that futuring would be our goal.

Putting the Intensive together has been an opportunity for us to learn and grow; to look at things in a different way. 

Attending the Intensive will be your gift to yourself and to your program. We’ll be stimulated and challenged together and may even “…boldly go where no one has gone before.”  Join us, your colleagues and experts in the field as we co-create the future of community-based palliative care.

Judith A. Skretny
Director of Palliative Care
National Hospice and Palliative Care Organization
Register Now: Advance registration ends October 7.


A series of blogs on the upcoming event THE INTENSIVES from educational content team members.

Building a Quality education Intensive takes a village and the NHPCO Quality team was up to the challenge.  

Topic development for this deep dive into quality education started with robust and lively discussion amongst the NHPCO Quality & Standards Committee under the leadership of Carol Spence, VP of Research & Quality. Spence presented this unique educational program as an opportunity to focus on the needs of the hospice quality community and the committee was instantly on board and excited about suggesting topics and speakers.  Quality topics from the NHPCO member education survey were also considered to determine the best mix of educational sessions for this 1.5 day learning program.

All through the planning process of the Quality Intensive was the guiding principle that each session builds on the previous session starting with  the how-to’s of successful quality assessment performance improvement (QAPI) and ending with  using implementation science to sustain improvement.  

Moving from the first to the last session is like walking the quality road and taking all that is learned to incorporate it into every day hospice practice at the end of the journey.  While the quality sessions emphasize compliance, the main aim of all sessions is improving quality practices that will in turn improve quality patient care. 

The best part about the Quality Intensive is that it is designed to reach a broad range of hospice professionals with varied quality experience and learning for all levels is guaranteed.  The combination of dynamic knowledgeable speakers and cutting edge topics is every hospice provider’s roadmap to the future of hospice quality.

Jennifer Kennedy, MA, BSN, RN, CHC
Senior Director, Regulatory & Quality
National Hospice and Palliative Care Organization
Register Now: Advance registration ends October 7.

Psychosocial and Spiritual Care

A series of blogs on the upcoming event THE INTENSIVES from educational content team members.

When first beginning to plan the Psychosocial and Spiritual Care Intensive, we took into account that the focus was on “next practices” versus best practices and that we wanted to have an Intensive that could help all disciplines become equipped with fresh ideas for the future, not only social workers, chaplains and counselors.  

We utilized NHPCO's educational needs assessment and our own experience and knowledge of the current hospice industry as to what most see as the biggest challenges and educational need areas.  We broke that down into 6-7 categories with many sub-categories under each.  We then started discussion on focusing on 6 of the most prioritized, developed the topics of 6 sessions and possible speakers.  Other meetings followed between our group and NHPCO to narrow down even further and solidify speakers.  

There are opportunities for all disciplines to expand their roles in psychosocial and spiritual care.  Not all disciplines know what to do beyond the medical perspective.  Roles and skills can grow in this realm with knowledge from eastern influence and research .  There are fewer resources across healthcare in general and hospice is not excluded from this.  Staff has to do more with less and delve into other areas with which they are not familiar.  Being able to teach families the skills they need to help the patient and family and themselves is pivotal in the future as resources continue to dwindle.  This also allows staff to make families the heroes as well. 

Acuity levels of families continue to increase and pose many challenges for the IDT.  New ideas and knowledge is needed to move forward to address such challenging cases.  There are many societal epidemics and issues that will continue growing and staff will need to be equipped in handling them. 

There are opportunities for growth, increased communication and increased care coordination, in knowing how to utilize the self and language in having difficult conversations, utilizing effective communication skills and cutting edge ways for the entire IDT to address spiritual care and healing.  Looking deeper within for cultural competence will be essential; we all have room for improvement.  Innovative self-care interventions will take us into the future to prevent burnout and compassion fatigue. 

The lack of resources, increased scrutiny and increased regulatory oversight will require all to be the best of the best going forward.  This will require expert guidance and creativity to meet goals without an environment rich in resources. 

Samantha Bechtel MSSA, LISW-S, ACHP-SW, GC-C
Chief Clinical Support Officer
Stein Hospice
Register Now: Advance registration ends October 7.

Regulatory and Compliance

A series of blogs on the upcoming event THE INTENSIVES from educational content team members.

Last winter, when I was first given the opportunity to be a part of designing something different for our fall conference, I jumped at the chance.  Yes, we have been providing regulatory content on hospice regulations, on Medicare changes, for a very long time.  Maybe I was just bored with doing the “same old, same old” yet another year.  What if this could be different?  What if we could design something where we would hear from new and different experts, along with the experts we trust and use in other programs?  What if we could design something where we could learn from each other, in roundtable discussions, and by being together for a day and a half?

We formed a planning committee for the Regulatory and Compliance Intensive, with volunteers from the NHPCO Regulatory Committee, immersed in the issues that every day we are working on.  They were pumped, so excited to think “outside the box” and think about making this Intensive different from other years.  We talked about speakers we had heard in other settings.  We talked about topics (and speakers) that we didn’t know whether we could address, like government audits.  We talked about the age-old problem of attending a conference but having no idea what to do with the information when any of us got home…. helpful content, but no path to determine how to implement all the new ideas we had heard.  

We decided to “shoot for the moon” – why not ask those great speakers if they could join us in October at the Intensives?  Or why not ask a ZPIC and MIC auditor to join us so that we could hear “from the source” about what they are seeing as they review hospices in government audits?  And why not ask someone from CMS to help us think differently, and more expansively, about the place of hospice in the post-acute care world?

We won!  While the MIC auditor we asked did not get CMS approval to speak, the ZPIC auditor did!  And she is a former hospice director, so she understands hospice from the inside.  Dr. Paul McGann, from the CMS Center for Medicare and Medicaid Innovation said yes too… he said he would help all of us position hospice as we move into the post-acute care world.  Meg Pekarske, Roseanne Berry and Charlene Ross said yes, too, saying “we’ll come and help participants with their audit risks and in developing a comprehensive compliance plan.”  All of the speakers agreed to help each participant develop a game plan for “taking it all back home.”

Join us in October.  It is sure to be exciting, thought-provoking, and stimulating.  You can talk, in person, to speakers and to other participants from around the country.  You can participate in roundtable discussions on various timely topics, and most importantly, what you learn will be usable the day you get home!  It’s a different kind of conference – an Intensive.  Planned with you in mind.

Judi Lund Person, MPH, CHC
Vice President, Regulatory and Compliance
National Hospice and Palliative Care Organization
Register Now: Advance registration ends October 7.

Pediatric Palliative Care

A series of blogs on the upcoming event THE INTENSIVES from educational content team members.

One of the challenges we’ve faced in the evolution of pediatric hospice and palliative care is the lack of an organizational “home,” despite a now decades-long history of practice in this “new” discipline. Fortunately, because of need and advocacy within the field, pediatric content at a variety of national conferences has grown steadily every year. Nevertheless, it’s difficult to find one event that satisfies multiple educational needs. That’s why I’m so jazzed about the upcoming “immersion experience” at the upcoming Pediatric Palliative Care Intensive this fall.

Our focus for this conference is on home – and community-based PPC, as this is clearly the next evolution in our maturity. (Funny – we started in homes and communities, and then concentrated on organizing ourselves in hospitals, and now the thrust is to re-engage in the community…. Ah, the cycles of life!) For our sessions, we chose topics that are the source of inquiries and questions each of us receives every day from others who are struggling with similar issues, from management of refractory symptoms with medications “only used in hospitals” to staffing ratios for a home-based PPC program.

The other day, we held a faculty planning call to ensure that we’re all focusing on “next practices” – a step beyond “best practices” – and outcomes through interactive content that goes beyond PPC 101. So impressive were the energy, enthusiasm, wisdom and drive to share and help others grow from our Intensive faculty members, that I got off the phone wishing the conference would start right away!

What will we be discussing? Every time I hear Julie Hauer speak or read what she’s written, I learn something and think about things in a new way. I’m really excited to learn more from her about serving children with severe neurologic impairment and their families in the home setting, since my team cares for more and more of these patients each year. We have also struggled with concurrent care here in Ohio – and with the hundreds of patients who really don’t meet the criteria to qualify, since they’re not hospice eligible. What are some strategies we can use to bridge the care gaps for them? How can we leverage the growing power of coalitions – local, state, regional and even national – to help us plan, deliver, fund and evaluate the care we’re providing? These and other issues will provide the fodder for group engagement and conversation as we focus on the future of our field, and care delivery in the home and community.

I’m also impressed with the structure of the Intensives – NHPCO has been thoughtful about allowing us to arrange the time to allow for networking and consultation with expert practitioners in various subjects, as well as for social gathering. And because there are parallel tracks (4 Intensives in each of the 2 groups), the conference allows for interaction with other attendees who may not be in the peds intensive but may share experience and perspectives. It’s easy to stay on for an additional day and a half of content organized around other pertinent topics as well. In short, the opportunity to have focused pediatric content delivered by experts in the field in such an efficient way (and in a beautiful location) is what we’ve been asking for. Come and join us in sunny Florida for a fabulous time. Hope to see you there!

Sarah Friebert, MD
Director, A Palette of Care
Haslinger Division of Pediatric Palliative Care, Akron Children's Hospital
Register Now: Advance registration ends October 7.

Clinical Practice

A series of blogs on the upcoming event THE INTENSIVES from educational content team members. 

Having worked in hospice for over thirty one years, I have learned the importance of looking ahead. What will be our challenges as an industry?  What will our patient population look like?  And who will be the caregivers of those patients; what will they be like? 

The Future is NOW!  The patient that hospice cares for today is not the same patient we cared for in the past.  We do not have the same resources that we have had in the past. We must take into consideration the diverse populations that we are caring for.  Do we have the capacity to care for the ever growing mental health population?

Nurses need to recognize, now more than ever, the potential of drug diversion.  We can no longer hide our head in the sand and be “Nurse Nicey.”  Gone are the days that we can believe that the cat spilled the Morphine.  We need to be doing opioid risk assessments, looking at legal issues and doing drug screening.

We think that we are honoring our Veteran population, but do all disciplines recognize and understand the clinical and psychosocial needs of Veterans at EOL from ALL war eras?  And what about other diverse populations?  We need to know how to respect and meet end-of-life care needs of the diverse ethnic cultures that we care for including the homeless and non-traditional families. 

Being a baby boomer myself, I pity the staff that will need to care for my parents. I have a world of information, good, bad and ugly, at my fingertips.   The hospice involved with my family will need to be sure they have excellent communication skills to deal with my attitude of “I want what I want and when I want it.”

When I was working in the field, the most challenging patients I cared for were those of the mentally ill population whose needs are vast and varied.  The study of mental health remains a very new one.  Hospices need to understand the common medications, interactions with common hospice meds and what to expect when the patient can no longer take their meds.

The Intensives will help us with some of these conundrums. Specifically, the Clinical Practice Intensive will give us an opportunity to hear from experts on these topics as well as allowing us time to network with our colleagues.   

Tracey Wheatley , RN, CHPN
Director Home Hospice
Hospice & Community Care
Register Now: Advance registration ends October 7.

Tuesday, September 6, 2016

NHPCO's First Virtual Career Fair

Don't miss this unique opportunity to take an important step toward career advancement. In just two weeks, on September 21, from 11:00am to 4:00pm ET, NHPCO's will host its first Virtual Career Fair, exclusively for those looking to work in the hospice and palliative care field.

NHPCO’s Virtual Career Fair is a win-win for job seekers. It is a way for you to meet potential employers from wherever you are. And it’s easy to do from your computer or mobile device.

Registration for job seekers is FREE and will provide individuals the opportunity to connect with the following organizations:

The Watershed Group · Jordan Search Consultants · Amedisys Home Health Services · Carolinas Healthcare System · OSF Healthcare · Curo Health Services · BJC Home Care Services · Chapters Health System: LifePath Hospice and Good Shepherd Hospice · Pathways Home Health and Hospice · Suncoast Hospice · TrustBridge Health · US Medical Management · Seasons Hospice & Palliative Care · Celtic Healthcare · Baylor Scott & White Health . Hospice of the Chesapeake.

Learn more and register now to visit the employers’ booths and explore available job opportunities.

Thursday, September 1, 2016

NHPCO Meets with CMS on NOE/NOTR Issues

On August 31, 2016, NHPCO staff and provider representatives from NHPCO’s NOE/NOTR Workgroup, met with individuals from CMS’ Provider Billing Group and Chronic Care Policy Group to share concerns about the NOE/NOTR process. 

Provider representatives from Hospice of Michigan and Seasons’ Hospice and Palliative Care shared first-hand, on the ground examples of the financial and administrative burdens they’ve faced with the NOE/NOTR and sequential billing processes. 

CMS staff were receptive to NHPCO's concerns, especially with regard to NOEs that should fall within the existing exception categories as well as inconsistencies with NOE filings across and within the various MACs. CMS also stated that they do not hear much from the field (either providers or MACs) that this issue is a significant problem, nor do they hear concerns about the loss of provider revenue.

CMS continues to work on a new system function to submit NOEs electronically, and to revamping the FISS system for hospice data.  They predicted that the electronic submission fix is at least one year away, but is in development at this time.  A more complete revamp is a longer term goal.

NHPCO members will hear more about this issue as it moves forward; members will find the latest regulatory and compliance news in the Regulatory & Compliance Center on NHPCO's website.