Monday, August 28, 2017

The Hurricane Disaster in Texas

The scope of the natural disaster in Texas is overwhelming. NHPCO has heard from a number of members throughout the country asking about ways to best support our hospice and palliative care colleagues in regions of Texas who are coping with the ongoing devastation of Hurricane Harvey and the continuing rains and flooding.

First, NHPCO extends thoughts and prayers to all those affected by this natural disaster.  We know that hospice and palliative care professionals are continuing to care for patients and family members despite flooding, blocked roads, power outages, property damage and personal loss. As the full impact of the situation unfolds, we stress the importance of safety as our colleagues face the brunt of this disaster.

During times of such disasters, it is essential that concerned individuals recognize the importance of following the direction of first responders and the agencies that are on the ground addressing the most critical needs. In these initial hours – and as the impact of flooding continues – we must heed the advice of emergency management systems that are responding as designed.

As with previous events of this nature, NHPCO traditionally coordinates with state associations to respond in the most effective manner; we have found that state associations best know the needs and priorities of providers in affected regions. Our leadership is working to contact our colleagues at the Texas & New Mexico Hospice Organization based in Austin.  We will learn more about the best ways to support our colleagues and providers in the region in the days and weeks ahead.

One way we have supported providers in areas affected by tragedies such as this is through the National Hospice Foundation (NHF) Disaster Relief Fund. This fund was specifically established to aid the hospice community when disaster overwhelms regularly-available resources. We have found that financial donations are one of the most helpful ways to address needs in the imminent wake of destruction.  NHPCO and NHF will be collecting donations through the fund and giving to the Texas & New Mexico Hospice Organization to use in the ways that will be most beneficial. We welcome your support of the NHF Disaster Relief Fund; to donate, please visit the NHF donation page online

Tragedy and loss are part of our world. Yet amid the wreckage and destruction, hope can be found. By surviving disasters, such as the hurricane and flooding that we are watching unfold in Texas, people recognize that they are part of a greater community, a community built upon our shared humanity. Ultimately, tragedy can show people they have more resiliency and strength then they realized. Neighbors help neighbors. Communities come together to rebuild. It becomes clear that survival is possible. While we cannot stop the forces of Mother Nature, we learn that the care and support of family and friends is essential.

National Hospice and Palliative Care Organization
August 28, 2017


Friday, August 25, 2017

Edo Banach Responds to Kaiser Health News

There is no question that the U.S. is coping with an opioid epidemic of overwhelming proportions. Unfortunately, the article from Kaiser Health News published in The Washington Post, “Dying at home in pain doesn’t keep relatives from stealing the pills,” unfairly points to the hospice community’s role in exacerbating this national crisis.  That could not be further from the truth.  Hospices take seriously their obligation to maintain the health and safety of patients and their loved ones.  Hospices have an obligation to the community and the patient to be sure that the medications are used appropriately, which includes careful monitoring of the patient’s pain and the family and home situation. However, hospices – and those who work for them – generally do not have the authority to confiscate or destroy unused opoids or other pills.   

As the author states, “The U.S. Drug Enforcement Administration encourages hospice staff to help families destroy leftover medications, but the agency forbids those staff members from destroying the meds themselves unless that is allowed by state law.”  I think it’s important to be perfectly clear, in most states, hospice professionals cannot touch the medications of a patient who has died – they belong to the family.  At the same time, Federal regulations require hospice professionals to go over the federal drug disposal guidelines with family caregivers, but hospice professionals are prohibited from taking a more active role in disposing or removing medications from the home.

Some states have taken action to put more control in the hands of the hospice professionals, but NHPCO supports a national policy and uniform set of practices.  To this end, NHPCO has already drafted legislation and has been working with Congress to expand the ability of hospice professionals to take a more active role in helping families dispose of these drugs.

Hospice professionals are trained in engaging with families about these medications – this includes addressing concerns of diversion or theft. Certainly, there are situations where a hospice professional failed, but such an instance should not be used to describe the entire provider community in this country. The 2013 study out of Virginia cited in the article, which reflects the practices of 23 hospices in Virginia, ultimately lead to training and resources made available throughout the state and country.

The author’s assertion that “hospices may go years without inspection” is not accurate. Legislation passed in 2014 (the IMPACT Act of 2014), strongly supported by the hospice community, requires hospices to be surveyed at least every three years. The hospice community has long worked with regulators to ensure high standards of practice, compliance and safety in the field. 

Drug diversion by friends, family members and caregivers must be addressed. However, readers of this article who may have a loved one in hospice – or be under the care of hospice themselves – should not be frightened by medications used to relieve suffering. If a patient or family has any concerns, please reach out to the hospice team providing care.

Not only are hospices working to do the right thing for patients and families, but they also working to ensure that the pain and suffering of dying Americans is properly addressed.  And no professionals are better trained to do this than those working in hospice and palliative care.

Friday, August 18, 2017

The Interdisciplinary Thought Behind IDC 2017

By Joan Harrold, MD, MPH, FACP, FAAHPM
Medical Director/Vice President of Medical Services
Hospice & Community Care, Lancaster, PA
Chair of NHPCO’s Professional Education Committee

In selecting the content for the 2017 Interdisciplinary Conference, we’ve pulled together an incredible group of people from the field of hospice and palliative care to answer some of the questions that are especially difficult for many programs. How to approach chronic pain in cancer survivors (especially in hospice when cancer is not an active diagnosis)?  How to manage addiction issues? What do studies really say about cannabis use? The IDC17 will offer variety of different sessions that really matter how we deliver care to people. 

While I know that it can be a sacrifice for programs to send people to an onsite educational program like this, it is incredibly valuable for both the individuals who attend and for the organizations that send them. First, an onsite program can gather many more people from different disciplines, cover a broader range of session topics, and offer many more presenters—all in a very short period of time. So while it may seem like it takes more time and money, it’s actually very efficient. Even more so if you plan beforehand to have your staff come home with handouts, other resources, and information to share with their colleagues.  The education shouldn’t stop with a handful of staff who attend the conference in person. 

Second, people who gather “in person” have the opportunity to follow up on what they learn.  Not just the questions you might ask during a presentation, but even more in depth conversation following a session. I’ve presented NHPCO webinars and been happy to answer questions that were emailed afterwards. I can often help more, however, when someone approaches in person and says, “I’m doing something like that, and I want to pick your brain.” You can often make time for a concentrated conversation about what matters to that person right then and there.

I think we can be a little blasé about “networking” at conferences and the benefits that offers. However, it goes beyond meeting other people from other places and having a good time; it’s actually taking the educational elements and figuring out very quickly how they apply to your program. Taking resources that matter to you. Having an intensive conversation with a presenter—or other attendee—about issues that really matter to your program. And if people go with this idea in mind, that they’re going to bring information back, it really can enrich their program.  

One of the things we’ve done for years at my organization is divvy up the sessions before the conference begins. After all, this is not like swimming after eating—you don’t need a buddy at every session! If you send three people and they’re all attending different sessions, they can come home with much more information than you would get in the same amount of time listening to webinars or reading articles. And this is an interdisciplinary conference, it’s not just for one discipline. It’s not just the docs; it’s not just the nurses. The psycho-social, spiritual, bereavement staff, volunteers, regulatory and quality professionals and interdisciplinary team leaders are such an integral part of our teams. They need to get the same kind of experience and bring it back. I think this is incredibly valuable way to learn. 

I’m so proud of the work that NHPCO’s professional education committee and conference planning committee members have done to create this very special event, the 2017 Interdisciplinary Conference. I hope many people from across the field will join us in San Diego this September.
2017 Interdisciplinary Conference:
Strengthen Your Organization: Care, Compliance, Quality

San Diego Marriott Marquis and Marina, San Diego, CA
Education Programs and Preconference Seminars: September 16-17, 2017
Main Conference: September 18-20, 2017

Register today – team discounts available.

(Look for a special registration discount on Monday & Tuesday, August 21 & 21 only!)


Tuesday, August 15, 2017

Stronger Together: A Message from Edo Banach

The last few days have been trying ones for our country. The events and protests that began in Charlottesville, Virginia this past weekend and are echoing across the nation have been difficult and hit close to home for many of us. As a Jew and the grandson of two holocaust survivors, messages of intolerance and hate associated with recent protestors are hard to hear and understand in the year 2017. Additionally, staff members at NHPCO attended the University of Virginia and have ties to the Charlottesville community, as do I, since my wife grew up close to that city which has become a focus of great debate in recent days.

This year, while we mark 50 years of hospice since the creation of St. Christopher’s in London and the pioneering work of Dame Cicely Saunders, we also note that Dr. Martin Luther King died almost 50 years ago; the wounds of WWII and Selma are still raw; the protests of Stonewall still reverberate for many who continue to feel disenfranchised in our nation.

As hospice and palliative care professionals and advocates, it is part of our philosophy of care to honor and celebrate the dignity of every individual. While events of this weekend are not connected to hospice per se, the approach we bring to the compassionate care we provide has the capacity to be a unifying force in the communities in which we serve. As a unified provider community, we find our strength is our ability to engage in respectful discourse that recognizes a wide range of perspectives.

These are the times that try and hopefully define the noble vision of our republic. There is no room for hate, bigotry, or racism in America. I hope that we will all redouble our efforts to engage in constructive dialogue, to meet hate with love, and to continue moving our country forward in a positive direction.

As we know so well, at the end of life, we are all simply people with hopes and wishes who share a unified humanity. Thank you for what you do; I am proud to work alongside you to help advance the care of the countless patients and families that you serve with compassion, dignity and respect every single day.

Edo Banach, JD
President and CEO

Monday, August 7, 2017

All Other Ground is Sinking Sand

This week, I had the honor of visiting with a music therapist, Georgia, from Seasons Hospice in Columbia, MD.  I came away with a renewed belief in the value of hospice, and the important role that music therapy can play in an interdisciplinary team.  I was also deeply moved by the connection and spirituality that I witnessed during my visit.  As a musician, I believe in the power of music to transcend words and connect people; yesterday, my faith in music, hospice and people was reaffirmed.

I have been disabused of any notion that music therapy is simply about strumming a guitar.  In the hands of a skilled music therapist like Seasons’ Georgia, the guitar and voice are spiritual and deeply connected tools that can be extremely meaningful to a patient that is in pain, or family that is in need of healing.

Georgia, her colleague Anne and I visited two patients at one of Seasons’ inpatient unit.  One, Ms. A, requested Johnny Cash songs initially.  I sang along to “I Walk the Line” and a few others.  We then learned from Ms. A’s nephew that she led a church chorus for 50 years.  The songs shifted to spirituals. As Georgia strummed the guitar, Ms. A confided that she was ready to go, ready to relieve the burden on her family.

Ms. A was sure that she was ready, but she did have a song request, “My Hope is Built on Nothing Less.” I hadn’t heard this song before, but I was so moved to see and hear Georgia and Ms. A harmonize beautifully, with Ms. A repeating the last line—“All other ground is sinking sand”—twice.  Ms. A sang these lines with a certainty and conviction.  We all knew, somehow, that Ms. A would soon die.  As I leaned in to speak with Ms. A, she asked me why I didn’t sing with her.  I told her that I didn’t want to mess up her beautiful two part harmony.  She smiled, as if she knew that I didn’t really know the words.

Two hours later Anne and Georgia let me know that Ms. A died.

I was so moved by this experience, and so aware that this experience plays itself out every day in countless rooms and homes across the nation.  Music therapists—and all members of the hospice interdisciplinary team—help provide peace to patients and families at the end of life.  As President and CEO of NHPCO, I stand on the solid foundation that our professionals provide each and every day.  Thank you to Georgia, Anne, and all of our amazing hospice and palliative care teams.   

By Edo Banach, JD
President and CEO

Wednesday, August 2, 2017

FY 2018 Updates to the Hospice Wage Index and Payment Rates

On August 1, CMS issued a final rule that updates FY 2018 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries, and also updates the hospice quality reporting requirements. Section 411(d) of the Medicare Access and CHIP Reauthorization Act of 2015 amends section 1814(i) of the Social Security Act to set the market basket percentage increase at 1 percent for hospices in FY 2018. Hospices will generally see a 1.0 percent ($180 million aggregate) increase in their payments for FY 2018. As mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014, the cap amount for accounting years that end after September 30, 2016, and before October 1, 2025, must be updated by the hospice payment update percentage, rather than the Consumer Price Index. The cap amount for FY 2018 will be $28,689.04 (2017 cap amount of $28,404.99 increased by 1 percent).

The final rule also includes:
  • Hospice Quality Reporting Program, including submission exemption and extension requirements for the FY 2019 payment determination and subsequent years 
  • Hospice CAHPS® Experience of Care Survey 
  • Public reporting 
  • Quality measure concepts under consideration for future years 
  • New data collection mechanisms under consideration: Hospice Evaluation & Assessment Reporting Tool

 For More Information:
Final Rule (CMS-1675-F)

See the full text of this excerpted Fact Sheet (issued August 1).
(Information from CMS.)