NHPCO Draws Providers’ Attention to Article in New York Times

NHPCO members may have seen the article from Kaiser Health News that was posted on the New York Times website yesterday and appears in print in the Health & Science section today, "Concerns about costs rise with hospices' use."

NHPCO wanted to let members know that President/CEO Don Schumacher wrote a letter to the editor reminding the NY Times that growth in hospice over the past decade reflects our caring more compassionately for the dying in this country. He also made the point that NHPCO has been calling for more federal oversight of hospice for many years.

The NY Times blog page, New Old Age, welcomes comments from readers. Please feel free to share any thoughts you might have through the comment section of the New Old Age blog. An insightful comment was posted on the New Old Age blog that NHPCO would like to draw provider's attention to. An individual wrote: "I'm so thankful that this article was published, because we weren't aware that hospice care was available for end stage Alzheimers. We want to do everything we can to honor my mother's wish that she die in her own home, but if things become impossible,,,well it gives me great comfort to know there is another option."

To many of us, so close to issues that involve the field, it can be easy to forget that many members of the public are concerned about issues as they affect them in a personal way. Even challenging news articles can provide valuable information about hospice that is important to the public.

In addition to Don's letter to the editor, we are submitting an op-ed to the NY Times that we hope will get serious consideration.

Additionally, the Public Policy team has put together some specific talking points they are sharing with legislators and their staffs on Capitol Hill who may have concern or confusion resulting from this article.

We wanted to assure members that NHPCO has been actively responding following the release of this article.

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Don's 2010 May Update

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

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.

Don's November Message

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Monthly Message from NHPCO's President and CEO Don Schumacher

July 2009


Exploring Multiple Pathways to Earlier Referrals


Our cover story this month draws needed attention to the myths surrounding palliative care. Much like hospice, palliative care is not being fully utilized within our nation’s healthcare system due to sheer misunderstanding on the part of patients and physicians. As the author notes, there are nearly one million patients who are dying in hospitals or other institutions each year who are unaware of the palliative care services available to them—care that would not only help them, but would also reduce hospital and pharmacy costs.


While it’s certainly our collective responsibility to help educate our communities about palliative care, we are missing a very important opportunity if we don’t do more—if we don’t expand into palliative care ourselves. In one of my first conference plenary addresses as president/CEO of NHPCO, I urged members to “think outside the Medicare Hospice Benefit box” and explore palliative care as a pathway to earlier referrals. I was not asking members to do something I had not done myself. While president/CEO of a hospice program in Buffalo, I was one of the first providers to integrate palliative care into our continuum of care and saw firsthand the many benefits of such expansion.


Today, with healthcare reform very much a reality and with CMS now looking at ways to serve more Americans more cost effectively, there is even greater reason to expand our expertise into other cost-effective services. Palliative care is a natural fit for hospice providers.


Opportunities at the National Level


This month’s secondary feature recaps findings from NHPCO’s recent Economic Impact Survey. Understandably, most programs reported a reduction in revenue, with reasons ranging from reductions in average daily census to expected reductions in philanthropic contributions and changes in payment rates. First, on behalf of NHPCO, my thanks to all of you who took time to respond. Secondly, NHPCO hears you.


While NHPCO can’t address all of the factors that are impacting your bottom line, we are committing significant resources to the one that poses the greatest threat to the majority of members—Medicare Hospice Benefit rates. In partnership with The Alliance for Care at the End of Life, protecting these rates remains our top priority (see page 16 for an update on our advocacy efforts). However, we are also exploring other ways to improve your bottom line through expansion of the Benefit. NHPCO’s Public Policy Committee recently approved two potential demonstration projects to examine concurrent care and transitional care, both of which would enable hospice providers to build relationships with patients and families earlier in the illness trajectory and, in so doing, improve hospice utilization.


A favorite expression of mine reminds us that there are, indeed, many paths up a mountain. In today’s hospice environment, we must be open—and willing—to explore them all.

Don

Read July NewsLine

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

Elizabeth Edwards Presented with Person of the Year Award

Elizabeth Edwards Presented with Person of the Year Award by National Hospice and Palliative Care Organization at National Conference

(Alexandria, Va) – Minutes after Elizabeth Edwards was presented with NHPCO’s Person of the Year Award, she took a moment at the podium to look at her notes as a shout came from the audience, “We love you!” A wide smile brightened her face as the audience of 1,600 broke out in spontaneous applause, filling the room with positive energy and optimism that was reinforced by Edwards’ remarks.

Edwards received NHPCO’s Person of the Year Award in recognition of her work as a fierce advocate for improved and accessible healthcare. In addition, she was acknowledged for her courage in the face of serious illness and life’s challenges and her willingness to share lessons learned from her experiences.

J. Donald Schumacher, NHPCO president/CEO, honored Edwards at the April 23rd opening session of the organization’s annual Management and Leadership Conference in Washington, DC.
The Person of the Year Award honors an individual outside of the hospice and palliative care community who is a true supporter of the hospice cause.

“Mrs. Edwards is rallying for changes to the healthcare system that will improve access, quality and—for those facing the end of life—comfort and dignity. Her personal experience in coping with cancer, caring for aging and ill parents, and her professional work in the legal and policy areas have made her a passionate proponent for change,” Schumacher said in his introduction.

A key message Edwards brought to the assembled leaders from hospice and palliative care programs across the nation was the obligation we all have of making sure that every American gets the care they need, when they need it, wherever they are.

Edwards stressed that an individual facing illness should never be defined by his/her medical condition. This philosophy—that puts the person at the center of care and emphasizes the dignity and individuality of all people—is one shared by hospice and palliative care providers.

A poignant moment came at the conclusion of her plenary address when she said she knew that one day she would need hospice care as a patient, and she thanked the attendees and all hospice professionals who care so compassionately for patients and families at the end of life.

She received a standing ovation and then graciously spent the next two hours signing autographs and copies of her book, Saving Graces: Finding Solace and Strength from Friends and Strangers.

Edwards served as the Honorary Chair of the National Hospice Foundation gala held the following Friday evening, which was attended by 600 guests. NHF’s annual gala is a philanthropic event supporting efforts to expand and improve care at the end of life.

As attention turns to the release of her new book and her publicized appearance on Oprah, NHPCO salutes Edwards for her efforts to advance care and compassion.

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Contact:

Jon Radulovic

Vice President, Communications

703-837-3139

jradulovic@nhpco.org

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