Promising Steps

I am heading to our conference on “Developing the Care Continuum” next week and I’m looking forward to what I know will be some thoughtful, forward-thinking discussions. Devoting an entire event to exploring the various ways we can become more visible, more available, and more valuable to the people in our communities is, in itself, a forward-thinking strategy—and also very timely.

Greater attention will be placed on improving care coordination and eliminating duplicative services as the health reform law is implemented over the next several years. All hospices, not just a select few, need to begin thinking, planning, and taking steps toward greater collaboration or the diversification of their services if they want to grow their census. Palliative care is certainly one option that is already on the rise in hospitals. However, other services are also helping hospices to establish relationships with patients and other providers earlier in the life cycle. In the coming weeks, NHPCO will make available both webcasts and session tapes from the conference to help members who were unable to attend.

Be mindful, too, of the positive steps that are also being taken here in Washington (yes, Washington!):

• From our conversations with Senator Ron Wyden, we know the Concurrent Care Demonstration Project is now taking shape. This three-year project, which will be conducted by CMS, will monitor patients at 15 different hospice programs who will be permitted to receive other Medicare-covered services as well as hospice care. The goal is to evaluate the impact of concurrent care on the patient and family’s quality of life as well as the cost of care. It has the potential to strengthen the bridge between hospice and palliative care—and may be another good reason to consider a partnership or expansion into palliative care.
• Undaunted by the ‘death panel’ debacle of last summer, Representative Earl Blumenauer has also re-introduced legislation calling for Medicare and Medicaid to cover voluntary consultations about end-of-life care planning between patients and their physicians. NHPCO worked with the Congressman to help advance this valuable legislation, including a formal letter of support.

I know that running a hospice program today is not easy, given the regulatory and economic challenges of our times. As one colleague admitted, “it’s easy to get stuck in the weeds.” But it is far too critical a time to let that happen. This new decade holds much promise—if we are all poised and ready to be part of it.

Don

FY2011 Wage Index and Tools for NHPCO Members Now Available

CMS has posted the FY2011 hospice rates and aggregate cap. NHPCO offers members two important tools.

1) FY2011 Excel spreadsheet with the FY2011 wage index and the FY2011 rates for each county in each state.
2) FY2011 rate calculator that projects the wage index values and rates through FY2019. The calculator also allows you to project a percentage growth in your hospice's census for each year.

Links to these tools are available on the Wage Index page of NHPCO's website. Here's a link to the Regulatory Alert that went out to members on July 26, 2010.

Additionally, the PDF of CR7077 is available on the CMS website.

Don Schumacher Interviewed on Marketplace

President/CEO Don Schumacher was interviewed on public radio’s Marketplace about current issues in end-of-life care. Produced by American Public Media, Marketplace is broadcast internationally and is available online. Part one, of “End of life care: More or less of it?” was broadcast 07/20/10.

Part two of the story, “Better Training for Better End-of-Life Care,” looks at palliative care and visits San Diego Hospice and Institute for Palliative Medicine. Marketplace links to materials from NHPCO’s Caring Connections as helpful resources.

The story also features a photo slide show.

A Time to Take Pause

I have the good fortune of living in our nation’s capital, a wonderful spot to be during the July 4 festivities. While the fireworks are always spectacular and the spirit of patriotism palpable, what I also enjoy is the time we take to pay tribute to the many individuals in our own communities who, through their service and dedication, enrich our lives.

Julia Quinlan, the mother of Karen Ann Quinlan, is one of the first people that comes to my mind. June 11 marked the 25-year anniversary of her daughter’s death and, in May, she helped celebrate the 30-year anniversary of the hospice she and her late-husband, Joseph, founded in their daughter’s honor. I had the opportunity to talk with her last month about her family’s decade-long ordeal, how she came to learn about hospice, and the work she is still doing at the vibrant age of 83. Excerpts from our conversation appear in the July issue of NHPCO’s NewsLine, and I think, as you read it, you will find her accomplishments inspiring. Members can find July NewsLine at www.nhpco.org/newsline)

Mrs. Quinlan is one of the exceptional people who make hospice care what it is today, but there are others. A few weeks ago, as I was reviewing our first digital edition of Insights, I was reminded of many others. This magazine, which is a publication of NHPCO’s National Council of Hospice and Palliative Professionals, is very much a forum for our membership. Under the guidance of NCHPP’s leadership, members from around the country contribute articles about the work they are doing to improve care at the bedside. This particular issue mirrors the theme of our August conference on Developing the Care Continuum, and includes 15 articles by well-known hospice leaders as well as lesser-known clinicians who are equally committed. I’d like to offer a link to the digital issue of Insights for those who are interested in sharing the work of NHPCO members.

Last but not least, I’d like to personally thank John Thoma, the CEO of Hospice of Wake County, for writing the July NewsLine cover story about NHPCO’s new Standards and how it has benefited his program. He and his fellow members on the Quality and Standards Committee were instrumental in making this critical document a practical tool for the entire membership.

While the long holiday is now behind us, I hope you have each set aside time to enjoy some sunshine with your friends and loved ones. While our dedication to service excellence is both necessary and laudable, it requires sufficient rest.

Don

Attention on Medical Overtreatment Raises Awareness on Advance Care Planning, Hospice and Palliative Care

NHPCO's Caring Connections Encourages People to Learn More

(Alexandria, Va) – Recent media coverage (Associated Press 06/29/10) on the challenges patients and families face with overtreatment of a life-limiting illness brings the issues of hospice and palliative care and advance care planning to public attention.

“It’s important to remember that quality of life and a patient’s personal wishes, beliefs and values must be a factor when making care decisions brought about by a serious or terminal illness,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

“Discussions helping patients and families understand the many benefits of hospice and palliative care must be more common and held long before a family faces a medical crisis,” Schumacher added.

Advance Care Planning

Advance care planning—which includes completing a living will and appointing a healthcare proxy—is somewhat like planning a road trip to an unfamiliar destination. Very few people would expect to get to a destination safely and comfortably without having a well-thought-out map in hand. Yet, it’s estimated that 70 percent of Americans have not completed a living will.

• A living will charts the course for your healthcare, letting your family and health care providers know what procedures and treatments you would want provided to you—and under what conditions.
• A healthcare proxy or healthcare power of attorney form, allows you to choose someone you trust to take charge of your healthcare decisions in case you are unable to make those decisions yourself.
• Advance directives can be changed as an individual’s situation or wishes change.

Hospice and Palliative Care

Many people mistakenly think that hospice is simply a place you go when nothing more can be done to address an illness. That misunderstanding can keep people from accessing the expert care that hospice and palliative care offers.

NHPCO reports that more than a third of hospice patients received care for seven days or less—not enough time to take full advantage of the range of available services.

Hospice and palliative care provide symptom management, pain control, and support to address emotional, psychological, and spiritual needs.

“Hospice brings patients and families compassionate care when a cure isn’t possible. Palliative care provides comfort and support earlier in the course of a serious illness and is not dependent upon prognosis,” explained Schumacher. “Together, hospice and palliative care provide solutions beyond traditional medical care. Most importantly, hospice and palliative care provide dignity at a time when it’s needed most.”

Important Facts

• Over 80 percent of hospice care takes place in the home.
• Over 1,300 hospitals have palliative care programs; many of the nation’s 4,800 hospice providers offer palliative care services as well.
• Hospice care is covered under Medicare, Medicaid, and most private insurance plans.
• Bereavement services are available to family for a year following the death of a loved one.
• Research has shown that hospice patients lived an average of 29 days longer than similar patients who did not opt for hospice care.

Learn more about advanced care planning, hospice care, and palliative care from NHPCO's Caring Connections at www.CaringInfo.org or call the HelpLine at 1-800-658-8898.

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Contact:
Jon Radulovic
NHPCO, Vice President of Communications
Ph: 703-837-3139
jradulovic@nhpco.org

A Message from Don Schumacher, June 2010

Becoming a Larger Part of the Care Continuum

My opening plenary at the Management and Leadership Conference in April touched on many issues that, as an industry, we must be keenly aware of—and address together. In the limited space I have here, I’d like to talk about one of the issues of increasing import right now. That is, finding additional ways to serve more people in our communities.

I actually raised this issue when I became NHPCO’s president/CEO in 2002. As an industry, we were far too dependent on reimbursement from the very fragile Medicare system—and we still are today. While hospice payment reform will be the ultimate catalyst for change, my hope is that all providers will begin taking steps now to assess the needs in their community and explore ways to utilize their skills to meet their broader community’s needs. This is what I mean when I speak of becoming a larger part of the ‘care continuum.’ Much of my plenary address was devoted to this issue and I truly believe it is the very crux of our future success or demise as an industry.

The diversification or expansion of our services is, of course, not a quick or easy task to undertake. It requires planning and a thoughtful business strategy. But it is doable—there are programs which are now demonstrating just how doable it is.

Some hospices are now offering adult day care and home-diversion programs, others have become PACE providers, and still others are expanding into palliative care. In some cases, these providers are partnering with other organizations and in other cases they are going it alone. So I ask that you study the work now being done; explore various reimbursement models, including community-based waiver programs; and identify and begin dialog with potential partners in your community. Our cover story this month shares the process that Pathways Hospice followed to develop its community grief center in Fort Collins, Colorado—an excellent example of how one program assessed a community need and, building on a core strength, expanded its services. Our thanks to Nancy Jakobson, director of the center, for sharing her program’s experience with us.

In the coming months, NHPCO will be providing tools and resources to help you in this process. Our specialty conference in August, “Developing the Care Continuum: Innovative Models to Meet the Unique Care Needs of Patients/Families” will also serve as a dynamic forum to help jumpstart discussions among providers.

I encourage every provide-member to find additional ways to become a larger part of the care continuum. If we don’t step up, others will—leaving our industry a very marginalized component of the nation’s new healthcare system.

Don

Note: Don’s monthly message appears in NewsLine; members can access this month’s and previous issues at www.nhpco.org/newsline.

June 2010 Palliative Care Grand Rounds

The June Palliative Care Grand Rounds, a "monthly blog carnival" highlighting blog post focusing on hospice, palliative care and grief matters, is being hosted this month by Julie Rosen at the Schwartz Center Blog. Check it out today!

The views expressed in the Palliative Care Grand Rounds are the sole responsibility of the authors of each blog highlighted and does not necessarily reflect the views of NHPCO, this blog or its editors.