Comments on CMS Proposed Payment FY2014 Update for Hospice

On Monday, April 29, The Centers for Medicare and Medicaid Services released a proposed rule which would update the fiscal year (FY) 2014 hospice reimbursement rates.  The CMS notice claimed that hospices would receive a 1.1 percent market basket increase in their reimbursement.

NHPCO's official comment letter to CMS will be submitted as instructed; however, J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization offers the following public comments on the proposed rule.

Beyond the policy considerations, the numbers just do not add up. For CMS to characterize hospices as receiving a positive update, much less an $180 million dollar increase, without factoring in the impact of the sequester is disingenuous.  The truth is, under current law, CMS’ proposed payment update would mean a -.9 percent decrease for the nation’s hospice community.

Hospices are already struggling with an increased regulatory burden and productivity cuts associated with PPACA.  For the hospice community, which has a high proportion of Medicare/Medicaid patients (almost 90 percent) and an average margin of 4.6 percent – without even taking into account the impact of sequestration – any proposed negative update could be catastrophic.

This is a time when access to hospice should be encouraged, not threatened.  Virtually every responsible policy maker acknowledges that more end of life care patients should have access to the high quality and compassionate services offered by the nation’s hospice programs.  

New research out of Mount Sinai’s Icahn School of Medicine, published in the March 2013 issue of Health Affairs, (affirming previous cost saving research from Duke University) found that hospice enrollment saves money for Medicare and improves quality from Medicare beneficiaries by reducing emergency room stays, ICU days and hospital readmissions.  And yet, we’re already seeing layoffs and consolidation in the hospice community.  The proposed negative update sends a message to the hospice community to expect more of this disturbing trend.

J. Donald Schumacher, PsyD
President and CEO
National Hospice and Palliative Care Organization

 

e-hospice-USA is a New Resource for Healthcare Professionals Powered by NHPCO

Designed to Help Hospice Referral Sources Better Understand End-of-life Care Options

ehospiceUSA, a new resource designed to help healthcare and other professionals that care for patients and families facing serious and life-limiting illness, was unveiled at the opening plenary session of the National Hospice and Palliative Care Organization’s leadership conference on April 25, 2013.

Powered by NHPCO, ehospiceUSA is a free resource created specifically for hospice referral sources, such as physicians, hospital discharge planners, and other professionals who will benefit from a comprehensive understanding of the ways that hospice care will help their patients. 

“Any professional caring for or supporting patients and families who may be appropriate for hospice will find useful information on ehospiceUSA,” said J. Donald Schumacher, president and CEO of NHPCO.

“One of the most frequent comments we hear from the families we care for, is that they wish they had known about hospice earlier. ehospiceUSA will help clarify what hospice is and how it can help people, with the goal of ensuring more timely access to the services hospice offers,” added Schumacher.

In addition to the resources for professionals, ehospiceUSA also offers information on hospice and advance care planning that can be shared with patients and family caregivers.

ehospice recognizes the potential to connect people working in hospice and palliative care using the technology available today.  ehospice is available as a free iPhone app, as well as a mobile web app, which is compatible with most modern smart phones.  There is also an updated iPad app launching today. 

In addition to ehospiceUSA, there are 10 other country and regional editions covering the latest news, commentary and analysis from around the world. Available editions include England, Canada, South Africa, Kenya, India, Australia and others.

 

The brainchild of the UK-based organization, Help the Hospices, the goals of ehospice are to improve patient care through access to information, to foster a sense of community in hospice and palliative care worldwide and to give a voice to people associated with hospice and palliative care, whether as professionals, volunteers, patients or family caregivers.

“ehospiceUSA does not replace the NHPCO website, rather, it’s our hope that hospice and palliative care providers in the U.S. will share ehospiceUSA as a helpful resource with the referral sources in their communities that might benefit from a better understanding of how hospice works and the many benefits it would offer patients under their care,” noted Schumacher.

Find this new resource at:  http://www.ehospice.com/usa.

Policy Symposium: Conversations Before the Crisis

NHPCO and Hospice Action Network will host a Policy Symposium, "Conversations Before the Crisis: The Intersection of Family, Faith and Policy," on Tuesday, April 23, 2013.

What role does federal policy play in advance care planning? What opportunities are there for congress to act on the issue? What obstacles stand in their way? NHPCO is proud to announce that several members of congress will join Conversations Before the Crisis to tackle these issues.

Featuring:

Senator John Isakson, GA

Senator Ron Wyden, OR

Congressman Phil Roe, TN

About Conversations Before the Crisis:
Communities, families and individuals need to have access to the proper tools in order to have conversations about care needs, wishes and values earlier and throughout the course of a lifetime. The time for a robust and open dialogue by policymakers, care providers, hospice experts, opinion shapers, journalists and religious/spiritual leaders has come. There is no better time than now to start these conversations.

 

Learn more on the HAN website. The event is offered free-of-charge.

 

Join the discussion on twitter: #CB4C

Comments from NHPCO's Don Schumacher on the Tragedy in Boston

It’s April 16, National Healthcare Decisions Day, and people across the nation are focused on the unpredictability of life and the world around us in a way we could not have foreseen. A senseless act of violence in Boston yesterday afternoon at the Boston Marathon has left us horrified, angry, frightened and confused. Very rarely can such violence be explained in any manner that makes sense to rational people.

Our thoughts and prayers go out to all those affected by the bombings in one of America’s most historic cities.

I began my hospice career as CEO of Hospice West in Boston more than 30 years ago. My daughter, Amelia, son-in-law and two granddaughters live in Boston and I am a frequent visitor. Many of the supporters of our National Hospice Foundation’s Run to Remember program have also participated in this great event in past years. In fact, Amelia and the two girls were watching the marathon waiting for a friend to pass by and had left the race only a short time before the bombing. My fondness for this city runs deep, hence, my urge to share some thoughts with you.

Upon reflection of Monday’s events, I am reminded of the courage and skill of our nation’s first responders and law enforcement. I am touched by the acts of kindness by many who came to the aid of the seriously injured and frightened. I am also reminded of the resilience of the American people.

The world is a different place than when I lived in Boston but our humanity has not changed. Issues involving national security are part of our normal lives. Increased security and awareness are not intended to put us on edge but, rather, to help us to live our lives without feeling controlled by terror or violence.

Today, many of you will care for someone who will end their life’s journey. You will be there for them, and comfort their families as they say a final goodbye and grieve their loss. I know you will care for them with the professionalism and compassion that are hallmarks of hospice care. Your mission to serve others will not be diminished or hampered.

 

Yet, yesterday’s events do affect us. We should allow ourselves time to process what we are seeing and hearing via ongoing newscasts. We are reminded to be attentive to our children and monitor what they may be seeing on the news or on the Internet. Let us also support those heroes who respond in such emergencies and lend an ear to our friends and neighbors who may need to share their fears or concerns without judgment. It’s also an important time to take an extra moment to tell those near to us that we love them.

As we mark National Healthcare Decisions Day, I encourage all of you who are able to consider donating blood in the weeks ahead. The tragedy in Boston demonstrates the importance of this simple act. Let this be one way we honor those who have died or have been injured as we continue to live free from the shadow of terror.

I consider myself blessed to be part of this community.

Don

The 2013 Innovation Intensive is a Special Part of April's MLC

NHPCO's Mary J Labyak Institute for Innovation is proud to present the 2013 Innovation Intensive - an exclusive educational event within the 2013 Management and Leadership Conference.

 

Healthcare is changing every day. New alliances are being formed between health systems, providers, payors and community organizations. NHPCO is offering you a unique opportunity to learn how to participate in alliances, partnerships and contractual agreements designed to meet the needs of the chronically and seriously ill.

The 2013 Innovation Intensive, which is an exclusive event held during the MLC, will focus on how hospices can develop strategic business alliances and partnerships to provide hospice palliative services to people much earlier in their disease process/life.

Faculty will come from outside the hospice community to offer a fresh perpsective on strategic thinking regarding end-of-life care.

Registration for this event within the MLC is only open to NHPCO members who are registered for the Main Conference.  :earn more about this unique offering: http://www.nhpco.org/mlc2013/intensive.

Call for Proposals - 2013 Clinical Team Conference

NHPCO’s 14th Clinical Team Conference and Pediatric Intensive will explore the care continuum, interdisciplinary team, medical, clinical, psychosocial, spiritual, bereavement and team innovation and excellence – in all their myriad facets, ideas, forms and outcomes.

Join colleagues from across the country that are committed to innovation and excellence by submitting a proposal that demonstrates significant work and achievement for the 14th Clinical Team Conference and Pediatric Intensive to be held from September 26 – 28, 2013 in Kansas City, Missouri. The Conference Planning Committee is particularly interested in proposals for advanced (for the expert) topics. The deadline for proposals is March 25, 2013.

To learn more and submit a proposal, please visit: http://nhpco.confex.com/nhpco/CTC2013/cfp.cgi.

We hope to have you join us in Kansas City this September!

New Research Validates That Hospice Saves Medicare Dollars

Research out of Mt. Sinai shows hospice patients have lower Medicare costs, reduced use of hospital services, and that hospice can improve care quality

 

New research published in the March issue of Health Affairs found that hospice enrollment saves money for Medicare and improves care quality for Medicare beneficiaries with a number of different lengths of services.

The National Hospice and Palliative Care Organization applauds this study that adds to a growing body of research demonstrating the value of hospice care both in terms of high quality and cost savings.

Led by Amy S. Kelley, MD, MSHS, from the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mt. Sinai, researchers looked at the most common hospice enrollment periods: 1 to 7 days, 8 to 14 days, 15 to 30 days, and 53 to 105 days. Within all enrollment periods studied, hospice patients had significantly lower rates of hospital and intensive care use, hospital readmissions, and in-hospital death when compared to the matched non-hospice patients.

The study reveals that savings to Medicare are present for both cancer patients and non-cancer patients. Moreover, these savings appear to grow as the period of hospice enrollment lengthens with the observed study period of one to 105 days.

Study authors suggest that investment in the Medicare Hospice Benefit translates into savings overall for the Medicare system. “If 1,000 additional beneficiaries enrolled in hospice 15 to 30 days prior to death, Medicare could save more than $6.4 million,” they note.

Furthermore, the authors write, “In addition, reductions in the use of hospital services at the end of life both contribute to these savings and potentially improve quality of care and patients’ quality of life.”

“We know that hospice care addresses so many critical issues involving quality of care at the end of life and that hospice brings dignity and compassion when they are needed most. This new study reaffirms other reasons why hospice is the best solution for caring for the dying in a way that provides patient-centered care and is cost effective for the Medicare system,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

This study builds on the valuable work of the 2007 Duke University study by providing further proof that hospice care saves the federal Medicare system money.

Added Schumacher, “For many years, hospice professionals have known through firsthand experience, that the interdisciplinary care they provide to patients and family caregivers coping with life-limiting illness significantly improves quality of life and allows people to focus on living as fully as possible even as life draws to a close. Now the broader healthcare community, regulators and legislators understand more fully the many benefits of hospice care.”

NHPCO reports that more than 44 percent of dying Americans were cared for by hospice in 2011. Among these patients, 84 percent of hospice care was paid for through the Medicare hospice benefit.

 

“We have an example of a care delivery model that not only scores high in patient and family satisfaction, reduces hospital services, and promotes the dignity of every person cared for but also can be cost effective with regards to federal spending,” Schumacher noted.

Based on the study’s findings, the researchers questioned recent aggressive efforts, including the Office of the Inspector General’s investigation of hospices that enroll patients with late-stage diseases but unpredictable prognoses.

“Our finding suggest these efforts maybe misguided,” write the researchers. “Rather than working to reduce Medicare hospice expenditures and creating a regulatory environment that discourages continued growth in hospice enrollment, CMS should focus on ensuring that patient’s preferences are elicited earlier in the course of their disease and those who want hospice care receive timely referral.”

NHPCO has consistently supported earlier discussions of care options once a person receives a diagnosis of a serious illness.

 

NHPCO and Hospice Action Network offer some key messaging points about the study; additionally, a link to the study is available on the HAN website.