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

See the other blogs that are part of this series.

Register Now: Advance registration ends October 7.

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.

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. 

New Quality Reporting Requirement for Hospice Providers

The Centers for Medicare and Medicaid Service’s (CMS) posted the FY2017 Hospice Wage Index final rule on August 5, 2016 with updates to quality reporting for hospice providers that will be effective in 2017.

The FY2017 Hospice Wage Index final rule will bring some new and interesting changes to Medicare hospice quality reporting. While there will be no changes to the seven hospice item set (HIS) measures, CMS confirmed that two new quality process measures will be implemented in 2017. The two new measures include:

1.  Hospice Visits When Death is Imminent

This is a process measure pair that assesses hospice team member visits to patients and their family in the last week of life. The first measure of the pair assesses the percentage of patients who received at least one visit from either/and a registered nurse, physician, nurse practitioner, or physician assistant in the last three days of life for the purpose of case management and clinical care provision.  The second measure of the pair assesses the percentage of patients who received at least two visits from either/and a medical social worker, chaplain or spiritual counselor, licensed practical nurse, or hospice aide in the last seven days of life. This second measure in the pair allows providers flexibility to provide care that is individualized for the patient/ family’s preference and measurable goals of care. The process measure pair data will be collected as four new items on the HIS discharge record beginning April 1, 2017.

2. Hospice and Palliative Care Composite Process Measure

This quality process measure uses the current seven HIS measures as its components and calculates the percentage of patients for whom HIS admission records contain data on all seven HIS quality measures. The individual component of the composite measure is assessed separately for each patient and is then aggregated into one score for each hospice.

Final Reminders for Hospice Providers:

• Providers who do not submit data to CMS per regulatory requirements will be subject to a two percentage point reduction to the market basket percentage increase for that fiscal year.  This includes failure to report HIS data and/or CAHPS data.
• CMS confirmed the following compliance thresholds for the submission of HIS records in the final rule:
  • January 1, 2016 to December 31, 2016 - 70 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2018 payment
  • January 1, 2017 to December 31, 2017 - 80 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2019 payment
  • January 1, 2018 to December 31, 2018 - 90 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2020 payment

Members of NHPCO will find a comprehensive Regulatory Alert looking at the Final Rule available online.

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

AHA releases Appropriate Use Compendium offering 5 Toolkits

The American Hospital Association’s Physician Leadership Forum and Hospitals in Pursuit of Excellence initiative has released a compendium to help hospitals, in partnership with their clinical staff and patients, to closely examine the appropriate use of medical resources for five hospital-based procedures or interventions.

The compendium offers a toolkit on each of the five areas:  blood management, antimicrobial stewardship, ambulatory care sensitive conditions, elective percutaneous coronary intervention, and aligning treatment with patient priorities for use of the ICU.

The toolkits are an outgrowth of the AHA white paper, “Appropriate Use of Medical Resources,” which recommends a way forward that will place hospitals at the forefront of innovative change for reducing the use of specific non-beneficial services while improving health care overall.

AHA collaborated with a broad group of national organizations and content experts that included National Hospice and Palliative Care Organization to produce each toolkit.

The new compendium is available at www.aha.org/appropriateuse.

New Edition of NHPCO's Pediatric E-journal Now Available

Communications with children and families is the theme of the new edition of the pediatric e-journal produced by NHPCO's Children's Project on Hospice/Palliative Services. This resource is available free of charge online.

These articles included in this edition of the e-journal offer suggestions for and examples of engaging in this important aspect of providing pediatric palliative/hospice care.

In the introduction, the e-journal editors write, "We appreciate that a single issue on this subject will not do complete justice to this very broad subject area, but we hope that the articles in this issue will spur increased awareness and discussion of this subject and we note that all communication is a cooperative enterprise with children, adolescents, their family members, the professionals, the volunteers, and the organizations involved in their care. We welcome communications from anyone who has more to offer on these subjects."

Download the PDF.

An archive of past editions of the pediatric hospice and palliative care e-journal is available also.

World Hospice and Palliative Care Day 2016

"Living and dying in pain: It doesn’t have to happen" is the theme of World Hospice and Palliative Care Day being celebrated on Saturday, October 8, 2016.

World Hospice and Palliative Care Day is a unified day of action to celebrate and support hospice and palliative care around the world. This year, World Hospice and Palliative Care Day theme tackles the critical issue of access to essential medicines for pain management and palliative care worldwide, and resonates with the advocacy work being done in the lead up to – and beyond – the United Nations General Assembly Special Session on the World Drug Problem.

According to the International Narcotics Control Board (INCB), 75% of the world’s population (5.5 billion people) does not have adequate access to controlled medications for pain relief.

As a result, millions of people suffer from pain which is avoidable and could be managed with proper access to the correct medications. Various barriers prevent people in need from accessing these essential medications. This year’s World Hospice and Palliative Care Day campaign will focus on three major barriers for access to pain relief:

1. overly restrictive national regulations
2. poor education of healthcare providers in relation to opioid medications; and
3. economic barriers to availability of these medications.

Between the launch of the theme and World Hospice and Palliative Care Day itself, the WHPCA will provide case studies, advocacy resources, and examples of good practice to help you address these issues in your country and region.

You can find out more and access the Key Messages for this year on the World Hospice and Palliative Care Day webpage. Follow World Hospice and Palliative Care Day on the WHPCA Facebook page, as well as on Twitter. Join the conversation using the Twitter hashtag #WHPCDay16.