A Busy Day in Washington for the HPM Community

On a cold March morning at NHPCO headquarters in Alexandria, Virginia, ten hospice and palliative care CEOs from across the country gathered with NHPCO leadership to meet with officials from the Department of Health and Human Services in Washington D.C.  On the agenda – reinforcing the message that hospice is the original care coordination model and plays an integral role in our healthcare system.

L to R: Edo Banach; Melinda Gruber, Caring Circle; Reggie Bodner, Carroll Hospice, Greg Wood, Hospice of the Ozarks, Ann Mitchell, Montgomery Hospice; Dame Cicely in bronze; Norman McRae, Caris HealthCare; Susan Lloyd, Delaware Hospice; Ben Marcantonio, Hospice of the Chesapeake; and Rafael Sciullo, Empath Health/Suncoast Hospice.

Provider members had the opportunity to share patient and family stories to demonstrate how hospice not only provides services to eligible beneficiaries at the end of life, but in many other meaningful ways.  Several examples were cited of how hospices have filled the gap in times of crisis by offering grief support and other services for not only victims of the opioid crisis, mass shootings, community tragedies, and natural disasters but also their families.

“We appreciate how the administration welcomed us and were truly engaged in the conversation,” says NHPCO President and CEO Edo Banach. “They connected with how our work directly supports the Secretary’s four top priorities – particularly around the opioids crisis and value-based healthcare.”

At the Department of Health and Human Services in Washington, DC.

Edo continues, “Sometimes face-to-face conversations are needed to really help focus everybody on what is important.  Instead of bickering, we spent yesterday focusing on expanding minds and connecting on how hospices and palliative care programs are integrally involved in helping people live their best life.”

“The topics were not uplifting:  Disaster relief, grief counseling, opioid addiction, serious illness and death.  However, connecting on ways that we are helping communities and people get through these issues, was uplifting.  I think we melted some hearts on a cold day in March, and I am so grateful for the members and board members that accompanied us.”

The meeting was a success and HHS officials were left with a positive impression of hospice, our providers, and acknowledged that they learned something new about the care we provide.

After the meeting at HHS, Edo and Darren and Brian Bertram of Infinity Hospice, traveled to Capitol Hill to meet with Senator Jacky Rosen.  It was another successful meeting and opportunity to talk about the importance of hospice care. Senator Rosen is a founding member of the bipartisan Palliative Care Task Force in the House and is committed to continuing to find ways to improve care for those with serious illness.

L to R: Darren Bertram, Edo Banach, Senator Rosen, Brian Bertram.

At NHPCO, we are proud to take the lead on shaping what the future of hospice and palliative care could look like, and we are proud to partner with our provider members to make those recommendations. It is vital that we, as one community, rally together to carry our message to the regulators and policymakers who have the control to change the care we provide to patients and families every day. 

Want to be looped in to our community's advocacy efforts, connect with the My Hospice Campaign. 

An Evening for Celebration

In her role as Development Specialist, Emily Van Etten plays a significant part in the planning and hosting of the annual National Hospice Foundation Gala. She shares some thoughts in preparation for the April 16 event.

On our way back to the office from the Marriott Wardman Park Hotel in Northwest, D.C., my colleagues Edo Banach and John Mastrojohn commented that the menu tasting we had just done was the best part of planning a gala. I definitely agree with that sentiment. Between the many emails and meetings to determine décor and secure sponsorships, it’s nice to get out of the office and get a real feel for what the evening will be like for our guests – and sampling the Gala menu is a great way to do just that.

This year’s National Hospice Gala, to be held on April 16 in conjunction with the Leadership and Advocacy Conference, will be my third gala with NHF. I’m much more deeply involved with the event this year, and it’s been a great experience to get to know our supporters and see the event come together.

What makes NHF’s gala particularly special is the unique opportunity it provides to celebrate the hospice and palliative care community. End-of-life care attracts people with a passion for others, who happily give much of their time and hearts for the dying and their loved ones. So often when we give much of ourselves to others, we forget to nourish ourselves. The annual gala encourages us to step back, take a breath, and have fun with friends and colleagues.

Along with a delicious meal and a live band, the fun is rounded off with an auction and fundraising appeal. This year, the live appeal will support one of NHPCO’s most successful initiatives – our Veteran Services programs. These initiatives, such as community outreach and the We Honor Veterans partnership program, empower hospices and caregivers to provide Veterans at the end of life with the best care possible.

I think I speak for the entire NHPCO team in saying how much we’re looking forward to this very special evening. I hope you can join us; I’ll save a seat for you.

By Emily Van Etten
Development Specialist
National Hospice and Palliative Care Organization

There’s still time to join us for the 2019 National Hospice Gala! Visit the NHF website for more information about sponsorship opportunities and tickets. For questions, contact Emily at evanetten@nhpco.org.

Photos from the 2018 NHF Gala.

Congress: To Better Understand Value-Based Care, Look to Hospice

Introduced by the Institute for Healthcare Improvement a decade ago, the “Triple Aim” is an approach that focuses on three critical areas of care: improving the patient experience (via increased quality and satisfaction), strengthening population health, and reducing costs to the health care system. The approach is still viewed across the health care sector as the ultimate option for optimizing health system performance, but successful examples remain as elusive as the proverbial “unicorn.”

But unicorns do exist. And Medicare’s hospice benefit is a rare unicorn in our health care system.

Hospice began as a demonstration program over 35 years ago and continues to be an exemplar of the kind of care we want for everyone. Hospice is a value-based, person-centered model of care that works to meet the unique needs of patients and their families by addressing all aspects of a patient’s well-being, including physical and emotional health, spiritual needs, family support and patient preferences. It is quite literally the nation’s first proven integrated — or coordinated care — model of care.

Policymakers have taken notice and proposed models for expanding access to hospice care. While we are encouraged hospice is being recognized as a valuable asset in the care continuum, it is critical that any new models are designed to optimize care for patients and families while not diluting the integrated care approach that makes hospice work.

Hospice is currently only accessible during a patient’s final six months, but this model of care — or one like it — should be offered much earlier than at the end of one’s life. Further, there are ways to strengthen the current Medicare hospice benefit to enable it to improve the lives of more people facing serious illness.

First, any new payment models must protect the integrity of the benefit. The Centers for Medicare and Medicaid Services recently announced plans to expand its Value-Based Insurance Design Model to all 50 states and allow Medicare Advantage plans to provide hospice care.

We are committed to ensuring that MA plans maintain the integrity of the hospice philosophy and care for patients and families entirely. We strongly believe that testing the model first is far more responsible than a premature, broad legislative change.

However, any demonstration must be better for patients, families and those that serve them. The hospice community is ready to work collaboratively to ensure real and legitimate improvement.

Second, we hope to work with Congress to expand access to palliative care that offers patients relief from pain and stress when living with a serious illness. To ensure hospice programs can provide the right care at the right time, Congress should establish a statutory standard definition of community-based palliative care that would allow payment for and access to at least a minimal standard set of palliative care services and supports.

Last, the hospice community welcomes the opportunity to work with the administration as it explores avenues for regulatory relief. While providing high-quality care to the seriously ill demands close oversight including quality outcome measures, regulatory policies must promote and support program integrity rather than create excessive administrative work that leads to unintentional clerical errors and distracts from patient care. The goal of regulation should be to guarantee patient quality of care and the weeding out of willful bad actors, rather than burdening honest providers.

Expanding access to the compassionate and personalized care that patients and families want is not an impossible fantasy, but rather it is attainable. Hospice and palliative care providers are eager to join with policymakers to lead the way. Expanding hospice access, supporting community-based palliative care and reducing regulatory burdens that restrict access to care are a good place to start.

While we are awash in models that promise to meet the Triple Aim by moving away from volume-based care and toward value-based approaches, we often treat the promise as an idea, like a unicorn, as one that exists in our imagination but not yet in reality. As the 116th Congress begins the tough process of governing and advancing policies to further strengthen our nation’s health care delivery system to achieve the Triple Aim, I urge it to look no further than the hospice model — health care’s unicorn — already achieving the desired outcomes of value-based care.

By Edo Banach, JD
President and CEO
National Hospice and Palliative Care Organization 

This op-ed was originally published by Morning Consult.

Call for Conference Session Proposals – IDC 2019

Help strengthen and improve the quality of hospice and palliative care programs.

Submit a concurrent session proposal for consideration to be a part of the esteemed faculty for the National Hospice and Palliative Care Organization’s 2019 Interdisciplinary Conference to be held from November 4 – 6, 2019 at the Gaylord Palms Resort and Convention Center in Orlando, Florida.

The Call for Presentation Proposals is open through March 18, 2019.

Proposals are being sought for intermediate to advanced learning level sessions. Proposals of the highest interest will include attention to both adult and pediatric populations in these specific focus areas:

• Community-Based Palliative Care
• Interdisciplinary Team Leadership
• Medical Care
• Quality
• Regulatory
• Supportive Care (psychosocial, spiritual and bereavement)

Prepare your presentation proposal and submit online; and make plans to join us in sunny Florida in November.

Leadership & Advocacy Conference – early bird registration

The early-bird registration rate for the National Hospice and Palliative Care Organization’s 2019 Leadership and Advocacy Conference is available through January 31, 2019. This is the lowest conference registration rate available. The 2019 LAC will be hosted in Washington, DC, at the Marriott Wardman Park Hotel, April 15 – 17, with preconference offerings on April 13 and 14.

Leaders and managers in the field understand the importance of developing professional skills, hearing insights from experts in the field, and networking among peers at this national conference. NHPCO’s 2019 LACwill provide such opportunities in abundance. The LAC will also reach beyond the development of one’s own skills and last beyond the conference itself by featuring sessions that focus on strengthening the entire organization and nurturing other members of teams in workplaces at home.

Conference offerings are developed with a cross-section of NHPCO members, representatives from the board and committees, staff, and relevant content experts all work together to ensure the conference experience is of value right now, for issues leaders and managers are facing today and preparing for in the future.

Additionally, the advocacy focus of LAC will help professionals stay up to date on critical issues relevant to their communities. Participants will develop an understanding of the value of grassroots advocacy and find tools to use at home. And for those who are interested, the LAC affords attendees the opportunity to meet with Congressional staff members on Capitol Hill in a strategically designed day created to amplify the voice of hospice throughout the halls of Congress – all included in the conference registration.

•  Review the list of concurrent sessions organized by focus area. 
•  Check out available preconference offerings.

Visit the LAC homepage for more information and to find links to registration. Register today and save!

NHPCO Comments on CMS Announcement Regarding Medicare Advantage Demonstration and Hospice

The Centers for Medicare and Medicaid Services issued a press release on 01/18/19 announcing a new demonstration involving Medicare Part D and updates to the existing model for Medicare Advantage. This includes the ability for MA plans to test offering hospice care services beginning in 2021. 

National Hospice and Palliative Care Organization offers some comments regarding this announcement from CMS. First and foremost, NHPCO is concerned about any changes that could adversely impact patient and family access to care.

“To the extent that this expansion of the Value-Based Insurance Design (VBID) demonstration is about enhanced access and a potential opportunity to ensure that more beneficiaries will get high-quality interdisciplinary care when it is most appropriate, we are encouraged,” said NHPCO President and CEO Edo Banach, JD. “If this demonstration restricts choice and access, we will take appropriate action. We will also assure that Congress is engaged on this issue and provides appropriate oversight.”

NHPCO and the hospice community has known that the Administration has prioritized expansion of MA. For this reason, NHPCO has been focused on the issues that will impact the hospice provider community and has engaged with policymakers.

In October 2018, NHPCO hosted the first in a series of convenings on hospice and MA in collaboration with the Better Medicare Alliance, supported by Cambia Health Foundation. 

Added Banach, “I can say that we are heartened that CMS noted in its public statement that patients should not have a decision forced upon them and that this new model is voluntary.”

NHPCO will be building upon existing relationship with plans and plan associations to assure that the model will test a variety of geographic variation, plan size, and hospice contracting so any change involving hospice enhances access to quality hospice care.

Q&A with New President of Hospice Medical Director Certification Board

Since its inception, the independent, nonprofit, HospiceMedical Director Certification Board (HMDCB) has worked to meet its mission of “helping to relieve suffering and improve quality of life by promoting the excellence and professional competency of hospice physicians.” That work has allowed nearly 950 hospice physicians and medical directors, spanning all 50 states, to become certified in the first five years since its creation.

Following the organization’s Fall 2018 Board of Directors meeting, Brian Murphy, MD MBA FAAHPM HMDC, a hospice physician at Orange Regional Medical Center in New York, took over as HMDCB’s president. His two-year term will see the organization’s first certificants navigate its Continuing Certification Program (CCP), launched earlier in 2018. Upon assuming the role, Murphy answered several questions about his excitement, the organization, the value of certification for hospice leaders, and the new Continuing Certification Program.

As you take over as president of the Hospice Medical Director Certification Board (HMDCB), what are your hopes for the organization as it moves into its sixth year of offering certification to hospice physicians?

To continue to raise awareness about the certification by sharing the message to more and more hospice physicians. I also would like to allow opportunities for hospice CEOs to discover why certification means the hospice employs a true leader, someone with the skills and knowledge to elevate patient care, to avoid documentation traps, to ensure regulatory compliance, to excel.

Being that the organization has certified nearly 950 hospice physicians in its first five years of existence, what has made it so popular to physicians and their hospices’ leaders in such a short time?

Hospice physicians are a certain breed, taking extra pride in their work and in their field. Our work isn’t easy, it takes extra time, extra knowledge. Verifying that effort and knowledge and establishing it through this credential is then seen not only as worthwhile but essential.

There has been some confusion in the field about whether this certification is strictly for those in the Hospice Medical Director role or not. Can you help clarify who is HMDCB certification is intended for?

The certification is actually intended for any and all hospice physicians, inclusive of full-time and part-time, who meet the eligibility requirements (below*). If you’re a physician seeing hospice patients, this certification is for you.

In your discussions with hospice CEOs, what have been their responses about why they have encouraged their physicians to become HMDCB-certified?

Universally positive. “My physicians must do this!” The CEOs know they have great hospice physicians. They want to be able to brag about them. They want their hospice to stand apart from the rest.

How does having a physician with the HMDC credential positively impact a hospice?

With physicians who have a verifiable knowledge base, a hospice is then stronger. The HMDC physician has learned to avoid regulatory and documentation pitfalls, and they have leadership skills, which strengthen not just their care, but that of the whole IDT.  Having someone who has shown they have a certified knowledge base can be a differentiator for your hospice.

As a follow up, how does having a physician with the HMDC credential help the CEO or administrator specifically in their role?

The knowledgeable HMDC physician keeps the documentation aligned with regulatory issues, decreasing audit risk. And with skillful patient review, they can bring in those patients with less clear diagnoses and prognoses with minimal risk, helping to grow census — and similarly help to maintain census by keeping patients with longer length of stays on service with justifiable rationale and documentation.  Finally, an HMDC physician can help get through an audit with wins for the hospice.

How can a physician’s preparation and completion of the HMDCB certification exam impact operations at any given hospice?

For the better!! How? By enhancing patient care, staying up to date on medication and pharmacologic knowledge, and improving documentation with up to date regulatory expertise. Also, the preparation and completion of the examination strengthens communication skills not only with patients and families but also with the IDT, as well as referring physician colleagues, and administrative hospice leadership.

There are some hospices who have chosen to both support and pay for their physicians to participate in the certification program. Why is this important for hospice CEOs to do?

A hospice who supports their physicians will have a physician who supports their hospice.  This allows a CEO to say, “I support you, I want you to be and I’ll help you to be a strong expert physician. I care.” A hospice employing HMDC physicians will recruit stronger physicians.

How do physicians with the HMDC credential help differentiate a hospice from competitors in the ever-increasing competitive landscape?

The HMDC credential demonstrates to consumers, patients, and families that this hospice wants and demands their physicians to be the best. The credential is a symbol of dedication to the hospice field and quality to the care the physician provides.

How is HMDCB ensuring that there is ongoing learning and development of its certificants?

After proving their knowledge with the initial exam, the certificant establishes continuing education in hospice as a part of their work and job. We test every 6 years for a reason, because things change in hospice quickly. We require CME during those 6 years to ensure the learning continues. We offer self- evaluation too, so a physician can learn where to focus their education. There are numerous opportunities for certificants to continue developing and learning through the Continuing Certification Program.

* The eligibility requirements mentioned earlier include holding a current license to practice medicine in the US or Canada, adhering to HMDCB’s Professional Code of Conduct, and demonstrating a minimum of 400 hours of broad-based hospice activities during the previous five years. We also have three different pathways to choose from for eligibility which adhere to a wide range of practicing hospice physicians.

More hospices are making the determination that having certified hospice physicians is important enough to require it.  If you are interested in learning more about how having a certified hospice physician can positively impact your hospice, please visit HMDCB.org/CEOs. 

Please note that the HMDCB application cycle will open January 8 and close on April 22, 2019. Physicians interested in applying can do so at HMDCB.org/Apply.