Choosing Wisely® Campaign Promotes more Informed Healthcare Decisions

The National Hospice and Palliative Care Organization applauds new recommendations released as part of the Choosing Wisely^® campaign to promote more informed healthcare decision making. 

The American Academy of Hospice and Palliative Medicine and the American Geriatric Society have both developed lists  identifying five specific tests, procedures or medication therapies  that physicians and patients should question – all part of the Choosing Wisely^® campaign.

• Read the AAHPM Recommendations
• Read the AGS Recommendations

NHPCO encourages physicians to review this new information, particularly in areas that are relevant to people coping with serious and life-limiting illnesses, specifically:

• Don’t recommend feeding tubes for patients with advanced dementia; instead offer to assist with feeding.
• Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.
• Don’t leave an implantable cardioverter-defibrillator (ICD) activated when it is inconsistent with the patient/family goals of care.

NHPCO has been a strong advocate for earlier access to hospice palliative care services. Additionally, the organization has a position statement on the Care of Hospice Patients with Automatic Implantable Cardioverter-Defibrillators (PDF) available online.

 Choosing Wisely^® is a national campaign launched in April by the ABIM Foundation and Consumer Reports that promotes conversations between physicians and patients about utilizing the most appropriate tests and treatments and avoiding unnecessary care.

For more information on Choosing Wisely, visit:

• http://consumerhealthchoices.org/campaigns/choosing-wisely/
• or choosingwisely.org.

For information on advance directives, and helpful information on end-of-life care, visit NHPCO’s consumer website, Caring Connections at: www.caringinfo.org.

Call for Proposals - 2013 Clinical Team Conference & Pediatric Intensive

Join colleagues from across the country that are committed to innovation and excellence by submitting a proposal that demonstrates significant work and achievement for NHPCO’s 14th Clinical Team Conference and Peditaric Intensive. The deadline for proposals is March 25, 2013.

The theme for NHPCO's 14th Clinical Team Conference and Pediatric Intensive underscores a drive for the hospice and palliative care field to innovate and pursue excellence in all endeavors. The conference will explore care continuum, interdisciplinary, team, medical, clinical, psychosocial, spiritual, bereavement and team innovation and excellence – in all their myriad facets, ideas, forms and outcomes.

The CTC will be held September 26 – 28, 2013, in Kansas City.

Whether you provide care to patients and families directly through interdisciplinary practice, manage interdisciplinary team staff, lead quality efforts or are responsible for related practices and processes, you need to keep pace with evidence-based practice, adapt and respond to impending changes in the field, work in partnership with your community to meet patient and family needs across the care continuum and ensure that every component of the care and services you provide is excellent.

Visit the Call for Proposals page online.
http://nhpco.confex.com/nhpco/CTC2013/cfp.cgi

Hospice Medicare Rates Impacted by Sequestration

Most Americans are aware that Congress took action in January to avoid the fiscal cliff that would impact just about every aspect of federal spending. While most individual income tax increases were avoided, Congress provided only short term relief from dramatic spending cuts within the federal budget. Indeed, absent a more considered alternative, “across the board” spending cuts will be made effective on March 1, 2013. These forced spending cuts are a process called sequestration – and in most cases, legislators want to avoid sequestration because the cuts are done with such a broad brush that they negatively impact just about everyone.

As March 1 approaches, NHPCO wants to provide more detailed information on the implementation of sequestration, which will involve a 2% cut in Medicare payments, effective for services provided on or after April 1.

What does this mean?
 1. Hospices will continue to bill at the FY2013 rates.
 2. For services provided on or after April 1, 2013, the MAC will deduct 2% from the reimbursement before paying the claim.  The hospice will NOT bill at the 98% rate.
 3.The sequestration cuts will continue for 10 years, unless there is Congressional action to discontinue them.

NHPCO issued a Regulatory Alert (02/12/13) for members that provides links to some additional information, including a wage index chart and rate calculator.

NHPCO Brings 100 Hospice Leaders Together to Create Future Care Delivery Models

More than 100 hospice and palliative care senior level managers and leaders gathered in Florida to identify and explore innovative approaches to bring the benefits of hospice care to people with advanced or chronic illness. 

Creating the Hospice Palliative Care Continuum: A Futuring Forum was the first official event hosted by NHPCO’s Mary J. Labyak Institute for Innovation at the Westin Diplomat Hotel, January 22 – 24, 2013. The focus of the Futuring Forum was to identify and create innovative approaches to bring the services hospice provides – including pain and symptom management, care coordination, home safety assessments, emotional and spiritual support and caregiver education and services -- to individuals and family caregivers coping with serious and chronic illness.

The Futuring Forum built upon participatory experiences with forum attendees engaging with presenters during five master classes and working in small groups to explore new ideas.

Master Classes featured guest speakers from outside of the hospice palliative care field. They included Tom Szaky, founder and CEO of TerraCycle; Clement Bezold, PhD, founder and chairman of the Institute for Alternative Futures; Jennie Chin Hansen, executive director of the American Geriatrics Society; Jim Kinsey, senior consultation services specialist for Planetree; and Steve Gross, chief playmaker and executive director of Life is Good Foundation.

“The opportunity for us to tap into the great minds of a number of dynamic innovators from many different fields fostered a spirit of creativity that allowed many of us to think in new ways and reframe the traditional hospice model as a series of services or products that individuals with serious illness so desperately need,” said J. Donald Schumacher, NHPCO president and CEO.

Added Schumacher, “Some of the common themes that repeatedly came up as our guest presenters interacted with Forum attendees centered on the dedication and passion that motivates hospice professionals. The hospice field was created by those striving to innovate how the dying were cared for over 30 years ago – the need to tap back into this creativity came up repeatedly during the Forum.”

NHPCO plans to share ideas from the Futuring Forum at its upcoming Management & Leadership Conference (April 25-27, 2013, at the Gaylord National Harbor Convention Center, National Harbor, MD) and via other member platforms to prompt further discussion and collaboration of new ideas and innovations.

New Pediatric Concurrent Care Report Emphasizes Need for Collaboration

Affordable Care Act Provision Expands Access to Pediatric Palliative Hospice Care

 Children living with life-limiting or life-threatening conditions and their families need the expertise that hospice and palliative care professionals can provide throughout the course of a serious illness.

 A pediatric-focused report, Pediatric Concurrent Care Briefing, has been released by the Mary J. Labyak Institute for Innovation, a program of the National Hospice and Palliative Care Organization based at the National Center for Care at the End of Life.

 It’s important to remember that the care provided to a child with serious illness is different from the care that we would give to an adult,” said J. Donald Schumacher, NHPCO president and CEO. NHPCO is the organization that created the Mary J. Labyak Institute for Innovation in 2012.

 Children aged 0-19 years accounted for 1.9 percent of all deaths in 2009. Slightly more than half of childhood deaths occur in infancy.

“While the numbers of children that die from each year from a serious illness in the U.S. are low, we have a responsibility to compassionately care for each of these children and their families,” Schumacher added.

 Effective management of pain and symptoms together with psychosocial and spiritual care that are sensitive to developmental, personal, cultural and religious values and practices are critically important. The need for such care begins at diagnosis and continues throughout the entire course of a child’s life and for their families beyond the child’s death.

 For many years, children facing such illnesses had few options for Medicaid coverage when children were very seriously ill. Parents in all but a few states were faced with forgoing curative treatments for their children to be eligible for hospices services – considered to be the gold standard for end-of-life care. The patient Protection and Affordable Care Act (ACA) changed that situation.

 Under the ACA all state Medicaid programs are required to pay for both curative and hospice services for children under age 21 who qualify. This is covered by a provision, Section 2302, termed the “Concurrent Care for Children” requirement.

 The Pediatric Concurrent Care Briefing shares examples from states that have implemented options to provide pediatric palliative and hospice care services and outlines eight implementation strategies that can help ensure that providers are serving the children and families in the community that may be in need of the unique services hospice and palliative care brings.

 The goal of the briefing is to foster the necessary collaboration among providers and advocates within each state to ensure that the most medically fragile children and their families have the quality care they deserve and desperately need.

 NHPCO encourages the formation of statewide pediatric palliative and hospice care advocacy coalitions to work towards improved options of care.

 This new report joins other materials created by NHPCO such as the Concurrent Care for Children Requirement: Implementation Toolkit and a series of seven online learning modules on Pediatric Palliative Hospice Care that will soon expand to a series of 10 modules. 

Download the Pediatric Concurrent Care Briefing (PDF) free of charge from the NHPCO website and learn more about available resources for pediatric palliative care at www.nhpco.org/pediatrics.

 

 

A Look Back at NewsLine Articles During 2012

NewsLine, NHPCO's digital publication for providers, features exceptional articles by hospice leaders and clinicians on a range of relevant topics—from “understanding geriatric frailty” to “crafting an effective elevator pitch.” The January issue of NewsLine includes a partial list of the features that appeared in 2012—with quick links to the actual articles.

NHPCO invites you to take a look, and download copies of any you may have missed or want to share.

35.7 Percent of Hospice Patients Die or Were Discharged within 7 Days

A record number of dying persons in the U.S. – an estimated 1.65 million patients – received care from the nation’s hospices in 2011, reports the National Hospice and Palliative Care Organization.
Approximately 44.6 percent of all deaths in the U.S. were under the care of a hospice program. This is up from 41.9 percent in 2010.

While there is an increase in the number of patients cared for, NHPCO reports that 35.7 percent died or were discharged within seven days of admission, up from 35.3 percent in 2010.

“We continue to see more dying Americans opting for hospice care at the end of their lives, yet far too many receive care for a week or less,” said J. Donald Schumacher, PsyD, NHPCO president and CEO. “We need to reach patients earlier in the course of their illness to ensure they receive the full benefits that hospice and palliative care can offer.”  

NHPCO’s annual publication, Facts and Figures: Hospice Care in America (PDF) reports on hospice trends and provides updated information on the growth, delivery, and quality of hospice care in the U.S.

Schumacher added, “In recent years regulators have been focused on long-length patients (11.4 percent received care for 180 or more days) and while it is understandable that they are interested in the long-length statistic, we should not overlook the fact that far too many people receive care for too short a time.”

Earlier access to hospice care can reduce emergency room visits and hospitalizations; additionally, quality of life for patients and family caregivers can be improved.
Research has shown that eight out of 10 Americans would prefer to be at home at the end of life, and hospice can make this happen.

NHPCO continues to stress the importance of having healthcare providers discuss hospice palliative care as an option for patients coping with a serious or life-limiting illness. Similarly, NHPCO encourages patients and family caregivers to ask their health care providers about the benefits hospice might offer.

“There’s a common misconception that hospice care is giving up,” said Schumacher. “Nothing could be farther from the truth. Hospice provides high quality medical care and services from an interdisciplinary team of professionals and trained volunteers that maximizes quality of life and makes the wishes of the patient a priority.”

Usage of hospice has doubled in the past decade due in part to providers learning to care for a wider range of patients with more complex diagnoses such as dementia, heart disease, lung disease and more. This growth reflects the expertise of hospice providers in caring for dying Americans who need quality end-of-life care, reports NHPCO.

Facts and Figures: Hospice Care in America (PDF) is available in the News Room section of NHPCO’s website, nhpco.org/newsroom.