It’s All About Getting the Care You Want

To twist a familiar expression attributed to Benjamin Franklin: “In this world nothing can be said to be certain, except ‘life’ and taxes.” I only wish people would put as much effort into planning for their future healthcare needs as they do on their annual tax returns. As we near tax day, I hope that we can all pause to consider or re-consider our health care wishes.   

Advance care planning is not about the end…it’s about having heart to heart conversations with our loved ones, talking about our values, priorities and wishes.  It’s about documenting those wishes in an advance directive and sharing that with friends, family and healthcare providers so that we will get the care we want should we not be able to speak for ourselves. It’s about giving a gift to our loved ones who will know what’s important to us long before we ever face a serious illness or medical emergency.

All forms of advance directives – which can include a living will, healthcare proxy or health care power of attorney, or even a POLST or MOLST form from our physician – are tools one can use to make healthcare preferences known and help ensure we get the care we want.

These conversations and an advance directive do not have to be done in a lawyer’s office, but can take place around the kitchen table or in the family room, during calm times, not in the midst of a healthcare crisis. 

A recent bipartisan report from The Aspen Institute Health Strategy Group, “Improving Care at the End of Life,” offers five big ideas to improve care during this challenging time and will help take away some of the fear about having these important conversations. I support the five ideas, particularly the concept of “building the development and updating of an advance care plan into the fabric of life.”   This includes the integration of advance directives and planning tools into smart phones, and utilizing employee on-boarding and insurance sign-up periods to provide advance planning tools and allow individuals to execute an advance directive. 
 

I would like these conversations to be part of a person’s annual physical or a natural step when applying for insurance or starting a new job. Even a birthday or annual event like Thanksgiving can be a time to talk and make these conversations part of our family routine. And, yes, even the tax season can be a good time to have conversations about our health care wishes.                

Like taxes, these conversations can be difficult to begin but once we have, we’ve already gotten over the biggest hurdle. 

National Hospice and Palliative Care Organization offers a range of materials to help people understand advance care planning and begin the discussion, all available free of charge at www.CaringInfo.org. This includes state-specific advance directive forms.

By Edo Banach, JD

President and CEO
NHPCO

 

MedPAC Releases March Report to Congress

The Medicare Payment Advisory Commission released its annual  March report to Congress on Wednesday, March 15, 2017.

The hospice chapter begins with an updated snapshot of the hospice industry. According to MedPAC, 1.38 million Medicare beneficiaries (or almost 49% of Medicare decedents) received hospice care in 2015 from 4,200 hospice providers. In that year, Medicare spent $15.9 billion on hospice care, up from $15.1 billion in 2014. However, Medicare spending on hospice care constituted less than 3% of overall Medicare spending.

In the report, the Commission recommends that “Congress should eliminate the update to the hospice payment rates for fiscal year 2018,” which is consistent with previous MedPAC recommendations.

It is important to remember that Congress must take action for a MedPAC recommendation to be implemented, which it has not done in recent years.

Learn more about the hospice chapter from the  Hospice Action Network blog.

Listen to NHPCO's Podcast, Episode #12 to here more about the report's focus on live discharge.

SMRC Audit on GIP Claims

The Centers for Medicare and Medicaid Services has contracted with StrategicHealthSolutions, LLC as a Supplemental Medical Review Contractor (SMRC) for a review of patient GIP stays. (NHPCO members will find a Regulatory Alert offering further information on this GIP claims audit.)

Many hospice providers have asked for clarification about the role of the Supplemental Medical Review Contractor. What follows is some basic information about SMRC.

As the Supplemental Medical Review Contractor (SMRC), StrategicHealthSolutions, LLC has been contracted by CMS Center for Program Integrity to perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs. One of their primary tasks will be conducting nationwide medical review as directed by CMS. The medical review will be performed on Part A, Part B, and DME providers and suppliers to determine whether Medicare claims were billed in compliance with coverage, coding, payment and billing practices. 

The selection of topics and time frames to be reviewed is determined by and at the direction of CMS. The focus of the projects may include, but are not limited to issues identified by Federal agencies, such as the Office of Inspector General (OIG), Government Accountability Office (GAO), CMS internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations and First-Look Analysis Tool for Hospital Outlier Monitoring (FATHOM) report and Program for Evaluating Payment Patterns Electronic Report (PEPPER). The SMRC is conducting medical review based on the analysis of national claims data versus data that is limited to a specific jurisdiction as performed by Medicare Administrative Contractors (MACs). Unlike the MACs, the SMRC does not perform claim payment functions.

Message from Edo Banach

I’ve completed my first official week as President and CEO at NHPCO.  I am honored to lead the organization at this important time of change, and look forward to working together. 

Over the next several weeks and months, I will be learning more about your needs and the ways we can best serve you in the important work you do in your communities every single day.  I look forward to telling your stories to consumers, caregivers and policy-makers and expanding awareness of your dedication and skill. Together, we will build on the strong foundation of hospice and palliative care to grow innovative and compassionate care programs that will serve all in need. 

As I begin my tenure working with you and for you at NHPCO, National Hospice Foundation, and the Hospice Action Network, it seems fitting to reflect on the guiding values of this organization:

• Service… engaging with you, our members and constituents, is at the heart of all that we do.
• Respect and Collaboration… valuing the expertise, skills and contributions from the field and fostering partnerships and relationships with all our stakeholders is vital to future success.  
• Excellence… exceeding the expectations of our members and embracing change and innovation will allow us to continually improve and grow in a manner that will allow us to embrace opportunities.  
• Stewardship… managing resources with the highest ethical and fiscal standards will ensure accountability of your investment within NHPCO and foster integrity throughout our organization.

Please know that I take these values seriously and they will serve me and the entire team as we work together towards the bright future I see ahead of us all. A future that will not be without challenges, certainly, but I know that we can meet these challenges together as we strive to provide the highest quality care for those in need of our services and care.

I’ve been fortunate to meet a number of NHPCO members during my first week and I know this will continue.  I look forward to meeting you at our upcoming Management and Leadership Conference on May 1 – 3, 2017 at the Washington Hilton. If you have not already registered, I hope you’ll consider joining us. This will be a great opportunity to get to know each other better.

I look forward to our work together.

Edo Banach, JD
President and CEO

 

“Culture” + “Curiosity” = Culturosity®

A Desire to Learn about and Interact with Different Cultures

There are populations who do not benefit from equitable access to quality end‐of‐life care because of a history of healthcare disparities. Culturosity: Competence inTransitioning End‐of‐Life Care for Underserved Populations from Disparity toEquity is a special preconference seminar addressing this topic that is being offered on Sunday, April 30, 2017, the day before the 2017 Management and Leadership Conference officially begins. 

This daylong workshop will provide participants the opportunity to work through the cultural and systemic issues, and the inherent biases that exist for underserved and LGBT communities and communities of color. Using small group sessions, role play and other cutting‐edge interactive techniques, participants will acquire the knowledge and skills to help themselves and their programs develop care that brings equity out of disparity.

A look at NHPCO’s current edition of “Facts and Figures: Hospice Care in America” provides a snapshot of patient race and ethnicity of hospice patients for 2014. While the African American population accounts for over 12% of the overall U.S. population, only 7.6% of those entering hospice programs across the country were African American – and it should be noted that this percentage has dropped in recent years. Those of Hispanic or Latino origin account for 7% of hospice patients and Asians or other Pacific Islanders account for 3%  (this represents a slight increase in reaching these populations); multiracial individuals account for 13%. 

The provider community has made strides to increase under-utilization of hospice and palliative care by minority communities but much remains to be done as the minority populations in the U.S. are projected to increase in the years ahead. 

This seminar, Culturosity, will help providers understand many of the issues involved in disparities and access. Online registration for the Management and Leadership Conference and the preconference seminars is open through March 27, 2017. Register today!

 

Call for Sessions Proposals Open for Interdisciplinary Conference

Become part of the esteemed faculty for NHPCO’s Interdisciplinary Conference, Strengthen Your Organization: Care, Compliance, Quality, to be held from September 18 – 20, 2017 at the San Diego Marriott Marquis and Marina, San Diego, California. 

The Call for Presentation Proposals is open and proposals are being sought for intermediate to advanced learning level sessions in one of six key areas:

• Interdisciplinary Leadership: Developing, leading teams and ensuring their optimal functioning 
• Medical Care: Emergent clinical topics to attract physicians and nurses
• Supportive Care: Emergent topics in psychosocial, spiritual and bereavement care
• Regulatory: Latest news on compliance implementation provided by selected faculty
• Quality: Emergent topics provided by selected faculty
• Community-based Palliative Care: Featuring model programs/practices and practical “how to" topics
  

The Call for Proposals is open through Sunday, March 12, 2017; don’t delay. Hospice and palliative care professionals with ideas for a session falling into the six key areas are encouraged to submit a proposal.

Application Cycle for HMDCB Exam Now Open

The application cycle for the 2017 Hospice Medical Director Certification Board (HMDCB) exam is now open through March 21, 2017. Nearly 650 individuals from across the country have already been certified in the organization’s first three exam cycles.

So why is physician certification important? According to Suzanne Karefa-Johnson, MD HMDC, a Physician at Hospice of the Comforter in Altamonte Springs, FL, "The HMDCB certification program is an important avenue to establishing one's expertise in the administrative and clinical skillset demanded of a hospice medical director. It helps to affirm the importance of physicians providing end-of-life care within the larger palliative and medical continuum of care."

In addition, initial physician certification and the continuing education required to maintain certification contribute to the creation of an environment of professionalism and a culture of retention — a critical issue for hospices today. Certification is also a vehicle for hospices to differentiate themselves from competitors and demonstrate to consumers that they have attracted the most skilled and experienced healthcare professionals.

By visiting HMDCB’s Physician and CEO pages on its website, you can learn more about the benefits of applying and watch two videos featuring hospice colleagues who share why the certification is valuable. 

The early bird application deadline for the Hospice Medical Director Certification Board’s 2017 exam is Tuesday, February 28. Applicants who complete their application before the deadline save $250!