Free Webinar on New NCP Guidelines

The National Coalition for Hospice and Palliative Care will host a complimentary webinar to present the newly published National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care, 4th edition (NCP Guidelines) on Monday, December 17, 2018 from 2:30 to 4:00pm ET.

The 4th edition has been expanded to improve access to quality palliative care for all people living with serious illness, regardless of setting, diagnosis, prognosis, or age.

Registration deadline is Friday, December 14.  Space is limited and early registration is encouraged to ensure your attendance. The webinar will be offered via computer access only and no phone lines will be available. No CEUs will be provided. 

Learn more and register online.

For additional questions about the NCP Guidelines, please  contact info@nationalcoalitionhpc.org.

New National Guidelines Call for Improved Access to Vital Palliative Care

Many people living with a serious illness, whether heart failure, lung disease, cancer or another illness, don’t have access to palliative care, which can make all the difference in how they feel physically, emotionally and spiritually. The Clinical Practice Guidelines for Quality Palliative Care, 4th edition were released on October 31 and area available for free download.

New palliative care guidelines set out to improve access to this care, which provides relief from the symptoms and stress of serious illness; improves quality of life for both the patient and the patient’s family; and is provided concurrent with disease-focused treatments.

"Palliative care should be provided throughout the community wherever people living with serious illness receive care. To reach that goal, the guidelines promote consistent criteria and encourage continuity of palliative care across settings," Martha L. Twaddle, MD, FACP, FAAHPM, HMDC, Steering Committee Co-Chair, National Consensus Project for Quality Palliative Care.

To improve access to this care, the new guidelines urge clinicians and health care organizations to integrate palliative care into the services they provide all people living with serious illness, regardless of their diagnosis, prognosis, or age. The guidelines also call for palliative care to be available wherever people receive their care, including: outpatient clinics, cancer centers, long-term care facilities, office practices, homeless shelters, dialysis units and at home.

The guidelines include tools, resources and practice examples to help with implementation. They expand on the eight domains of palliative care: structure and processes of care, physical aspects of care, psychological and psychiatric aspects of care, social aspects of care, spiritual, religious and existential aspects of care, cultural aspects of care, care of the patient nearing the end of life, and ethical and legal aspects of care.

So what can you do right now to ensure your patients and their families are getting this vital care:

• Read the guidelines and share with your colleagues.
• Review the eight domains with your health care team and/or organization to assess how you can use the Guidelines to best address the gaps and needs of people living with serious illness and their caregivers.
• Identify specific action steps that your organization can implement to provide quality palliative care and focus on the easily attainable goals first.

The purpose of the guidelines is to improve access to quality palliative care by fostering consistent standards and continuity of care across settings. Please join us in this national effort so that all people living with serious illness and their families will receive the best care possible. Learn more at www.nationalcoalitionhpc.org/ncp.

TRIBES

In my job working on behalf of person- and family-centered care, I am fortunate to travel the country, and I love the opportunity to meet our members and many professionals who are seeing the value of NHPCO and becoming members.  Many things stand out for me— the beauty of America and its people, the caring and compassionate nature of all the folks serving hospice and palliative care patients and families, and the lingering tribalism that, intended or not, undermines the first two things.

You see, we are all on the side of patients and families.  We are all trying to do our best to improve care and to improve our communities.  I see this shared commitment in communities across the country—and I am proud. What’s different is how we talk about ourselves, and how we describe what we do.  Not what we ARE.  Democrat or Republican, small or large, rural or urban, hospice or palliative care, physician, nurse, social worker, chaplain or administrator…and I could go on.  There are so many tribes we all belong to in our personal and professional lives.  Sometimes we allow our tribe to become us and to cause us to question others’ motivations or constitution.  This is natural, but we must resist doing so at all costs.

Whenever I speak about palliative care—and note that the term is not fully or clearly defined—it seems that I am immediately accosted by a dedicated palliative medicine physician that questions my commitment to palliative care.  When I speak about hospice in loving terms, I am immediately told by a well-intentioned provider that a local for-profit entity or large non-profit is not committed to the original model and they are eroding the “heart” of hospice.  When I speak of health care reform, I am accused of being a Democrat, and when I embrace market reforms, I am accused of being a Republican.  I am accused by city folks of being a country dweller (which I am) and by country dwellers of being an out of touch city boy (which I was, sort of).  I am guilty as charged of all of that— but I want to note that what motivates me— and most of us— is that we are guilty of wanting a better life for our communities, our families and our country.

As we enter this elections season, I want to urge all of us to focus on the only tribe that matters— our fellow human beings.  Please, don’t let labels or divisive rhetoric prevent us from uniting around person-centered, interdisciplinary care.  This care is not about our tribe, it is all about putting our tribe aside and doing what’s best for our patients and families and doing so while collaborating with our colleagues, even those who have a different point of view.  That’s the best model I can think of for participatory democracy. I hope that we will show the rest of the country how to put labels aside and just move forward in a decent and productive manner.  And as we move forward, let us never lose the ability to engage with one another in a constructive manner on challenging issues. Only by working together can we build on the success of those who forged our path as both a nation and a provider community.

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

Opioid Packages Includes Safe Disposal Provision

National Hospice and Palliative Care Organization applauded Members of Congress for including key provisions related to safe disposal of expired or no longer needed medication in the final opioid legislative package that has passed both chambers of Congress with bipartisan support on October 3, 2018. 

“Opioid abuse is truly a national crisis, and one that the hospice community is dedicated to helping prevent and treat,” said NHPCO President and CEO Edo Banach. “In fact, as a key part of this nation’s grief support safety net, hospices are acutely aware of the toll that this epidemic takes on families and communities.” 

A provision in the passed bill will help reduce the number of unused controlled substances at risk of diversion or misuse by allowing qualified hospice employees to safely dispose of these medications on site after the death of a patient, or when the controlled substance is expired or no longer needed because the hospice patient’s plan of care has been modified. 

Granting appropriate hospice professionals the legal authority to dispose of unused medication after a hospice patient’s death would not only alleviate grieving families of this responsibility but also help prevent potential diversion or illicit use of these drugs. 

Opioids play a key role in alleviating pain and suffering for those with advanced illness and at the end of life. Patients admitted to hospice care frequently require intensive medication management of both chronic conditions and symptoms associated with end-stage disease such as pain, shortness of breath, nausea, delirium, and depression. Our nation’s hospice and palliative care providers can be an important part of the care continuum for people with serious pain, including those with serious illness and facing the end of life, and should be looked at as a resource for these populations.

A new frontier, and I’m not afraid to stay curious

If Hamlet were a 21st century hospice leader, he might very well ponder the question, “To be (carved-in) or not to be (carved-in)?”  Will the Medicare hospice benefit be carved into Medicare Advantage Plans or not?  We have been discussing the implications of this since March 2014 when I was a CMS staffer and MedPAC discussed the possibility of ending the Medicare Advantage carve-out.  Since then, I’ve left the federal government, but  I am more curious than ever about whether Congress will act on MedPAC’s recommendation.

In the past, MedPAC recommended that Congress include the Medicare hospice benefit as part of Medicare Advantage plans’ scope of services.  MedPAC’s recommendation anticipates that MA plans take on the financial responsibility associated with offering patients high-quality hospice and palliative care services they need as a part of the full continuum of care – under the assumption that this will promote coordination of care resulting in lower Medicare spending.

There was and continues to be vocal protest from many stakeholders including the hospice provider community as well as the managed care plan community against MedPAC’s recommendation, which has likely prevented any action toward implementation. Our members at NHPCO have shared their concerns regarding the possibilities of reduced beneficiary access; reduced quality of hospices services; impact on the interdisciplinary care plan; and financial sustainability.  Some of the concern is based on the hospice experience with state managed care plans which has neither resulted in improved care coordination nor financial stability for hospices.

I do not consider their concerns trivial and I believe we need a deeper dive into the policy goals, technical complexities, and implications for the patient and caregivers.  An article from a March 2018 HealthAffairs blog helps put some of this into context.  Whether the hospice MA carve-in would help hospice providers and end-of-life care is still up for debate.

I am encouraged to see that CMS includes a new policy interpretation of what is considered “primarily health related” in its Calendar Year 2019 Call Letter.  Furthermore, Section 50322 of the Bipartisan Budget Act of 2018 requires the Government Accountability Organization to study the expanded supplemental benefits for the chronically ill, due to publish in 2023.  Both, the legislation and CMS policy, mark a new vision of the changing health care environment to one that recognizes the person-centered care model.

Hospices are uniquely poised in communities across the country to transform a health care industry from a medical model to a compassionate holistic care that accounts for the psychosocial and emotional needs of patients and caregivers.

This fall, NHPCO will partner with Better Medicare Alliance to take an unprecedented step by jointly holding a convening with key stakeholders to discuss the issues MA plans and hospices may face if hospice is included in Medicare Advantage plans.  It’s imperative that we fully engage in thoughtful discussion on this complex issue and remain curious together. 

By Zinnia Harrison, MHS
Vice President, Innovation & Inclusion
NHPCO

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NOTE: NHPCO is working to gather input from its hospice and palliative care membership regarding the MA carve-in and challenges and opportunities for the provider community.  NHPCO members may attend a free Virtual Town Hall on Thursday, October 4 at 2:00pm EST. Registration is required.

NHPCO Participates in Seminal Briefing of the Congressional Palliative Care Task Force

Lori Bishop, Vice President of Palliative & Advanced Care for the National Hospice and Palliative Care Organization, participated in the first-ever meeting of the Assisting Caregivers Today (ACT) Caucus’ Palliative Care Task Force. Hosted on September 14, the bipartisan task force was launched by Congresswoman Jacky Rosen (D-NV) and Congressman Bruce Poliquin (R-ME) and inspired by their personal experiences providing long-term care to loved ones.

While the briefing served to introduce congressional staff to palliative care, the task force will work to enhance palliative care services to improve the quality of life of millions of Americans managing serious illnesses while also raising the public’s awareness and promoting the availability and benefits of palliative care through bipartisan solutions to expand access these services.

“NHPCO wholeheartedly stands behind the efforts of the bipartisan Palliative Care Task Force and is committed to continuing its work to support efforts to educate lawmakers about this important type of care,” said Ms. Bishop. “We thank Representatives Rosen and Poliquin for spearheading this important effort and commend their goal to create bipartisan policies and solutions that address the needs of the palliative care community. We look forward to working with them and other task force members to advance palliative care for all Americans.”

Palliative care helps to prevent and reduce the physical and emotional suffering for patients dealing with serious illness, providing individuals with the best possible quality of life for both them and their families.

In July the House of Representatives passed the bipartisan Palliative Care and Hospice Education and Training Act (PCHETA) which is co-sponsored by both Representatives Rosen and Poliquin and furthers the task force’s goals as the bill would expand access to palliative care services and provide awards, grants, career developmental opportunities, and support to physicians, nurses, hospitals, social work schools, medical schools, and other medical institutions to promote education and research in palliative care.

“NHPCO commends the House of Representatives for advancing PCHETA and urges the Senate to take up the popular bipartisan bill so that Americans with life-limiting illnesses are able to access the hospice and palliative care they need to be comfortable and at-peace alongside their loved ones,” concluded Ms. Bishop.

Launch of Bipartisan Congressional Task Force Championing Palliative Care hosted on September 14.