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Hospice News Nebraska, Nov. 30, 2017
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Events

March 20-21 (Tues-Wed) - 2018 NHPCA "Living a Good Life... at the End of Life" Annual Conference

 

Nebraska News


HOSPICE COMPARE SEARCH FUNCTION ALERT

The Centers for Medicare and Medicaid Services is aware that the location search on Hospice Compare may return incorrect results. As a result, CMS has provided a message on the home page of Hospice Compare informing users that when searching by location, the list of agencies provided may not serve the ZIP code, city or state they entered. The message also recommends consumers call hospice providers to confirm their service areas. CMS is currently working to improve the search functionality and will update the website as soon as possible. Please continue to monitor the Hospice Quality Public Reporting web page for updates.


ASPR TRACIE NEWSLETTER

The U.S. Department of Health and Human Services’ Office of Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) provides a monthly newsletter, The Express. Read the November 2017 newsletter here.

 

TELEPHONE INQUIRY PILOT PROJECT

Do you often have several inquiries for the customer service representative when calling the Home Health and Hospice Provider Contact Center (HH&H PCC)? According to the most recent Medicare Satisfaction Indicator (MSI) Survey feedback, many providers wish they could ask more than 3 inquiries per call. Based on this feedback, CGS is offering a one time only special event, beginning Monday, December 4, 2017, allowing you to ask an unlimited number of inquiries when you call the HH&H PCC. The goal from this event is to collect data to evaluate if CGS can revise the current limit of answering only 3 inquiries per telephone call while still continuing to meet our contractual requirements set by the Centers for Medicare & Medicaid Services (CMS). Read More




2017 NEBRASKA END-OF-LIFE SURVEY REPORT AND OTHER RESOURCES AVAILABLE

The Nebraska Hospice and Palliative Care Association recently released the 2017 Nebraska End-of-Life Survey Report. Five copies of the report have been mailed to each member agency. A digital version of the report is available for download here. To request additional physical copies, please contact us at info@nehospice.org or 402-477-0204 and we will mail them to you free of charge.

NHPCA has also created a members-only web page full of resources utilizing data from the 2017 Nebraska End-of-Life Survey Report.

Lastly, NHPCA has updated several "Hospice lets me be..." outreach campaign tools with 2017 data. Updated tools are marked with a red "new!" tag.


SAVE THE DATE FOR 2018 NHPCA ANNUAL CONFERENCE

The 2018 NHPCA "Living a Good Life... at the End of Life" Annual Conference will take place March 20-21, 2018, at Embassy Suites in Lincoln. More information will be released in the coming months.

NEW MEDICARE NUMBER: PREPARE YOUR SYSTEMS FOR APRIL 2018

The Centers for Medicare and Medicaid Services will begin mailing new Medicare cards with a new Medicare number (previously called the Medicare Claim Number on cards) to your patients in April 2018.

Beginning in October 2018, through the transition period, CMS will return your patient’s new Medicare number (Medicare Beneficiary Identifier, or MBI) on every remittance advice for claims you submit with their valid and active Health Insurance Claim Number (HICN). On electronic remittance advice transactions, the MBI will be in the same place you currently get the “changed HICN”: 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code).

If the vendors you partner with to bill Medicare haven’t shared their MBI system changes with you, contact them to make sure you are both ready for the change; they can also tell you how they will pass the new Medicare number to you.

Visit the Provider web page for the latest information.

 

NHCA TEAM UPDATES

Jennifer Eurek has resigned from her position as NHCA Vice President of Regulations and Guidance/Nebraska Hospice and Palliative Care Association Vice President of Hospice and Palliative Care. Her last day will be Dec. 29. Jennifer enhanced numerous programs related to education, research, advocacy, community engagement, and quality improvement.

Michaela Mallery has submitted her resignation from NHCA. Her last day will be Dec. 15. As Vice President of Finance, Michaela has made significant contributions to NHCA’s strength as an association.


HQRP QUARTERLY UPDATE DOCUMENT FOR THIRD QUARTER 2017 NOW AVAILABLE

The HQRP Quarterly Update document for the third quarter (July-September) of 2017 is now available in the “Downloads” section of the HQRP Requirements and Best Practices web page. This document was formerly referred to as the HQRP Quarterly Q+A Document, and was formerly posted on the Hospice Item Set (HIS) web page. 

This document reflects frequently asked questions that were received by the Hospice Quality Help Desk during the third quarter of 2017, as well as general HQRP updates and events from the third quarter, and upcoming events in the fourth quarter. 


NEW MEDICARE CARD: HELP NOTIFY YOUR PATIENTS

The Centers for Medicare and Medicaid Services is starting to conduct a major education campaign about the new card for people with Medicare. Help alert your patients by displaying a poster in your office and giving your patients tear-off sheets or fliers.

Register then order these free color products:

  • Poster, 11”x17” (product #12009-P); limit: 10
  • Pad of 50 tear-off sheets, 4”x 5.25” (product #12006); limit: 25
  • English flyer, 8.5”x11” (product #12002); limit: 100
  • Spanish flyer, 8.5”x11” (product #12002-S); limit: 50

You can also print these products on 8.5”x11” paper. The poster and tear-off sheets will be available in Spanish later this year.

Hospice Notes

* NHPCO has released a new video highlighting the benefits of palliative care. The video features Michael Sampair and his wife, Liz, and relates their experiences with treatment while he was a patient at The Elizabeth Hospice in San Diego. It also features thoughts and explanations of palliative medicine from George Delgado, MD, FAAFP, HMDC. (NHPCO)

* In San Diego, a 3-year-old black Labrador named Stevie is bringing joy to patients. In a local TV news segment, her “TLC” interactions were captured. For Carrie Greenstein, who recently lost her mother-in-law, she says Stevie "brought me a smile to my face and she brought a sense of ‘everything is gonna be OK.'” (CBS8)

* “Improving Individual and Family Outcomes through Continuity and Coordination of Care in Hospice” is a funding opportunity issued by the National Institutes of Health. NIH issued this call under the PA-18-148, R01 Research Project Grant. The effort seeks to support research that focuses on reducing negative outcomes that might be related to “unwanted transitions at the end of life and optimizing the individual and family outcomes related to high-quality coordination of care of individuals who are enrolled in hospice.” This can be in any hospice setting, including the home, inpatient facility, assisted living or hospital. Details are online and proposals will be accepted beginning in January 2018. (NIH)

* Thanksgiving and Christmas are good times to discuss end-of-life wishes, says Paul Malley, president of Aging with Dignity. “We see a bit of a Thanksgiving rush and a bit of a Christmas rush in December,” he says, pointing out that as people come together for the holidays they increasingly take action on securing documents. “It's a natural time to discuss, 'Which one of us boys do you want to be your health care agent?'” Malley says. (News Medical)

 

End-of-Life Notes

* “Greater wisdom” is necessary when it comes to end-of-life care, says Pope Francis. In a statement to medical professionals, he urged caregivers not to “step back from the patient” as they face mortality. He called for avoiding the temptation to euthanize while, at the same time, still always pursuing treatments that are best for the individual. He cautioned that with advances in medicine, we see “treatments that have powerful effects on the body, yet at times do not serve the integral good of the person.” (EWTN)

* A new study published in Aging & Mental Health reviews articles that address end-of-life care for patients with neurodegenerative diseases. The study describes four areas or themes among patients. First, they value autonomy and control. Second, they want the health knowledge needed to make informed choices. Third, they’re concerned with contextual factors including familial or social input, disease progression, and feelings of hope. Fourth, patients are concerned about the quality and accessibility of care. As one patient put it, “I get pats on the cheek or, worst of all, on the head, like a child. So I hate it. That patronizes compassion.” (ALS News Today)

* Much literature on terminally ill youth focuses on the attitudes of children. But a new study looks at 62 nurses, physicians, physical therapists, social workers and psychologists, focusing on their perspectives on the distinct needs of adolescent patients. Their experiences constitute a slice of the support teams’ perspective. “The first theme was that the reality of the loss was unthinkable to the teens. Another theme was that the loss generates negative emotions, including aggression, loneliness, uncertainty and depression.” Further, the study discusses “loss as a catalyst for change”—forcing a maturation process—and the theme of “authentic relationships” between bereaved children and adult support staff. (Medscape)

*An article in US News and World Report explores the utilization of Medicare-reimbursed discussions on patient preferences in end-of-life care. Just over 1 percent of Medicare beneficiaries engaged in the advance care planning talks with their physicians in 2016. Donald Taylor of Duke University examines the barriers and explains that increases in utilization are slow. Barriers include billing systems issues and physician discomfort with the process. Judi Lund Person, National Hospice and Palliative Care Organization, notes that utilizations, while low, are still impressive, with over a half-million people having these conversations during the first year of Medicare reimbursement for the talks. (US News and World Report)

 

Palliative Care & Advance Care Planning Notes

 

* Turn-Key Health is “a national company that serves payers by providing specialized palliative care to patients who are struggling with advanced illness and living at home. Turn-Key Health’s Palliative Illness Management (PIM) program found 97 percent were “satisfied” or “very satisfied” with their symptom management and saw a one-third reduction in health care expenditures. Turn-Key Health’s proprietary analytic model identified members at risk for over-medicalized care or inappropriate death. The individuals in the PIM program spent 37 percent fewer days in intensive care units than the control group. Health Affairs highlights the potential of the program by presenting the case of Dwight. Dwight’s first visit was from a PIM nurse from a hospice. His story “represents a promising approach for those nearing the end of life: a patient-centered palliative model that aligns care with personal wishes, reduces economic burdens, improves outcomes, and enhances quality of life for patients and their family caregivers.” (Health Affairs)

* In the Journal of Palliative Medicine, Miguel Julião, MD, MSc, PhD, presents data on dignity therapy (DT). DT is “a novel, brief, individualized intervention, which gives terminally ill patients the opportunity to convey memories and important disclosures and to prepare a legacy document that can be given to patients for them to share or bequeath to individuals of their choice.” Julião begins with a review of a previous study showing that many family members find that DT: enhanced patient dignity (78 percent); heightened meaning of life for the patient (72 percent); and provided comfort in a time of grief (78 percent). Further, family members would recommend DT for other patients and families (95 percent). In the new study of 45 terminally ill patients, the same results weren’t found, but showed “no significant differences.” These findings were attributed to the small sample size and that “loved ones already had a moderate-to-high level of psychological well-being and it would be challenging for an intervention to show a further increase or effect.” (Journal of Palliative Medicine)

* A new study published in Health Psychology finds that patients with depression and advanced cancer live longer after receiving palliative care intervention. The findings come from the study of two randomized controlled trials in which cancer patients received the ENABLE (Educate, Nurture, Advise, Before Life Ends) intervention. “Although the effect of the palliative care intervention on survival is clear, the mechanism behind it is not,” says co-lead author Dr. Jay G. Hull. “One possibility is that those who are depressed are less attentive to their health, illustrating how traditional care may be insufficient to help patients overcome this deficit. Yet, a tailored intervention may succeed by motivating health-promoting behaviors, which may enable patients to live longer.” (PsychCentral)

 

* Residents at the University of Colorado Medical School are expected to have advance care planning (ACP) conversations with patients. But, they often feel inadequately prepared, according to the authors of a study in the Journal of Palliative Medicine. The authors report on an intervention used at the school. Groups of three to 11 patients come together to discuss ACP in two two-hour sessions. Four themes emerged regarding resident perspectives. They heard diverse patient perspectives. They modeled clinical interaction. The ACP process was clarified. And they learned how to better maximize the use of clinician time. “Resident participation in ACP group visits is a promising method of educating and modeling person-centered ACP,” the authors conclude. “Additional efforts are warranted to expand effective ways to educate residents about ACP conversations, including participation in ACP group visits. Residents involved in innovative efforts to improve ACP may be well-positioned to lead future ACP initiatives.” (Journal of Palliative Medicine)

* Even if you have a will, you’ll need 11 additional end-of-life documents, says CNBC. Most people don’t have key documents in place, says Kelli B. Grant, who cites a 2014 American Journal of Penetrative Medicine study showing that 74 percent of adults have no health care proxy, living will or advance directive. Grant outlines a range of documents including living wills, POLST, durable power of attorney, and DNR/DNI orders. She highlights the fact that while documents like DNR and POLST may overlap, “redundancy can help ensure your wishes are followed." (CNBC)

* Patients who are seen for palliative care consultations rarely complete advance directive forms. This is the conclusion of a study from Kara Bischoff, MD, Director of Quality Improvement for the Palliative Care Service at the UCSF Department of Medicine. She examined the characteristics of nearly 75,000 hospitalized patients who are referred to inpatient palliative care consult services, the activities that occurred during those consults, and the resulting outcomes. Though care planning was the most common reason for a consultation (72 percent), “legal forms such as advance directives and Physician Orders for Life-Sustaining Treatments (POLST) forms were completed for just 3.2 percent and 12.3 percent of the patients seen by palliative care teams, respectively,” Bischoff reports. “This highlights an important quality gap in need of improvement.” (Medical Research)

* A majority of nursing home residents are eligible for palliative care, but don’t get that support. This is the finding of a UC San Francisco study published with JAMA Internal Medicine. “To our knowledge, this is the first prospective evaluation of nursing home residents’ palliative care needs,” writes lead author Caroline Stephens, who surveyed 228 residents in three California nursing homes. The study finds large gaps between the amount of care that could be provided and what is actually being utilized. During a smaller study of nursing home residents who were eligible for palliative care, it was found that 53 percent rated their overall quality of life as fair to very poor. (The Mercury News)

* Kaiser Health News shared a video of a discussion on advance care planning moderated by senior correspondent JoNel Aleccia. “The discussion covered how to navigate the medical, legal and ethical landscape of end-of-life care.” Topics included: what advance directives are and who should have one; how people make sure their wishes for end-of-life medical care are honored; and the special needs of dementia patients. (Kaiser Health News)

* The number of individuals with dementia is expected to increase worldwide in the coming decades, with an estimated rise from 47 million cases in 2015 to 132 million in 2050. The authors of a new article in JAMA write, “Although progress has been made developing video aids and conversation kits to facilitate discussions about advance care planning in dementia, many patients do not have access to a simple written document to express their wishes for care if they should develop dementia.” Because of this, others - not the patient - make many important decisions. A JAMA article encourages patients and caregivers to talk about the care they would like if they had mild, moderate or severe dementia. (JAMA)


Other Notes

 

* Trump announced on Twitter that Alex M. Azar II is his nominee for the secretary of human health and services. Azar is a former executive of Eli Lilly, one of the country’s largest drug companies. According to the New York Times, allies of the administration predict that Azar will utilize his background as “his deep knowledge of the federal bureaucracy to advance Mr. Trump’s agenda of undermining President Barack Obama’s health care law,” which Azar has called a “fundamentally broken system.” Detractors like Senator Patty Murray (D-WA) wonder how, “given Mr. Azar’s professional background, he believes he can fairly execute any significant effort to lower drug prices for patients.” Representative Peter Welch, Democrat of Vermont, illustrates the point, saying that “instead of draining the swamp, [Trump] has sent the fox to guard the henhouse.” (The New York Times)

* Bill Gates donated $50 million to the Dementia Discovery Fund to address Alzheimer’s disease. The donation is personal rather than through his charitable foundation. Gates says men in his own family have suffered from the disease, and that he hopes Alzheimer’s could become a chronic condition that is treatable with medication. The first treatments for the disease may not be feasible for a decade or more and are expected to initially be expensive. In the future, the Gates Foundation may consider expanding access to poorer countries as treatments are developed. (CNBC)

* Signature HEALTHcare identifies spiritual care as an integral part of its care. Dave Baumgarnter is vice president of spirituality for the organization, its’ 120 long-term care centers, and 80 chaplains. The organization is sensitive to persons of backgrounds and beliefs. The chaplains who serve with Signature HEALTHcare serve residents, family members and staff. Staff are allowed time to share with other staff, and to address spiritual and emotional needs. Issues such as “denial, anger and grief” are often addressed when residents die. The mission is interfaith, and this can mean seeking out those to help host services of varying religions with the vision of “treating … residents with humility, joy, acceptance, perseverance and love.” An article in Provider shares more about the programs and services that the organization offers. (Provider)

* Slate invited reader stories about postmortem social media moments ahead of its Dec. 6 Future Tense happy hour in Washington. The gathering will focus on planning your “digital afterlife.” Slate asked for ways that technology has complicated the legacy or interpretation of the death, like notable tweets on celebrities’ accounts after their death. “These days, when a loved one dies, her social media accounts and Web presence can just keep on living,” they write. “Whether it’s funny or sad, totally insane or sharply bittersweet, if it involves death and a digital format, we want you to share it with us!” (Slate)

* When is it appropriate to withhold dialysis in patients with chronic kidney disease? A new qualitative study reviewed surveys of nephrologists from the U.S. and England, finding several key themes in their answers. Respondents from both groups noted a lack of guidelines and accurate prognostic tools, cited default expectations of initiating dialysis, and note an inadequate emphasis on end-of-life issues during training. Further, nephrologists in the U.S. pointed to financial incentives to dialyze patients and disincentives to have extended discussions with patients regarding treatment options. (Journal Watch)

* HHS warns that Medicare must increase its revenue or drastically reduce benefits in order to remain viable in the long-term. In a recent wide-ranging report, HHS stated that the Medicare trust fund “is not projected to be sustainable over the long term with the projected tax rates and expenditure levels.” The shortfall is expected to be around $3.3 trillion over the next 75 years. “Absent an unprecedented change in health care delivery systems and payment mechanisms, the prices paid by Medicare for most health services will fall increasingly short of the costs of providing these services,” says Ernst & Young, the firm conducting the independent audit of HHS’ finances. (Modern Healthcare)

* A study published by JAMA Oncology identifies attributes that distinguish high-value oncology care. Douglas W. Blayney, MD, of the Stanford Cancer Institute, and his colleagues identified 13 attributes within five themes. “The theme were: treatment planning and goal setting, services supporting the patient journey, technical support and physical layout, organization and function of the care team, and external context. High-value practice sites were most sharply distinguished by five attributes: conservative use of imaging, early discussion of limitations and consequences of treatment, single point of contact, maximal use of registered nurses for interventions, and a multi-component health care system. Three attributes – early and normalized palliative care, ambulatory rapid response, and early discussion of limitations and consequences of treatment – were judged to have the highest immediate potential for reducing spending without compromising care quality.” (Physician's Briefing, JAMA)

 

OFFERING QUALITY LGBTQ END-OF-LIFE CARE

“Getting to know a patient enough to be able to be ‘holistic’ can be difficult,” writes Vivian Lam for Pallimed. “And in the case of LGBTQ individuals, getting to know the patient as a whole is not only all the more important—it’s integral.” Read More

 

NAVIGATING AGING IN AMERICA’S HEALTH CARE SYSTEM 

When patients are hospitalized, it’s common that a physician they’ve never met treats them. These encounters rarely allow for an understanding of daily concerns like dizziness, sleep troubles, or more minor symptoms.Read More

 

CONGRESSIONAL MEMBERS SERVE AS CAREGIVERS TOO

Caring for a member of your family in old age is a stressful endeavor, even for members of Congress. In a recent article in Forbes, Rita Rubin examines the engagement and conversations on Capitol Hill about the support provided to caregivers around the country, and the proposals put forward to elevate their burdens. Read More

 

ARTICLE EXPLORES BARRIERS TO EARLIER HOSPICE ADMISSIONS

An article in Home Health Care News, written by Amy Baxter, explores the issue of short stays in hospice due to late admissions. Baxter reports that nearly half of all hospice patients are enrolled in hospice during the last two weeks of their lives. Yet the Medicare Hospice Benefit was designed for much longer utilization. Read More

 

HOSPICE SOCIAL WORKERS BRING RELIEF AND ESSENTIAL CARE

J. Scott Janssen, MSW, LCSW, discusses hospice in the nursing home setting in his article “Hospice Social Work in Nursing Homes,” published in Social Work Today. When most people think of hospice care, notes the article, they imagine it taking place at home or in a freestanding hospice facility. So it’s sometimes a surprise, says Janssen, to find that the Medicare Hospice Benefit allows for hospice care in assisted living facilities and skilled nursing facilities, which are so often sites of rehabilitation and the stabilization of individuals. Read More

 

COMPASSION FATIGUE IMPACTS NURSE AND PATIENT HEALTH

The emotional stress and continuous demands that come with providing quality care are leading to “compassion fatigue,” says Jennifer Flynn, CPHRM, and Mary M. Gullatte, PhD, RN. This is not only applicable to nurses, but to any caregivers, and can lead to errors in care or even lead to skilled nurses leaving the profession. The co-authors outline the effects of this continual emotional exercise in “When Compassionate Care Takes a Turn Toward Fatigue,” an article appearing in Medpage Today. Read More


Thanks to Don Pendley for contributions. 

Hospice Analytics is the national sponsor of Hospice News Network for 2017. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209- 1237 or see www.HospiceAnalytics.com.

Hospice News Network is published 45-47 times a year.  Copyright, 2017.  All rights reserved to HNN subscribers, who may distribute HNN, in whole or part, to provider members of the subscribers’ state organizations.  If readers need further information, they should consult the original source or call their state association office.  HNN exists to provide summaries of local, state and national news coverage of issues that are of interest to hospice leaders.  HNN disclaims all liability for validity of the information.  The information in HNN is compiled from numerous sources and people who access information from HNN should also research original sources.  The information in HNN is not exhaustive and HNN makes no warranty as to the reliability, accuracy, timeliness, usefulness or completeness of the information.  HNN does not and cannot research the communications and materials shared and is not responsible for the content.  If any reader feels that the original source is not accurate, HNN welcomes letters to the editor that may be shared with HNN readers. The views and opinions expressed by HNN articles and notes are not intended to and do not necessarily reflect views and opinions of HNN, the editor, or contributors.  Only subscribing state hospice organizations have rights to distribute HNN and all subscribers understand and agree to the terms stated here.