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Hospice News Nebraska, May 4, 2017
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Nebraska News


Linda Rock received the National Hospice and Palliative Care Organization Galen Miller Leadership Award on May 1 at the 2017 Management and Leadership Conference in Washington, D.C. Congratulations, Linda!


(Click to enlarge)


Jennifer Eurek with NHPCA, Brooke Borer with AseraCare Hospice, and Tim Snyder with Hillcrest Hospice Care visited all five Congressional offices in Washington, D.C., on May 3, 2017, to discuss hospice care in Nebraska and to ask for support on current hospice legislation.

Left to right: Jennifer Eurek, Senator Deb Fischer, Brooke Borer, and
Tim Snyder.


On April 27, 2017, the Federal Register posted the FY 2018 Hospice Wage Index Proposed Rule for public inspection.

It was expected to officially publish in the Federal Register on May 3, 2017. NHPCA staff will analyze the proposed rule and issue a Special Bulletin in the coming days.

There are seven issues of note in this year’s proposed rule:

  1. The market basket increase for fiscal year 2018 is one percent. This includes a one-year adjustment to the market basket increase amount for hospices as part of the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
  2. The hospice cap amount for the 2018 cap year is $28,689.04.
  3. No new quality measures are proposed. However, two priority areas are being considered for development:
           a. potentially avoidable hospice care transitions, and
           b. access to levels of hospice care.
  4. The new data collection and patient assessment tool is named Hospice Evaluation & Assessment Reporting Tool (HEART). The new data collection instrument is under development but is not released in proposed form in this rule. Watch for this in future rulemaking.
  5. Only the seven NQF-endorsed HIS measures currently in use will be included in the 2017 launch of Hospice Compare, sometime in summer 2017.
  6. The eight final measures derived from the Hospice CAHPS survey are listed in the proposed rule, but will not be included in Hospice Compare in 2017. The Hospice CAHPS measures will be included in Hospice Compare in 2018.
  7. There will be a one to five-star rating system, but no timeframe is proposed at this time.


It's time for the 2017 MAC Satisfaction Indicator (MSI) Survey and the Centers for Medicare and Medicaid Services needs to hear from you! The MSI is a tool used by CMS to measure provider satisfaction with the Medicare Administrative Contractor (MAC) from which they receive services.

Please help by completing the MSI Survey and sharing the link with your colleagues. Read More


The Office of Management and Budget (OMB) periodically reviews the ABN (Form CMS-R-131) and in March 2017 approved it for renewal. There are no changes to the form itself, but the expiration date has been changed to 03/2020. To deliver a valid ABN, a provider must use the most recent version of the CMS-R-131. Providers are encouraged to incorporate the new form into their practice as soon as possible. More information on the CMS-R-131 is located on the CMS website.


Hospice and End-of-Life Notes

* A new initiative in Nebraska aims to encourage end-of-life planning. “Over the next three months, doctors from six Nebraska health care groups will pilot a new, standard emergency medical planning form at three Omaha-area doctors’ offices. The Nebraska Emergency Treatment Order ... provides a standard set of directions that can be used by emergency responders, hospitals, rehabilitation facilities, and nursing homes.” (Live Well Nebraska)

* The Spiritual Care Association asks consumers and health professionals to tell Congress that “spiritual care matters.” The Spiritual Care Association and its affiliate, HealthCare Chaplaincy Network, are spearheading a petition that calls on Congress “to recognize spiritual care as a key aspect of whole-person health care, and to support and facilitate expanded access to optimal spiritual care and resources across health care settings.” (eHospice)

* Are there times when advance directives should be ignored? Dr. Kathryn B. Kirkland argues that sometimes physicians must make decisions that go against the stated wishes of the patient, based on an awareness of likely outcomes. “As a physician, I know that advance directives are most helpful in situations where it is clear that death is inevitable. They are intended to protect people from receiving ‘life-sustaining treatments’ such as ventilators and CPR, in situations where those treatments only prolong the dying process. But many decisions about life-sustaining treatments must be made in situations ... where there is uncertainty about outcomes.” Based on conversations with loved ones who know what the patient would really want in a given circumstance, doctors can provide care that is not explicitly called for by advance care documents. (Forbes)

* The Centers for Medicare and Medicaid Services has compiled a study on how much time hospices are spending with patients. Hospices are looking at how this data can help them improve care. Missouri’s News-Press Now looked at some of the data on a small number of hospices. Researchers “found that the overall time spent with each hospice patient by those organizations was an average of .635 hours, or about 40 minutes, per day. In the last seven days of life, that number decreased to .587 hours per day.” (News-Press Now)

* Ellen Goodman is encouraging families and loved ones to have end-of-life conversations. The Pulitzer Prize-winning columnist said that in a culture that places a high value on youth and vitality, death and dying are often topics most Americans avoid. Yet a routine dinner table conversation about end-of-life wishes can be the ultimate show of respect. “It feels superstitious letting death in the room,” said Goodman, a founder and director of The Conversation Project, a nonprofit organization dedicated to helping people talk about their wishes for end-of-life care. “We are all mortal and immeasurably slow in acknowledging how many people we love are not dying in ways they choose.” (WFMZ)

* Finding real hope at the end of life involves moving away from the “focused hope” of physical recovery and embracing the “intrinsic” hope of a meaningful life. “Intrinsic hope is stronger and more durable than focused hope. It is more inwardly focused and addresses personal issues, such as caring about those who will be left behind. The lead investigator of a U.S. national clinical trial for acute leukemia in adults describes this state as ‘the peace, the comfort, the joy, and the sense of completion when a person chooses to live unencumbered by the demands of modern medical therapy.’” (BMJ, C-TAC)

Palliative Care Notes

* A new study seeks to understand trends in hospital-based palliative care. Researchers contacted all palliative care providers in Colorado, first in 2008 and again in 2013. The team compared the self-reported numbers of palliative care consults to occurrences of the V66.7 “encounter with palliative care” code in the claims for those years. Researchers found marked growth in the self-reported number of palliative care consults between 2008-2013. The data appear to show use of the V-code is improving, though more study is needed. (American Journal of Hospice and Palliative Medicine)

* The Permanente Journal has released a review article on Guidelines for a Palliative Care Initiative in the ICU. The report finds that the Guidelines are “an important tool to direct the development of a new palliative care ICU initiative.” (Permanente Journal)

Other Notes


Hospices all across the country have been actively engaged in encouraging people to complete advance directives. California’s Hospice by the Bay’s most recent public education campaign has garnered unprecedented attention for helping families support loved ones in discovering and honoring their end-of-life wishes. “The advertising campaign was designed to address the resistance that many people have to talk about the subject and to encourage them to complete an Advance Care Directive.” Read More


It’s well-established that competent adults have the right to refuse unwanted medical treatments, even ones that would save their lives. Despite this fact, many health teams may have a tendency to resist patient requests that could result in earlier death. But, there are also times when patients and families demand futile, even detrimental medical procedures out of a hope for longer life. What role can religious beliefs play in this scenario? In an ethics review for the Journal of Hospice and Palliative Nursing, Liz Blackler, LCSW-R, MBE, explores “religious coping,” which she defines as strongly held religious beliefs that provide hope in miraculous cures, and examines the impact this kind of hope can have on patient treatment and quality of life at the end of life. Read More

Thanks to Jeannette Kojane and Cordt Kassner 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

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