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Hospice News Nebraska, Jan. 11, 2018
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March 20-21 (Tues-Wed) - 2018 NHPCA "Living a Good Life... at the End of Life" Annual Conference


Nebraska News


On Jan. 8, Scott Benson joined the Nebraska Health Care Association team as Finance Director. He comes to NHCA with 21 years of nonprofit experience, most recently serving as Director of Finance and Information Technology at Nebraska Safety Council, Inc. Scott received a bachelor’s degree in Business Administration, with an accounting emphasis, from the University of Nebraska-Lincoln. Please help us welcome Scott!



Earlier this week, NHPCA emailed members to announce that beginning today, Jan. 11, the Nebraska Health Care Association will hold weekly “Capitol Insights” webinars to keep members up-to-date on Nebraska’s legislative session. The webinars will be held at 9:15 a.m. CST on every Thursday during the legislative session and will last approximately 15 minutes. Simply register once and you will be signed up for all of the webinars during the legislative session. After registering, you will receive a confirmation email with information about joining the webinars. You will also receive an automatic email notification prior to each webinar.

Capitol Insights Webinar
Every Thursday of 2018 Nebraska legislative session
9:15 a.m. CST



NHPCA 2018-1 - Survey and Certification on Texting Patient Information
On Dec. 28, 2017, the Centers for Medicare and Medicaid Services issued S&C 18-10-ALL: Texting of Patient Information among Healthcare Providers.


The Nebraska Hospice and Palliative Care Association is accepting applications for scholarships to attend the 2018 NHPCA "Living a Good the End of Life" Annual Conference, March 20-21, 2018.

NHPCA will award seven, one-day scholarships for qualified individuals in the following disciplines:

  • Nursing (two scholarships)
  • Chaplain (one scholarship)
  • Social Work (one scholarship)
  • Volunteer Coordinator (one scholarship)
  • Bereavement Coordinator (one scholarship)
  • Hospice Aide (one scholarship)

Scholarship recipients will be recognized at an awards banquet on Tuesday, March 20. Note: An email promoting the scholarships was sent to members on Jan. 5, 2018, announcing an incorrect date for the awards banquet. We apologize for any confusion.

Applications are due Feb. 16, 2018. Click here to apply.



As listed on the PEPPER Report website, hospices will be able to download their PEPPER report “on or about April 16, 2018.”



The December 2017 quarterly Hospice Compare refresh based off of patient stays discharged for Q1 2016 through Q4 2016 is now available. Visit Hospice Compare to view the data.



The Centers for Medicare and Medicaid Services Kansas City Regional Office invites you to attend the New Medicare Card Webinars. Recent legislation requires CMS to remove Social Security Numbers from all Medicare cards to address the current risk of beneficiary medical identity theft, and to replace the cards with a unique number for each Medicare beneficiary. These webinars will address the new card design, the time frame of the mailings and scenarios, what Medicare beneficiaries should do to ensure they receive their new card, and partner resources to help with education.

The goal of these free webinars is to educate those who serve people with Medicare and their caregivers so they can be a valuable resource on this initiative.

There are multiple webinars so you can choose one that best works with your schedule. All webinars will provide the same information. CMS will host separate webinars and informational sessions for people with Medicare and their caregivers.


Jan. 30, 2018, 11 a.m.–noon

Feb. 8, 2018, noon–1 p.m.

Feb. 16, 2018, 10 a.m.–11 a.m.

Feb. 21, 2018, 1 p.m.–2 p.m.

You will receive a confirmation email from Eventbrite after completing your registration that will include the login information for the webinar.

We look forward to your participation. If you have any questions or have difficulty registering, please contact Lorelei Schieferdecker at



The demographic data displayed on the Provider Preview Reports and on Hospice Compare is generated from information stored in the Automated Survey Processing Environment (ASPEN) system.

If inaccurate demographic data is included on the Preview Report or on Hospice Compare, hospices need to contact their Medicare Administrative Contractor (MAC) for assistance. When requesting updates to your demographic data, it is important to specify that you want your data within the ASPEN system updated, instead of referring to your data on the Hospice Compare site.

View the How to Update Demographic Data PDF for further information.

Please note: Updates to Hospice Provider demographic information do not happen in real time and can take up to six months to appear on Hospice Compare.

Hospice Compare Tip Sheets

The Centers for Medicare and Medicaid Services is working to make users' experiences finding and comparing hospices more accurate in the following ways:

  • Improving the data used to power the search over the next several months.
  • Working with hospice agencies to ensure that the data they're reporting to CMS is accurate and current.

View the tip sheets for users and providers when searching on Hospice Compare.

View the Hospice Quality Public Reporting: Background and Announcements web page for more information.



On April 1, 2018, the Centers for Medicare and Medicaid Services will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to everyone with Medicare. The MBI will replace the Social Security Number-based Health Insurance Claim Number for transactions like billing, eligibility status, and claim status after a transition period.

You must be ready to accept the MBI beginning April 1. People new to Medicare after April 1 will only get a card with the MBI.

Get ready to use the new MBI Format. Ask your billing and office staff if your system(s) will be ready to accept the 11-digit alpha numeric MBI. If you use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready. Consider automatically accepting the new MBI from the remittance advice (835) transaction. Prepare to process Railroad Retirement Board (RRB) claims: Ensure your staff can identify the RRB Medicare card; program your system to send these patients’ claims to the Specialty Medicare Administrative Contractor (the MBI itself will not indicate it is an RRB beneficiary). Make and internally test changes to your practice management systems and business processes before April 2018. Sign up for your Medicare Administrative Contractor’s portal now, so you can use the provider MBI look-up tool starting in June 2018. Subscribe to the weekly MLN Connects newsletter for updates and new information. Attend our quarterly calls to learn more. We will let you know when calls are scheduled in MLN Connects.

For more information:

Fact Sheet
Overview web page
Provider web page


Through the Nebraska Worker Training Program, businesses can apply for grants to support “the retraining and upgrading of existing workers.” View the program’s goals, 2018 application schedule, and guidelines.



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.


Hospice Notes


* “Many with deadly brain cancer don’t opt for hospice care,” according to a study reported by HealthDay News. Though the benefits of hospice are reduced with a late referral, the study’s author, Dr. Justin Jordan, writes that 37 percent of malignant glioma patients don’t receive any hospice care at all. The data from 12,000 patients in the U.S. were examined and additionally showed “patients who were younger, male and lived in rural areas were more likely to have short hospice stays. Race, education and income were not associated with length of stay.” (US NEWS)

* Despite guidelines calling for relaxed glycemic control in hospice, a study published in JAMA shows 12 percent of hospice patients in nursing homes who live with Type 2 diabetes experienced hypoglycemia within 180 days of admission to hospice. Medpage points out that 2016 guidelines from the American Diabetes Association say, “People with diabetes receiving end-of-life care should relax glycemic control targets and eventually discontinue diabetes medication in order to avoid hypoglycemia,” a preventable cause of suffering in hospice patients. (Medpage Today)

* The National Coalition of Hospice and Palliative Care published its second Coalition Blog post. The post reviews the coalition structure as well as its key accomplishments including advocacy, quality and standards, communication and outreach, and payment. (NCHPC)

* A GeriPal podcast talks about prognostication with Christian Sinclair, palliative care physician at the University of Kansas Medical Center. Topics include the importance prognostication plays in daily practice, how it changes the way we think about prescribing opioids, and what it means for hospice eligibility. (GeriPal)

* A policy alert from the Hospice Action Network says, “Congress is currently in the process of negotiating a package of Medicare-related legislation that would cut payments to hospitals when a hospice transfer is made sooner than a Medicare-established average length of stay.” The National Hospice and Palliative Care Organization is concerned that the change could lead to later hospice referrals and shorter patient lengths of stay. NHPCO encourages members to contact their Congressional members and “share their concern about the proposed hospital DRG change, and to encourage them to protect hospice and include the Rural Access to Hospice Act in the Medicare extenders package.” (Hospice Action Network)

* One in nine people experience low blood sugar at least once while receiving hospice care, according to a study reported in Medical Research. For those on insulin, the number was one in three. The study’s author, Dr. Laura A. Petrillo, MD, says the study “indicates that clinicians in nursing homes may not fully transition from standard care to comfort-focused care when adults with Type 2 diabetes are enrolled in hospice.” (Medical Research)

* A survey examines the impact of guided imagery meditation on perceived staff stress while caring for actively dying patients. The program was initiated in the summer of 2016 at the Smilow Cancer Hospital at Yale New Heaven Health. “Interestingly, none of the four participating patient care associates identified caring for actively dying patients as a stressful event; therefore, there was no change in evaluation of stress after guided imagery.” Looking forward, the study authors say, “The project provided a great foundation for further examination into the areas of self-care for nurses.” (Oncology Nursing News)


Advance Care Planning Notes


* A “false alarm” in the health care of one patient, which nearly ended in his death, highlights the need for discussing end-of-life wishes in detail. Hospice chaplain Dale Swan had clearly outlined his wishes not to be put on breathing assistance if he couldn’t make his own decisions or feed himself. He became violently ill one evening and was rushed to the hospital, where he was put on Dilaudid that caused a suspected overdose. The treatment included a possible breathing tube, and Swan’s wife insisted that he wouldn’t want the treatment. “Jill felt prepared. She and Dale had discussed many of the crucial questions involving the end of life and placed those answers into an advance directive.” Yet the medical staff knew the directive didn’t apply to a situation where full recovery was logically anticipated. After dialogue with Swan’s wife, he received the treatment that brought him back to health. The incident has increased awareness of the need to detail wishes within various circumstances. (Star Gazette)

* Pastor and pediatrician Rev. Gloria White-Hammond, Boston, takes on the subject of death with her congregants. She’s determined to get all 600 members to write down their end-of-life medical wishes and discuss them with their doctors and families. She and her co-pastor, Dr. Ray Hammond, were asked by The Conversation Project to lead death-and-dying workshops, which made her realize she didn’t have her own documents prepared. “It was kind of embarrassing,” she said. One discussion led by White-Hammond was centered on a screening of Extremis, a documentary about a woman who must decide how to respond to her incapacitated mother. She ended the discussion by praying to God to “put the fire under us” so the task doesn’t languish “on the to-do list.” (KHN)

* C-TAC invites participants to join a free web meeting on Jan. 16, 1-2 p.m. CST. The session will provide an exclusive brief on the findings of The Kaiser Family Foundation “Serious Illness in Late Life: The Public’s Views and Experiences.” The report gathers information from 1,000 surveyed people and families dealing with serious illness. Key findings include: 1) There is a disconnect between what the public acknowledges as realities of serious illness and what they actively plan for. 2) Older adults living with serious illness commonly report needing more help than they receive. (C-TAC)


End-of-Life Notes 


 * “End-of-Life Care Planning for Lesbian, Gay, Bisexual, and Transgender Individuals” was published in the December issue of JHPN. The article discusses a study that finds that LGBT individuals face many issues beyond medical concerns at the end of life. This includes worries about the health care system’s ability to respect their sexual orientation or gender minorities, and a need for personal advocacy without burdening friends or distant relatives. The article concludes by saying, “Providers may be able to facilitate open, comprehensive discussions of ACP by signaling a welcoming environment for LGBT patients, and by identifying issues related to dignity and quality of life, beyond medical interventions, that may constitute a good end-of-life experience.” At the systems level, the authors advocate for clear nondiscrimination policies, training, and inclusive data collection and marketing. (JHPN, Vol.19 No. 6)

* The U.S. House of Representatives has voted to support the Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act. The Senate passed a similar version of this bill in September. C-TAC writes that the act “directs the U.S. Department of Health and Human Services to develop, maintain and keep updated a National Family Caregiving Strategy that will provide resources and educational opportunities to family caregivers across the nation.” C-TAC predicts a swift passage when it returns to the Senate. (C-TAC; Congress)

* Why is end-of-life care planning necessary? Medical Economics contributor Larry Beresford approaches this question by looking at the progression toward a health care payment system based on value and outcome. He touches on Medicare’s advance care planning benefit and a push toward annual wellness visits that incentivize planning sessions. Beyond the payments and process, Beresford says that the “patient needs a say.” As Joseph Rotella, MD, says, “The people we care for want to have a say in their care.” He adds, “I don’t believe doctors want to give futile, harmful care to their patients, but the default position in our medical culture is to do everything.” (Medical Economics)

* Dr. Gil C. Grimes talks about how doctors deal with loss in a personal essay posted on KevinMD. Reflection is something that’s often hard to find room to pause for, he writes. “The patient in 124 dies, and [the nurses] stand for a moment with the family holding shoulders and witnessing tears until the bed alarm in 119 sounds and they depart to care for the next need. Moving from need to need in an ocean that is endless, never taking a moment to feel what has been lost or to notice what has gone missing.” Yet contemplation brings him closer to important questions: “Am I doing the things I need to do so that I can love what I am doing? Am I honoring the human that I am so that I can bring all of myself into this work and life?” (KevinMD)

* “The Long Goodbye” tells the story of Nancy Lundebjerg’s mother, who experienced a long decline in health. The article pivots to focuses on ways people can cope with sadness and grief before a loved one dies. To do this, the article says, you must acknowledge your feelings, talk openly, communicate sensitively, “lean in” and seek support. (KHN)

* “Don’t forget, you’re going to die.” This is the blunt reminder from WeCroak, an app built to remind you of your imminent death. Atlantic writer Bianca Bosker writes about the strangely calming sensation of these frequent but random notifications, backing her reasoning with studies about American phone usage (76 uses for 2.5 hours a day average) and the app’s role in a saturated market of mindfulness apps. “I’ve come to embrace WeCroak as the anti-app,” Bosker writes. “Social-media platforms seduce by providing a distraction from the tedium of everyday life—the awkward silences, boring waits in line, and unpleasant thoughts, chief among them the fact that we, and everyone we love, will kick the bucket.” (The Atlantic)


Palliative Care Notes


* Christian Sinclair advocates for “Moving Palliative Care Upstream” in an article with Pallimed. Finding the right time to start palliative care is complicated, but Sinclair says, “Unfortunately, not all the research is helping us define the right time to initiate palliative care, which is a crucial question because we still do not have the workforce to be undisciplined in what populations are served.” Sinclair surveys previous work like the Danish Palliative Care Trial (DanPaCT) to consider the “Goldilocks Principle” of how best to balance a “small but growing palliative care workforce” with the demands of patients. (Pallimed)

* In an interview with Health Evolution, Bill First, MD, talks about the state of palliative care. “People want to die at home with their family—no pain, no suffering—and that’s not how they die today,” First says, describing a chaotic end-of-life experience in hospitals. “All that is a product of a very fragmented health care system built on fee for service.” First goes on to discuss the importance of a team-based approach and key barriers when it comes to scaling. (Health Evolution)

* The National Hospice and Palliative Care Organization's December palliative care resource takes a look at two patients with ALS who find meaning in a skilled clinician’s use of music therapy. In “Finding meaning and hope while ‘my body entombs me’: music therapy for patients with ALS,” Yelena Zatulovsky discusses therapy and working with a patient who talks of enduring disease not as bad luck, but as punishment. (NHPCO)

* Christian Sinclair shares his palliative care resolutions for this year. For others with resolutions to share, Sinclair offers the hashtag #hpmResolutions. Among the tweets he cites, people have commented that they “want end-of-life care conversations to be everyday conversations!” Others hope to expand cultural horizons, mindfulness and gratitude, and to strengthen their ability to listen before offering an opinion. (Pallimed)


Other Notes


 * A Los Angeles Times op-ed addresses “why you should make end-of-life care decisions now.” Kristen McConnell walks through prolonged suffering within hospitals, arguing that “the incapacitated ill are profoundly disenfranchised, and the manipulation of their bodies is extraordinarily invasive and consequential.” She writes, “When I am face to face with a patient like this—someone who will never again be able to communicate, and who has been placed on the treadmill of continuous medical care—I feel the same type of shame as when I walk by a cold, crippled homeless person on the sidewalk. The wrongness is just as obvious.” McConnell urges readers to determine their own fate by developing advance care directives. “It will help move our medical system toward a more humane approach to end-of-life care.” (Los Angeles Times)

* “Allow modern medicine to relieve agonizing end-of-life experiences,” argues Kim Callinan in The Hill. She discusses obstacles to that goal, answering questions like, “Why are some members of Congress and state legislators trying to deny Americans this peaceful end-of-life care option?” She responds: “Personal religious objections. Misinformation. Irrational fear of change. These are the conclusions that I have reached after reading extensively, testifying before state lawmakers and debating opponents on the topic of medical aid in dying. The arguments against this humane medical option often are based on objections raised by some religious leaders, despite polling showing most people of faith support medical aid in dying.” She concludes, “It’s hypocritical to use medication to extend life but then deprive dying patients of that same tool to help shorten a painful dying process. It’s time we allow the miracles of modern medicine to relieve an agonizing end-of-life experience — if that is what the patient would like.” (The Hill)

* In “He, She, They: Some Tips for Treating Transgender Patients,” Jennifer Flynn, CPHRM, discusses a range of questions about approaching gender issues with patients. Flynn also touches on core challenges that transgender patients face, including avoiding medical care for fear of discrimination, and “what it means for a nurse to be culturally competent.” (Medpage Today)

* Traditional referral patterns have disappeared, writes Shelly Reese in “Want More Referrals? Here’s How.” The landscape of hospitals is changing, and that has disrupted tradition means of primary care physicians sending their patients to specialists. Reese outlines strategies and relationship-building techniques that can help professionals adapt and thrive. (Medscape)

* Family members may be less traumatized and make better decisions for their loved ones when they receive emotional support from health care workers. This is the observation of a new study that appears in the Journal of General Internal Medicine. Prior research focused on ICU patients, but a new study, with lead author Dr. Alexia Torke of the Indiana University Center for Aging Research in Indianapolis, reviewed experiences of patients and families in any area of three hospitals. The study revealed higher anxiety, depression, and PTSD rates for family decision makers throughout the hospitals. “Decision makers who felt they received emotional support from hospital workers were 35 percent less likely to have lingering anxiety and 20 percent less likely to have ongoing depression, compared to those who didn’t feel supported.” (Reuters)

* Snake venom may help researches develop analgesic drugs. The variety of means of pain-blocking results that researches have found in poisonous snakebites suggests that “there could be many ways to block pain,” according to R. Manjuantha Kini of the National University of Singapore. “Toxins that cause pain can be just as useful as those that block pain because they can teach us more about how pain works,” adds Bryan Fry of the University of Queensland. (The Scientist)

* In the new book "In Shock," Dr. Rana Awdish discusses how a brush with death led her to a greater focus on patients’ perspectives. During a fellowship at Henry Ford Hospital in Detroit, a cascade of medical problems threatened her life. Her doctor said things like, “She's been trying to die on us.” Awdish says, “I felt he was positing me as an adversary. If my care team didn't believe in me, what possible hope did I have?” She offers advice for doctors in their interactions with patients: “To listen to our patients with a generous ear does require a willingness to relinquish control of the narrative. … Our questions allow for the possibility that we do not already know the answers. By not dominating the flow of information, we allow the actual history to emerge.” (NPR)



The Medicare Payment Advisory Commission met in Washington, D.C., in December, and its proceedings offer a window into the state of Medicare. The committee’s purpose is to review issues facing the Medicare program and make policy recommendations to Congress in the form of two annual reports—one in March and the next in June. Read More



Nearly half of all adults in the U.S. have at least one chronic illness. When placed into an uncertain medical landscape of changing insurance and personal strains from divorce to constricting jobs, the journey to treatment is often complicated and expensive. Read More



Greg Lathrop and Said Osio of Ashville, North Carolina, joined forces for end-of-life activism after experiencing the death of a loved one. Their work is visible in Ashville on a Biltmore Avenue structure known as the “Before I Die” wall, which asks viewers one question: What have you left undone? Read More



The choices in care for patients nearing the end of life continue to expand and change. “Patients have at least two choices,” writes Bob Kronemyer, who says these choices are curative or palliative care. Read More



The story of the two-year-old cat named Oscar who would curl up next to dying patients took off after it appeared in a 2007 edition of The New England Journal of Medicine. Oscar, adopted by the medical staff at the Steere House nursing home in Rhode Island, had an astounding ability to pick out those who would soon die. Read More


Thanks to Don Pendley for contributions. 

Hospice Analytics is the national sponsor of Hospice News Network for 2018. 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

Hospice News Network is published 45-46 times a year. Copyright, 2018. 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.