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Hospice News Nebraska, May 17, 2018
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OPPORTUNITIES TO NETWORK WITH YOUR PEERS

NHPCA is sponsoring several teleconference calls throughout the year for members to discuss common issues, ask questions, and learn from peers. These calls are available for spiritual care, social workers, and volunteer coordinators. Registration is not required.

 

HOSPICE: PROPOSED UPDATES TO THE WAGE INDEX AND PAYMENT RATES FOR FISCAL YEAR 2019

On April 27, the Centers for Medicare and Medicaid Services issued a proposed rule that would update fiscal year 2019 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. This rule also proposes changes to the Hospice Quality Reporting Program.

Proposed Rule Details:

• Advancing My HealthEData: Request for Information from stakeholders
• Burden reduction
• Meaningful Measures
• Routine annual rate setting changes
• Hospice regulations text changes due to the Bipartisan Budget Act of 2018
• Improving transparency for patients

For More Information:
Proposed Rule: CMS will accept comments until June 26
Press Release

See the full text of this excerpted CMS Fact Sheet (issued April 27).

 

HQRP QUARTERLY UPDATE DOCUMENT FOR THE FIRST QUARTER OF 2018 NOW AVAILABLE

The HQRP Quarterly Update for the first quarter (January–March) of 2018 is now available for download. This document features frequently asked questions that were received by the Hospice Quality Help Desk, as well as on the March 27th, 2018 Hospice Quality Reporting Program Webinar. It also highlights general HQRP updates and events from the first quarter and upcoming events in the second quarter of 2018.

To download the HQRP Quarterly Update document for the first quarter of 2018, please refer to the “Downloads” section of the HQRP Requirements and Best Practices webpage.

 

PEPPERS AVAILABLE FOR HOSPICE, SNF, IRF, IPF, CAH, LTCH

Fourth quarter fiscal year 2017 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for hospices, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), inpatient psychiatric facilities (IPFs), critical access hospitals (CAHs), and long-term acute care hospitals (LTCHs). These reports summarize provider-specific data statistics for Medicare services that may be at risk for improper payments. Use your data to support internal auditing and monitoring activities.

Hospices, LTCHs, and free-standing SNFs and IRFs: For instructions on obtaining your PEPPER, read the Secure PEPPER Access Guide. CAHs, IPFs, and SNF and IRF units of hospitals: Your PEPPER was distributed via the QualityNet secure portal.

For More Information:

•Visit the PEPPER Resources website for guides, recorded training sessions, QualityNet account information, frequently asked questions, and examples of how other hospitals are using the report
•Visit the Help Desk if you have questions or need help obtaining your report
•Send us your feedback or suggestions

 

CMS CHANGE REQUEST 10573

SUBJECT: Enhancements to Processing of Hospice Routine Home Care Payments I.

SUMMARY OF CHANGES: The purpose of this change request (CR) is to create new fields on the hospice pricer output to display the number of days paid at the high and the number of days paid at the low routine home care rates. This CR also instructs the Fiscal Intermediary Shared System (FISS) to create an output record to match the updates to the hospice pricer output and for the Common Working File (CWF) to store with FISS the number of prior days retained for the life of the claim.

EFFECTIVE DATE: Oct. 1, 2018. Unless otherwise specified, the effective date is the date of service.

IMPLEMENTATION DATE: Oct. 1, 2018 

 

NEW HOSPICE DOCUMENTATION CHECKLIST TOOL

Medicare is a continuously changing program, and it is important that correct and accurate answers to your questions are provided. To better serve the provider community, the Centers for Medicare and Medicaid Services allows the provider contact centers the opportunity to offer training to customer service representatives. Read More

 

CONSIDER APPLYING FOR WORKER TRAINING GRANTS

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.


NEBRASKA HEALTH CARE ASSOCIATION SEEKS PROGRAM ASSISTANT

The Nebraska Health Care Association seeks a reliable individual with meticulous attention to detail to fill the position of Program Assistant. Click here for details and to apply.

   

Palliative Care Notes

 

*Hospitals saved $3,237 per patient when palliative care was added to patients’ routine care, according to a new study published in JAMA Internal Medicine. The research showed palliative care costs savings was associated with $4,251 per cancer patient, and $2,105 for those with non-cancer diagnoses. The largest cost savings were seen with patients with the highest number of coexisting illnesses. (Becker's Healthcare, Eureka Alert)

*Palliative care providers “endorse cannabis for a wide range of palliative care symptoms, end-of-life care generally, and as an adjuvant medication,” says a new study in the Journal of Psychoactive Drugs. “Nevertheless, the gap between these beliefs and actual recommendation or prescription appears vast.” The study sought to examine attitudes and practices of palliative care providers regarding cannabis, finding that “many who support the use of cannabis in palliative care do not recommend it as a treatment.” The research comes at a time when “cannabis use appears low in palliative care settings, with few guidelines available to palliative care providers.” (Journal of Psychoactive Drugs)

*Stanford University School of Medicine has developed an algorithm that uses artificial intelligence techniques to give a prediction of which cancer patients will die within three to 12 months. In early tests, the program makes accurate predictions 90 percent of the time. The hope is to provide better and more accurate treatment options for patients, and the Stanford report cites palliative care as a key point of improvement: “Physicians may not refer patients likely to benefit from palliative care for multiple reasons such as overoptimism, time pressures, or treatment inertia,” they say. (The Wall Street Journal, The Daily Caller, US News and World Report)

*A change in federal law that allows physician assistants (PAs) to manage and provide hospice care for Medicare patients highlights the need for effective palliative care education aimed at PAs and other generalist clinics, says CISION PR Newswire. The Medicare Patient Access to Hospice Act, which allows this change, takes effect in 2019. (CISION PR NEWSWIRE)

*Dallas’ ABC 12 News profiles Terese Cullen, who plays the harp for those near the end of life. Before she was a music thanatologist, Cullen was an opera star who performed on some of Italy’s biggest stages. Now, she offers a treatment that doctors like Dr. Elizabeth Carroll of Baylor Dallas says she has “no medication for.” She says music “can help with pain in a very real and physical sense. It changes vital signs. It can calm the respiratory rate. It calms the heart rate at end of life. But it also provides a calm for someone’s anxiety and fear in a way that almost nothing else can.” (ABC 12 News)

 

End-Of-Life Notes

 

*John McCain published an excerpt from his new book The Restless Wave, following his brain cancer diagnosis. McCain references "For Whom the Bell Tolls": “The world is a fine place and worth the fighting for and I hate very much to leave it. I hate to leave it. But I don’t have a complaint. Not one. It’s been quite a ride. I’ve known great passions, seen amazing wonders, fought in a war, and helped make a peace. I made a small place for myself in the story of America and the history of my times.” (TIME)

*Paul Bunge, MD, provides tips for younger doctors about how to tell patients that they’re dying. First, he suggests watching a more experienced physician deliver the news and assessing the reception of the news. “Learn the skill of having and showing both humility and assuredness,” he says. He stresses the importance of timing the news properly. He walks through a potential script about how to introduce yourself and how to address patients and their families. “After giving the bad news, be sure to pause. This may seem unnatural or surreal, and it is, but the situation calls for it. Staying silent can be difficult. You must decide in advance to use pauses and then discipline yourself.” (KevinMD)

*Game simulations could improve conversations between doctors and patients, CNET reports. Kognito, a health simulation company, uses virtual patients to create mock scenarios that can help physicians, nurses, and other practitioners test their conversation paths. Kognito co-founder and CEO Ron Goldman says the simulations offer a risk-free environment. (CNET)

*UCLA is the first U.S. hospital to implement the 3 Wishes Project, which honors dying patients and creates memories for their loved ones. The program helps fulfill small wishes for dying patients. Requests have included hearing a harpist play classical music, personalizing the patient’s room, and creating keepsakes like thumbprint key chains or framed Word Clouds. The average cost per patient has been $30. (New York Times)

* Faced with Alzheimer’s? Your paperwork may not be in order, says New York Times personal health writer Jane E. Brody. Even the one-third of Americans who have done their due diligence—“completed the appropriate forms, selected a health care agent, and expressed their wishes to whoever may have to make medical decisions for them”—may not realize those documents don’t cover dementia, the sixth-leading cause of death in this country. Groups like End of Life Choices New York is trying to address this with a new advance directive that it hopes will be a prototype for the country. Clinical director Judith Schwarz urges the use of the group’s form to prepare for issues including nourishment that arise in cases of dementia. (New York Times, End of Life Choices)

*C-TAC released “Policy Barriers to Advanced Illness Care Models: Exploring the Obstacles to Implementing Innovative Clinical Models.” The report highlights innovative models designed to provide palliative care in community settings to people with advanced illness. It also reviews policy barriers such models face, and outlines recommendations to address them. C-TAC will host a webinar on the report Thursday, May 24, at noon CDT, including speakers Marian Grant, Senior Regulatory Advisor, C-TAC; Gary Stein, 2017 Health and Aging Policy Fellow, C-TAC; Lee Goldberg, Former Project Director, Improving End of Life Case, The Pew Charitable Trusts; and Janet Bull, Chief Medical Officer, Four Seasons. Register here. (C-TAC)

*Charlie Sabatino details the “seven deadly sins” of Physician Orders for Life-Sustaining Treatment (POLST) in an article with Bifocal. Sabatino observed the development of the National POLST Paradigm and had a hand in its development as a legal advisor to its task force. Sabatino says health care providers should be aware and conscientiously avoid the following sins: “1) Using POLST with people who are too healthy. 2) Signing a POLST form without meaningful discussion. 3) Having patients complete their own POLST form. 4) Providing incentives for completing more POLST forms. 5) Failing to review POLST forms. 6) Letting POLST disappear. 7) Failing to evaluate your use of the POLST Paradigm.” (Bifocal)

*How do you explain death to a toddler? In “The Hardest Talk,” Slate’s parenting advice columnist Carvelle Wallace responds to someone who writes about telling her grandson about a death. The hospice social worker has encouraged a coherent plan with the person’s grandson. "She advises the inquirer to not call death travel, sleep, or other euphemistic terms.” Wallace agrees with the hospice advice and suggests preparing him for what will be coming in the following days and weeks, including a funeral, visiting people who will be sad, and other details. (Slate)

*The End-of-Life University presents an interview with Kate Riley titled “Mothers and Daughters at the End of Life.” Kate Riley discusses how the mother-daughter relationship impacts the end of life. The interview can be streamed online or accessed by telephone. (End-of-Life University)

 

Hospice Notes

 

*“My mom’s death was perfect, and hospice helped. But her dementia made enrolling her and keeping her in hospice nearly impossible,” writes Jeanne Erdman in The Washington Post. Her personal story illustrates the hurdles of the Medicare Hospice Benefit to align with the slow declines faced by her mother. “From the start, we hit a snag,” she says. Despite her mother being frail and suffering from dementia, she was not bedridden and she could speak. Issues like the 2013 removal of “failure to thrive” as a primary diagnosis for hospice entry compounded problems. “People with dementia decline over years and years, and frailty is part of that decline,” she writes. Judi Lund Person, an NHPCO vice president, discusses the Medicare Care Choices Model (MCCM), a pilot program that might serve as a bridge into hospice care. (Washington Post)

*Broad changes in health care could mean a redefinition for the hospice benefit, writes Amy Baxter. Home Health Care News interviews NHPCO President and CEO Edo Banach to discuss how hospice is pushing boundaries within systems of care, payments, and regulations. “We’re getting more integrated. We are moving in the right direction,” says Banach. “I want to make sure that the integration and technology is used as a tool to help supplement real, compassionate interdisciplinary care, not one-step-removed care.” In the next few years—if not sooner—his goal is to create a pre-hospice palliative care benefit. “The problem with Medicare fee-for-service now is these black lines—if you’re on one side, it is OK, and on the other side it’s not.” Banach hopes that “interdisciplinary person-centered care actually becomes the rule rather than the exception.” (Home Health Care News)

*Terri Maxwell, PhD, MSN, wants people to fully appreciate the differences between palliative care and hospice. In her article for McKnight’s, Maxwell reviews the main attributes of hospices and palliative care providers. Hospice programs utilize an interdisciplinary team that provides “whole person” care, Maxwell writes. Palliative care is about “helping patients and their caregivers coordinate care across care settings,” she explains. The article concludes by pointing to demonstrated value in aspects like costs and hospitalization rates. (McKnight's)

*Death doulas are “gaining buzz” with hospices, reports Home Health Care News. “I think people have come to realize that we’re not doing death well, especially in this country,” says Janie Rakow, president of the International End of Life Doula Association (INELDA). Death is more of a medical event than a community event, she says, “And I think we’ve become so far removed from understanding it that people are becoming anxious and fearful.” Last year, the nonprofit put around 700 trainees through its three-day course. (Home Health Care News)

*Many patients facing kidney failure are faced with a harrowing choice: receive dialysis or hospice care. A new study in JAMA Internal Medicine found that only 20 percent of Medicare patients with end-stage renal disease used hospice, and those who did were twice as likely to have hospice stays of three days or less. “These findings argue for greater flexibility in hospice-entry criteria for this population,” says senior author Ann O’Hare, a professor at the University of Washington School of Medicine and a physician-scientist at the Kidney Research Institute. (UW Medicine Newsroom)

*An article in Journal of Palliative Medicine, by a group of authors including Cordt Kassner, seeks to “estimate whether the Medicare hospice benefit’s potential for cost savings will change as a result of the January 2016 change in payment structure.” By analyzing decedent’s records and using various research tools, the study reviewed all “age-eligible Medicare decedents” who received hospice care and died in North Carolina in 2009 and 2010. The study found “Medicare costs were reduced from hospice election until death using both 2009-2010 and the new 2016 payment structures and rates. Mean cost savings were $1,527 with actual payment rates, and would have been $2,105 with the new payment rates. Cost savings were confirmed by reducing the number of days used for cost comparison by three days for those with hospice stays of at least four days ($4,318 using 2009-2010 rates, $3,138 for 2016 rates. Cost savings were greater for males ($3,393) versus females ($1,051) and greatest in cancer ($6,706) followed by debility. “The study concludes that, with the changes in the 2016 payment rate, Medicare savings could continue.” According to the article, “Cost savings were found for all primary diagnoses analyzed except dementia.” (Journal of Palliative Medicine)

*Healthcare First informed readers that CMS’ fiscal year 2019 Hospice Proposed Rule includes a proposed increase in hospice reimbursements as well as changes to the Hospital Quality Reporting Program (HQRP). A 1.8 percent increase in reimbursements is proposed, which would have an estimated impact of an added $340 million in payments. The proposal includes other updates including the removal of the requirement that hospices report detailed drug data on claims in support of hospice payment reform, effective Oct. 1, 2018. (Federal Register)

*The shift from hospital to home would require a “quantum change” of care when it comes to patients with hematologic malignancies, who often see delayed initiations of hospice care. “Unlike most solid malignancies, where advanced disease is incurable, many advanced hematologic cancers remain potentially curable. This lack of a clear distinction between the curative and end-of-life phase of disease for many blood cancers makes it challenging to identify the appropriate transition to end-of-life care,” says Oreofe O. Odejide, MD, MPH, and instructor in medicine at Harvard Medical School. Researchers are evaluating the use of home-based models earlier in the course of a disease, and the article cites Hospital at Home at Huntsman Cancer Institute — which will begin operation in July — and their goal to provide at-home care for patients with cancer who have acute, palliative and hospice needs. (Healio)

*VITAS Healthcare joined the American Hospital Association. “Clinical research and decades of experience demonstrate that hospice is uniquely positioned to offer high-quality and cost-effective patient care — two key factors that define value-based care,” says VITAS CEO Nick Westfall. Nasdaq cites VITAS’ innovations that “enhance the patient experience and care transition from hospital to hospice care,” including a “proprietary interoperability system designed to interface with hospital and health system EMR technology, increasing the efficiency of case managers and reducing the hospice response time.” (Nasdaq)

*Politico examines "five unintended consequences of addressing the opioid crisis" for their Opioids in America series. These issues touch on patient pain, hospice care, and opioid prescriptions at the end-of-life. The article discusses: 1) The perils of an abrupt shift in pain medication. 2) The focus on the opioid crisis can ignore other drug issues. 3) Taking away painkillers doesn’t take away pain. 4) Care for the dying. 5) Hospital shortages of IV opioids. (Politico)

*Brookdale Senior Living, the nation’s largest provider of private-pay senior housing, saw its hospice revenue increase 45 percent on a year-over-year basis in the first quarter of 2018. The company says it intends to invest in expanding that business. This is in stark contrast to its first-quarter 2018 ancillary services operating income down 46.8 percent from the previous year. Interim CFO Teresa Sparks said the decline was primarily driven by the home health sector, which continues “to be a challenge and is below our expectations.” Home Health Care News points to “pressure on home health visits” and a “negative impact from lower Medicare reimbursement rates.” (Home Health Care News)

 

Other Notes 

 

*C-TAC hosted an event on Capitol Hill to address policy progress and solutions in advanced care. At the event on May 9, Rep. Earl Blumenauer (D-OR), who co-sponsored the Patient Choice and Quality Care Act of 2017 and co-authored Personalize Your Care Act 2.0, said, “High-quality, patient-centered care is something we should be able to come together on in this Congress.” (C-TAC)

 

PROMOTING VALUE IN THE MEDICARE HOSPICE BENEFIT

In Medicare’s fee-for-service model, reimbursements incentivize medical interventions, even if treatments offer nominal benefits. This “pathway of least resistance” is detailed by Joan M. Teno and Irene Higginson in the Health Affairs article, “Paying For Value: Lessons From The Medicare Hospice Benefit.” This way of providing services, they say, overlooks the in-depth conversations needed to formulate and execute personalized plans of care. Read More

 

GROUPS SEE NEED FOR A PRE-HOSPICE BENEFIT 

When Medicare beneficiaries are seriously ill, but not yet ready for hospice, how do they receive coordinated care? This is the question examined by Mindy Yochelson in a Bloomberg Law article, “Groups Seek Medicare Pre-Hospice Benefit for Seriously Ill.” Read More

 

OPIOIDS AND HOSPICE STAR RATINGS, TOP REGULATORY ISSUES

Hospice “has become the hot acquisition target of the moment,” Amy Baxter writes for Home Health Care News. Buyers have been enticed by high margins and fewer regulatory hurdles when compared to home health care. Still, new regulations regarding opioids and quality reporting loom as public demand and legislation address the need for compliance and transparency. Baxter says these two areas—opioids and hospice star ratings—are top regulatory issues for hospices to watch. Read More

 

BECOMING A QUALITY-OF-LIFE DOCTOR

The number of Americans who could benefit from palliative care could double in the next 25 years, says the Center to Advance Palliative Care. As baby boomers age, the current estimate of 6 million people in need of palliative care is expected to grow quickly. For those like Sunita Puri, medical director for palliative care at the Keck School of Medicine of USC, a key question leads the work of the team: “If a patient cannot be cured, what medical care will help them live the life they have left to its fullest?” Read More

 

Thanks to Brenda Clarkson and 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 www.HospiceAnalytics.com.

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.