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Hospice News Nebraska, July 27, 2017
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Nebraska News


The Long-term, Residential, and Assisted Living (LRA) Committee invites you to attend the meeting below: 

OMMRS/HPP/HCC LRA Committee Meeting
Friday, Aug. 18, 2017
1-3 p.m.
Hillcrest Grand Lodge
6021 Grand Lodge Ave., Papillion, Nebraska
(off Highway 370)

Presentation by Eve Lewis on the interpretive guidelines for the emergency preparedness final rule. Eve will be available to answer questions.


NET Television will be airing the program "Now What? Understanding Brain Trauma” on the following dates:

Now What? Understanding Brain Trauma

  • Thursday, July 27, 7:00 p.m. CST
  • Sunday, July 30, 12:30 p.m. CST
  • Thursday, Aug. 17, 7:00 p.m. CST
  • Sunday, Aug. 20, 1:00 p.m. CST

Now What? Understanding the Brain and Behaviors

  • Thursday, Aug. 24, 6:30 p.m. CST
  • Sunday, Aug. 27, 12:30 p.m. CST

Now What? Rural Health in Aging Populations

  • Thursday, Aug. 31, 6:30 p.m. CST

NET's "Now What?" series addresses a variety of issues related to elder care and dementia. Providers are encouraged to share the program with residents, families, staff, and the community.

NET’s “Now What?” series is funded in part by the Nebraska Health Care Foundation. Previously aired programs can be viewed online.


The Nebraska Hospice and Palliative Care Association is accepting presentation proposals for the 2018 NHPCA "Living a Good the End of Life" Annual Conference.

Submit the call for presentations application to Pam Truscott, Vice President of Professional Development, at or fax to 402-475-6289.

The deadline to submit a proposal is Friday, Oct. 20, 2017.

View the application for additional details including conference dates, submission requirements, and topic suggestions.


The Lincoln-Lancaster County Health Department will be hosting a free National Incident Management System/Incident Command System course on Aug. 3, Aug. 17, and Aug. 29 in Lincoln. If you are new to the emergency preparedness and planning role or just need a refresher, this is your chance to receive instruction on IS-100, IS-200, and IS-700 in one day. View the event brochure for additional details.

Due to limited seating, pre-registration is required. To register, call Julie Mach at 402-441-8094 or email

For those who aren’t able to attend the in-person training, online courses are also available:

You will be required to use a FEMA student identification number (SID) to participate in the online courses. Follow these steps to register for a SID.


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.


Each year, the Nebraska Hospice and Palliative Care Association surveys members to identify your education needs. The survey’s results help the Association plan education for the following year.

By Friday, Aug. 11, 2017, please complete the survey to help determine education for 2018. The survey will take no more than five minutes to complete. There is no limit on how many from your agency can complete the survey.


An Errata v2.01.1 for the draft version of the Hospice Item Set (HIS) data submission specifications (V2.01.0) is now available on the HIS Technical Information web page. This errata contains one issue, which is a revision to the text of warning edit -3077.


It has come to the attention of KEPRO that some Medicare notices have incorrect contact information, including the "Important Message from Medicare" and the "Notice of Medicare Non-Coverage." It is important that these notices contain correct information, so that Medicare beneficiaries are able to access KEPRO if they would like to file an appeal. Please take a moment to review your organization's notices and make sure the information has been updated. For additional information visit the KEPRO website.


Governor Ricketts’ office has announced the opportunity to serve on the Palliative Care and Quality of Life Advisory Council created by LB 323.

A notice has been posted for the application process of filling the terms. You are highly encouraged to consider applying or encourage a colleague to apply. Jennifer Eurek, NHPCA Vice President of Regulations and Guidance, will be completing an application to serve on behalf of the Association.

The application form may be completed online or printed and sent in.

It is recommended applications be completed by mid-August. The law goes into effect on Aug. 24, 2017, so appointments will most likely be made in September.

For questions or additional information, contact Kathleen Dolezal at 402-471-2256 or

Palliative Care and Quality of Life Advisory Council – Term: 3 years – Meets at least two times a year

The council shall be composed of nine members appointed by the Governor.

  • At least two of the members shall be physicians or nurses certified under the Hospice and Palliative Medicine Certification Program administered by the American Board of Internal Medicine.
  • One member shall be an employee of the department familiar with hospice and palliative medicine.
  • The remaining members shall:
  1. have palliative care work experience,
  2. have experience with palliative care delivery models in a variety of settings, such as acute care, long-term care, and hospice care, and with a variety of populations, including pediatric patients, youth patients, and adult patients, or
  3. be representatives of palliative care patients and their family caregivers.


  • Letters were mailed to hospice providers regarding HQRP/CAHPS noncompliance. Letters are also available in a hospice providers CASPER folder. There is only 30 days to submit a reconsideration in request.
  • The next CAHPS reporting deadline is Aug. 9, 2017. Suggest that providers check their reports prior to the deadline.
  • Reminder: Small providers need to submit a CAHPS exemption form to be excused from CAHPS submission. The form is available until Dec. 30, 2017. Exemptions are good for one year.
  • HQRP – Hospice Compare will go live soon. Watch for implementation details.


The Centers for Medicare and Medicaid Services provided notifications to facilities that were determined to be noncompliant with Hospice Quality Reporting Program (HQRP) requirements for calendar year 2016, which will affect their fiscal year 2018 Annual Payment Update (APU). Noncompliance letters were dated and sent both by USPS and via the QIES - Certification and Survey Provider Enhanced Reporting (CASPER) system on July 18, 2017. The CASPER letter also identifies why the provider is noncompliant. Please check your CASPER folder to determine if your hospice received this letter.

Any hospice determined to be noncompliant with the HQRP requirements may be subject to a 2 percentage point reduction in their APU. For example, calendar year 2016 data affects fiscal 2018 payment.

Every hospice that is noncompliant with their HQRP requirements received notification on July 18, 2017, so it is clear that the 30-day period starts July 18, 2017, and ends Aug. 17, 2017, for sending in reconsideration requests to CMS.

Hospices that receive a letter of noncompliance may submit a request for reconsideration to CMS via email no later than 12:59 a.m. CST, Aug. 17, 2017. Failure to submit a request for reconsideration by the deadline means you accept that your hospice is noncompliant with HQRP requirements.

If you receive a notice of noncompliance and would like to request a reconsideration, see the instructions in your notification letter and on the Hospice Reconsideration Requests web page.


Each year, Medicare providers are required to recertify their Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) user access. The recertification period is now open for home health and hospice providers. Please review the information below. Failure to recertify will result in the termination of FISS DDE/PPTN services.

NOTE: Out of 3,466 home health and hospice providers, EDI has received 848 recertification forms.

What You Need to Do

  • Complete the Annual DDE PPTN Recertification Form as soon as possible. Verify all User IDs, indicate if the User ID is active or inactive, and include an authorized signature, contact email, and phone number. Note: This form is not used to add new users, delete users or update current users. To add, delete or update User ID information, you must complete an Online Inquiry Services form.
  • Fax the Annual DDE PPTN Recertification Form as soon as possible to CGS at

If you have any questions concerning the recertification process, please contact the CGS J15 EDI department at 1-877-299-4500 and select Option 2.


The Office of the Inspector General announced the addition of a hospice topic to the fiscal year 2017-18 work plan. Entitled “Medicare Payments for Unallowable Overlapping Hospice Claims and Part B Claims,” the OIG has identified this area for noncompliance with Medicare billing requirements. They will review Medicare Part A payments to hospices to determine whether claims billed to Medicare Part B for items and services were allowable under current Federal regulations. The report is expected to be released in fiscal year 2018.


The HHS Office for Civil Rights has launched a new video training module for health care providers on patients’ right of access under the HIPAA Privacy Rule. The video module provides an in-depth review of the components of the HIPAA right of access and ways in which it enables individuals to be more involved in their own care. Upon completion of this activity, participants will receive free Continuing Medical Education credit for physicians and Continuing Education credit for health care professionals. The module is available via Medscape or via OCR’s Training and Resources web page.


The U.S. Department of Health and Human Services Office of Civil Rights has recently issued a reminder to covered entities and business associates of the potential risks associated with file sharing and collaboration tools, explaining the risks these services can introduce and how covered entities can use these services and remain in compliance with HIPAA Rules. Download the OCR guidance.


The Centers for Medicare and Medicaid Services has posted a new question-and-answer document in the “Downloads” section of the Hospice Item Set (HIS) web page. The Q&A document shares frequently asked Hospice Item Set questions that were received between April and June 2017. It also contains quarterly updates as well as what’s coming up in the third quarter.

Hospice and End-of-Life Notes

* “Does Medicare/Medicaid Incentive Payment Affect Home Hospice Care in Last Week of Life?” A research article in the Journal of Palliative Medicine finds the change does improve visits in the last week of life. The “results show the majority (86.3 percent) of hospice decedents who had RHC days in their last week of life received one or more visits that would qualify for SIA reimbursements, with an average total add-on payment of $202.50 per decedent.” The researchers conclude, “The relative size of the new SIA payment introduced by CMS has the potential to increase RN/SW visits and reduce disparities in visit patterns in the last week of life.” (Journal of Palliative Medicine)

* Americans plan poorly for death, says Dr. Sudip Bose, M.D., but we can do better. “Palliative care is appropriate at any stage of a serious illness, absolutely can work in conjunction with curative treatment, and should not ever hasten death.” (Huffington Post)

* Two-thirds of Americans don’t have an advance directive to spell out their end-of-life wishes, according to research published in Health Affairs. “Unfortunately, this disconnect can lead to unnecessary and prolonged suffering. Advance directives remain the primary tool for people to communicate their end-of-life care wishes and appoint surrogate decision makers, but improvements to the documents and completion process are clearly needed.” (Consumer HealthDay, Hospital Review)

* Could shared decision-making (SDM) provide an answer for giving the best care to children with disabilities? Research published in the journal Pediatrics suggests it can. “When conducted well, SDM affords an appropriate balance incorporating voices of all stakeholders, ultimately supporting both the child/family and clinician." (Pediatrics, AAP)

* It’s hard to tell someone they’re dying. Increasingly, doctors are receiving training on how to have these difficult – but vitally important – conversations. “[Anna-Gene] O’Neal, who runs Alive Hospice here in Tennessee, launched the SHARE simulation lab last year. Participants run through four scenarios.” The actors take on the feelings of patients, and “reply with all the emotions — confusion, denial, anger, grief — that doctors might encounter in real exam rooms. Afterward, O’Neal sits with the doctors as they watch the tape of these interactions on a big-screen TV.” (STAT)

* The National Hospice and Palliative Care Organization recently dedicated a new, permanent display at its Alexandria, Virginia, headquarters. “Hospice: A Historical Perspective documents the history of the hospice and palliative care community and efforts to better care for patients and families facing serious and life-limiting illness.” (NHPCO)

* If you want control over your death, you might consider a “Do Not Hospitalize” order, writes Ann Brenoff for the Huffington Post. “Eighty percent of terminally ill patients say they want to avoid hospitalization and intensive care at the end of their lives. But such hospital stays nevertheless occur fairly frequently, even though they don’t seem to make much difference. ... So it’s worth asking why elderly and terminally ill patients are put through stressful hospitalizations, procedures and medical tests that only wind up blemishing their final days.” (Huffington Post)

* Someday, Facebook will be the world’s “largest graveyard,” says Katie O’Connor for the Richmond Times-Dispatch. “Increasingly, social media companies are developing ways for death and social media to meet. Some apps allow Twitter users to create tweets to be posted after they die, allowing parents with fatal diseases to prepare tweets for their children years in the future, for example. Social media might also be a platform through which mental health providers can catch signs and symptoms before they worsen.” (Richmond Times-Dispatch)

* More U.S. veterans are getting access to hospice care than ever before. “Substantially more U.S. veterans are using hospice following a U.S. Department of Veterans Affairs initiative to improve care at the end of life. … The findings of a new study, published in Health Affairs, show the initiative encouraged more hospice use among military veterans, and that the growth outpaced the rate of increase among demographically comparable members of the public receiving Medicare.” (Futurity)

* What are the symptoms of dying? In two articles published in the New York Times, Sara Manning Peskin, M.D., explores some of the stages of the dying process, including “terminal lucidity.” Terminal lucidity commonly occurs shortly before death, when a dying individual “comes back” for a short time, fully aware and cogent. (NYT, NYT 2)

* More than 230 hospice advocates gathered recently on Capitol Hill “to meet with their Members of Congress to support the Patient Choice and Quality Care Act of 2017 and the Rural Access to Hospice Act.” The participants were in Washington, D.C., to attend the Hospice Action Network and the National Hospice and Palliative Care Organization’s 2017 Advocacy Intensive. (NHPCO)

* The University of Vermont and Cabot Creamery are partnering to create a new “End of Life Doula Certificate Program.” The purpose of the program is “to prepare graduates to meet the growing demand for end-of-life support, teaching essential skills to assist clients with compassionate care including emotional, spiritual, informational and physical support. These services complement the care provided by family members and other palliative and hospice professionals.” (VT Digger)

* In a recent randomized trial, researchers said, “PREPARE plus, an easy-to-read advance directive, resulted in statistically significantly higher advance care planning documentation (35 percent) compared with an advance directive alone (25 percent).” (JAMA)

* The way we use advance care documents can directly impact the way we experience the end of life. Danielle Scheurer, M.D., suggests some considerations that should inform our use of these documents. “1) These documents should be treated as dynamic decision-making documents, not static documents that are filled out and filed at a single point in time; and 2) These documents should be the start of a conversation, not the end of a conversation.” (KevinMD)

* “Inpatient cirrhosis-related deaths have decreased over the last decade while cirrhosis-related deaths at home or in hospice settings have increased, according to a recently published study. However, the number of cirrhosis-related deaths that occurred in hospice care was significantly lower compared with cancer-related deaths.” (Healio)

* What are five strategies for improving care for individuals with advanced disease? “1) Utilize a specialized population health management solution; 2) Introduce a specialized palliative care program; 3) Implement a community-based, in-home care program; 4) Relieve caregiver burdens; and 5) Remaining at home enhances member satisfaction with care and plan participation.” (Managed Healthcare Executive)

* Do physicians do wrong when they fail to give patients bad news? Art Kaplan, Ph.D., uses a case study to examine the question of what a physician’s responsibility is to provide prognostic details to patients who are facing life-threatening illness. (Medscape)

* “At the end of her life, my mother started seeing ghosts, and it freaked me out.” Stephen Petrow writes for the Washington Post about the experience of having his mother see visions of ghosts as she herself neared death. The article normalizes such experiences. (Washington Post)

* In dying, only one thing is certain: We will die with uncertainty. An NEJM article shares the story of one patient. “Although we had left diagnostic stones unturned and therapeutic paths untrodden, to Mrs. C. the potential benefits of seeking answers did not outweigh the potential harms. She had outlived her ‘three score and 10’ by nearly two decades and was happy to let her life end, even with some uncertainty that it had to end right then. ‘I have had a good life,’ she told us, ‘and this is its end; I accept that.’ She taught us to accept that, too.” (NEJM)

Palliative Care Notes

* Palliative care improves life for patients with heart failure, according to research published in the Journal of the American College of Cardiology. Patients who benefited from palliative care “showed clinically meaningful improvements in depression, anxiety and spiritual well-being.” (Medpage Today)

* The U.S. prison population is rapidly aging, and this is presenting challenges for a prison medical system that cannot keep up. What does this mean for palliative care for those aging behind bars? “Not only is caring for aging inmates logistically difficult, it is unbelievably expensive due to the increased health care costs for this particular population. Some figures estimate the cost per older prisoner in California at nearly $2 million per year.” (GeriPal)

* The palliative care program at Duke features “compassionate care, innovative teaching and pioneering research in the face of illness.” “We provide support to people whether they have a month to live or 30 years,” says palliative care section chief Dr. David Casarett. “Good palliative care can help people live longer.” (Duke Today)

* A recent study finds that cognitive behavioral therapy can improve functioning for people with chronic pain. “Cognitive Behavioral Therapy (CBT) is the most frequently used psychological intervention for people with chronic pain, and new approaches for improving CBT outcomes may be found in the psychological flexibility model and Acceptance and Commitment Therapy (ACT), according to research reported in The Journal of Pain.” (Science Daily)

* Patient choice is the foundation of all good medicine, and certainly of good palliative care. “I remember participating in a conversation with a gravely ill patient who asked initially for all available life-prolonging options. My preceptor did not challenge the patient or recommend a course of treatment. She simply inquired, ‘Help me understand your choice. What is most important to you in your life right now, and what would your ideal end of life look like?’” (Pallimed)

* A paper published in the Journal of Palliative Medicine suggests cannabinoids are useful as medicine to treat certain forms of chronic pain, and that certain cannabinoids are suitable for clinical trials. The full article is free online until Aug. 4. (JPM)

* What is the impact of community-based palliative care services (PCS) on the usage and cost of acute care hospital services at the end of life? A study published in the Journal of Palliative Medicine says, “In addition to supporting people to die out of hospital, PCS was associated with reduced acute care admissions, bed days, and costs over the last year of life. The provision of high-quality palliative care in the community alleviates the burden on acute care hospitals and, thus, may partially offset public funding of this model.” (JPM)

Other Notes

* A bipartisan group of congressional representatives is introducing legislation that would make it easier for Medicare recipients to do advance care planning. “The Medicare Choices Empowerment and Protection Act would offer a small, one-time financial incentive to encourage Medicare beneficiaries to provide clear legal guidance to their medical providers and family members should they become incapable of speaking for themselves. This legislation would incentivize Medicare beneficiaries themselves to create and register a certified and secure advance directive online. In addition, the bill would provide beneficiaries with access to a website with model advance directives representing a range of options.” (Rep. Mike Thompson)

* Bipartisan efforts hope to more fully recognize and financially support the work of caregivers offering care “for sick, elderly or disabled loved ones.” Several bills that address the issue have been introduced, and there is an effort to include support in tax reform. (US News and World Report)


Jeannee Parker Martin’s mother turns 99 this year. She’s living alone in the same house where she raised her children. For the last seven years, she’s been living with a slow-moving variety of breast cancer that accompanies her vascular disease. Despite her ailments, says an article in the Huffington Post, her doctor determined she was at no immediate risk of dying. This meant she was not eligible for palliative care coverage under Medicare. Sharon Pearce, vice president for public policy for the National Hospice and Palliative Care Organization, says, “If you are not terminally ill and ready to elect hospice, access to palliative care services is really limited.” Read More


The Washington Post published, “My mother wanted a peaceful death at home. I almost blew it for her.” Dina Keller Moss describes how her mother was able to die on her own terms, with the help of a palliative care team. “When—just a few days after her 89th birthday—my mother was diagnosed with a colorectal mass … she restated to me what I long knew to be her fervent wish: no treatment of any kind beyond symptom relief. No invasive procedures, no chemo or radiation, no life-prolonging treatments. None! She wanted only one thing: to spend the rest of her days, however many or few there were to be, in her apartment in her lively and supportive community.” But as Moss was about to find out, being an advocate for her mother’s non-interventionist wishes was to be no simple matter. Read More


Three years ago, Tracie White wrote about then-recent research that revealed, “Most physicians would choose a do-not-resuscitate or ‘no code’ status for themselves if they were terminally ill, yet they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis.” This “stunning disconnect” between physicians’ personal choices and the care they give to their patients led to the design of the Stanford Letter Project, led by palliative care expert and researcher V.J. Periyakoil, M.D. Read More


Dr. Michael Salvatore writes about the MedPAC proposal from March 2014 to have Medicare Advantage (MA) plans “assume both the clinical management and financial responsibility of the hospice benefit, essentially ‘carving-in’ hospice under MA.” The proposal creates a dilemma for those who provide hospice care. 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

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.