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Hospice News Nebraska, Aug. 10, 2017
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Sept. 18-21 (Mon-Thurs) - 2017 Nebraska Nursing Facility Association/Nebraska Assisted Living Association Fall Convention

Sept. 19 (Tues) - Nebraska End-of-Life Survey Press Conference

Nebraska News


NHPCA 2017-11 - CMS Releases 2018 ICD-10-CM Files

The Centers for Medicare and Medicaid Services has released the 2018 ICD-10-CM files. The 2018 ICD-10-CM codes are to be used for discharges occurring Oct. 1, 2017-Sept. 30, 2018, and for patient encounters occurring Oct. 1, 2017-Sept. 30, 2018. There are approximately 363 new codes, 142 deletions, and more than 250 code revisions. This special bulletin lists some of the updated code topics.

NHPCA 2017-12 - Submitting NOEs via Electronic Data Interchange
On July 27, 2017, the Centers for Medicare and Medicaid Services issued Change Request 10064, “Accepting Hospice Notices of Election via Electronic Data Interchange,” which will allow the submission of notices of election (NOEs) via electronic data interchange effective Jan. 1, 2018.


The Participation Exemption for Size Form is now available to complete on the CAHPS Hospice Survey website until Dec. 31, 2017. Please note, exemptions on the basis of size are active for one year only.

The Participation Exemption for Size Form will need to include for calendar year 2016 the number of patients who were discharged alive, the number of patients who died while in hospice care and a count of patients who fell into the following categories:

  • Patients who were discharged alive
  • Decedents:
    • who were under the age of 18
    • who died within 48 hours of admission to hospice care
    • for whom there is no caregiver of record
    • for whom the caregiver is a non-familial legal guardian
    • for whom the caregiver has a foreign (non-U.S. or U.S. Territory) home address
    • whose caregiver requested that they not be contacted

The CAHPS Hospice Survey Project Team will confirm receipt of the Participation Exemption for Size Form. Confirmation of receipt of the Participation Exemption for Size Form does not constitute approval or denial of this request. CMS will determine the eligibility for size exemption in 2018 when CMS reviews all hospices' data to see if they met the fiscal year 2019 Annual Payment Update (APU). If your exemption is accepted, you will not face a two percent reduction. However, if CMS data indicates you have served 50 or more survey-eligible patients in 2016, you would not qualify for the exemption and in that instance, you would face the reduction. Therefore, it is the responsibility of the hospice submitting the Participation Exemption for Size Form to accurately portray that the hospice meets the fewer than 50 survey-eligible decedents/caregivers for calendar year 2016 and provide the number of patients who died while in hospice care and count of patients who fell into the categories listed on the form.




Medical Review

Additional Resources


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 under the "What You Need to Do" heading. 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 processed 1,656 recertification forms. Read More


The Centers for Medicare and Medicaid Services issued S&C: 17-34-ALL, “New Guidance for the Formatting of Plans of Correction.”

The S&C memo includes:
Providers/Suppliers will no longer be required to write their PoC on the right side of the CMS Form 2567. Providers/Suppliers submit their PoC/AOC as a separate document attachment or may continue to document the PoC on the right side of the CMS Form 2567. Provider/Supplier Representative's signature is still required on the first page of the CMS Form 2566 for the PoC. The PoC can be sent as an attachment to the signed first page of the CMS Form 2567. Providers and suppliers are no longer required to enter their PoCs in the far right-hand column of the Statement of Deficiency. Instead, providers and suppliers are allowed to submit their PoC's in any format so long as they include a signed first page of CMS Form 2567.

CMS also reminded providers and suppliers that an acceptable plan of correction must contain the following elements:

  • The plan of correcting the specific deficiency. The plan should address the processes that lead to the deficiency cited
  • The procedure for implementing the acceptable plan of correction for the specific deficiency cited
  • The monitoring procedure to ensure that the plan of correction is effective and that specific deficiency cited remains corrected and/or in compliance with the regulatory requirements
  • The title of the person responsible for implementing the acceptable plan of correction

PoC's are publically releasable documents, so providers and suppliers are required to omit any Privacy Act or Protected Health Information.

NHCA contacted Eve Lewis, DHHS Program Manager for the Office of LTC Facilities, who states she did not see this S&C memo providing any specific changes to current practices. This memo changes the State Operations Manual wording to bring it into alignment with the current practice of the electronic POC process.


Register for the Reporting Hospice Quality Data: Tips for Compliance call, Sept. 20, 2017, 12:30-2:00 p.m. CST.

During this call, learn more about Hospice Quality Reporting Program requirements. Find out how to be compliant and successfully submit Hospice Item Set (HIS) data and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey in the next reporting year. A question and answer session follows the presentation.


  • HIS and CAHPS® submission requirements
  • Reasons for noncompliance and how to address them
  • Timelines for data submission and compliance determinations
  • Resources for success, including how to access important websites and helpdesks


Pam Truscott, NHCA Vice President of Professional Development, was recently featured in Lincoln Business Journal. Click here to read the interview.


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
1:00-3:00 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, 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 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.


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.

Hospice and End-of-Life Notes

* Infant Charlie Gard died in hospice care on July 28. His story was followed internationally. In the end, his parents wanted quality time with Charlie and wanted to be away from media and hospitals. His parents said, “‘Mummy and Daddy love you so much Charlie, we always have and we always will and we are so sorry that we couldn't save you. We had the chance but we weren't allowed to give you that chance. Sweet dreams baby. Sleep tight our beautiful little boy.’" (CNN)

* Emotional intelligence, observation skills, and empathy are key to patient-centered care. Hospice admissions nurse, Pamela Moss Blais of Norfolk, Virginia, relates personal experiences from across her career that highlight the importance of focusing on life goals rather than letting patients “[assume] the sick role.” (New York)

* The Centers for Medicare and Medicaid Services issued Change Request 10064 explaining that hospices may, as of Jan. 1, 2018, submit notices of election via Electronic Data Interchange. The change will help reduce errors that have occurred with Direct Data Entry. (CMS)

* Sherri Williams relates a personal tale of the importance of friends, family, and allies when caring for elders. She supports her narrative with advice from experts like John Mastrojohn III, executive vice president and chief operating officer of National Hospice and Palliative Care Organization. He emphasizes the importance of caregivers to have support when undertaking this demanding work: “‘Caregiving is difficult … It's physically, emotionally demanding. It's a really tough job.’”(Elle)

* Filmmaker, Dan Krauss, and Palliative Care Specialist, Dr. Jessica Zitter, appeared on "The Doctors" to discuss their Netflix documentary "Extremis." The film follows several families making difficult end-of-life choices. (The Doctors)

* Two researchers say, “Policies that facilitate appropriate imaging, opioid, and hospice use, and that encourage supportive care may improve end-of-life care and quality of life.” The study focused on 6,568 commercially insured patients. (Physician’s Briefing)

* Geriatrician, Shannon Tapia, shares how she responds when asked, “How do you deal with death all the time?” She breaks her answer into five parts: “1) Rework the hierarchy of goals in medicine to reflect reality; 2) Take control and responsibility for what you can, but recognize when it’s out of your control; 3) Allow yourself to grieve with the families of the deceased; 4) Know yourself; and 5) Ask for help” (KevinMD)

* End-of-life care conversations are difficult, but necessary. Kellen Browning writes about Frederick Bannon Jr. and the plans he made with both of his parents after his mother’s diagnosis of a rare muscle cancer. But 70 percent of Americans lack advance care planning, according to the U.S. Centers for Disease Control and Prevention. The article directs readers to Rebecca Sudore’s website, which provides step-by-step instructions and stories to help navigate end-of-life care. (KHN)

* Allowing ourselves to look at death is a highly personal experience. Dr. Benjamin Gold specifies this in his article, “Mr. H. was dying. His son couldn’t stand it.” As the patient’s son tries to remove himself from seeing the inevitable, Gold assesses his own relationship with palliative care. “Seeing palliative care as a victory would have been unthinkable for me just a few years ago. You go to medical school thinking you can figure out ways to save people, not usher them toward death.” (Houston Chronicle)

* The Centers for Medicare and Medicaid Services has finalized rules that will provide hospices with a one percent rise in 2018 Medicare payments, an estimated increase of $180 million. This follows a 2.1 percent increase ($350 million) in 2017. CMS will also launch the Hospice Compare website, and will automate the process for beneficiaries to elect hospice treatment. The Hospice Compare site will feature metrics to gauge how well the patients feel their hospice assessed their needs, along with a five-star rating system. Find the CMS fact sheet here. (Modern Healthcare)

* Hospice patient Carole Rymshaw of Pennsylvania donated her therapy dog to a veteran with PTSD. “I want to leave something before I go,” Carole Rymshaw says. The young dog was named Nick after Nicholas Rodriguez, who committed suicide after struggling with PTSD. She hopes to bring attention to the issue. “Everybody should think more about PTSD,” says Rymshaw. (WFMZ-TV)

* The National Hospice and Palliative Care Organization and the Center to Advance Palliative Care will offer a free webinar for community-based palliative care. “Hospices as Providers of Community-Based Palliative Care: Planning Your Service Strategically” will be held on Sept. 12, 2017, 12:00-1:00 p.m. CST. Presenters Lynn Hill Spragens, Liz Fowler, and Judi Lund-Person “will provide an overview of the options available to hospices when creating complementary service lines.” Registration is online at the link provided. (eHospice)

* Kathy Hull discusses the work of the George Mark Children’s House, a space for terminally ill children to live at the end of their lives while around their families. She discusses the difficult transition from "cure" to "care" and reminds readers, “We cannot change the outcome, but we can change the journey.” Hull does not look away from the deaths of children, but instead wants to focus on the power of life. “Children don’t stop dying just because we, the adults, can’t comprehend the injustice of losing them. […] If we can be brave enough to face the possibility of death […] we gain an unparalleled kind of wisdom.” (TED)

* We want “not only to live well, but to die well,” says philosopher, Luc Bovens, in an interview with Big Think. In an online video, Bovens touches on meaningful lives, secular hope, and a survey of thinkers on the subject of living for legacy or ephemerality. “We want to live our lives,” he says, but we also “want to die in a way that is reflective to the way that we’ve lived, and we want to leave some kind of legacy towards the future.” (Big Think)

* A practical guide from Reader’s Digest shares personal stories of families and friends going through loss and grief. These vignettes seek to answer questions like: “Is it best to give a grieving person space or lend a helping hand? Offer advice or just a shoulder to cry on?” (Reader’s Digest)

* Death isn’t like what you see in the movies, writes Glenn Ellis. “Movies consistently present death in a false or unrealistic way. Real-life death is not always dignified, simple, or tidy.” Agitated patients, unexpected infections, and the decision of whether to donate organs are some of the real-life decisions of the hospital. Ellis suggests starting conversations early and digging into what people mean by phrases like “extraordinary measures." (The Philadelphia Tribune)

* Health care students at Union College in New York spend eight weeks volunteering at the Joan Nicole Prince Home, an end-of-life home that accommodates only two residents at a time. The setting provides a much different posture toward dying. “Health care is very focused on cure — I'm going to cure this, I'm going to treat that, I'm going to give you medicine for this,” says board member Carol Weisse. “This experience forces students to step back and realize there isn't always a cure, but that doesn't mean there's nothing we can offer to alleviate your pain, your suffering. There is healing that happens at the end of life, and being present, being comforting, and attentive is a form of medicine and it does provide healing.” (Times Union)

* Cory Taylor was an award-winning author of “Me and Mr. Booker,” “My Beautiful Enemy,” and “Dying: A Memoir.” The New Yorker published Taylor's “Questions For Me About Dying.” In a New Yorker article, Taylor addresses a wide variety of questions readers submitted to her as a person with cancer. Taylor died in 2016, and the article’s text was drawn from Taylor's “Dying: A Memoir.” Her book was released in the U.S. posthumously on Aug. 1. (The New Yorker)

Palliative Care and Other Notes

* Two Texas physicians share their perspectives on the value of early access to palliative care. Jared Rubenstein and Daniel Mahoney warn against seeing palliative care as a tool for “‘people we can’t fix.”’ Instead, they affirm, “Our goal at every step is to maximize quality of life and minimize suffering.” The physicians call for palliative care to be introduced early and not be seen as only end-of-life care. (Houston Chronicle)

* Medical professionals are redefining palliative care by extending it to children and adolescents living with cancer, not just those dying from it. “Physicians now agree that whether or not these children are explicitly informed of their condition, they discern it.” Though they have to deal with the tremendous effects of treatment, they don’t have the resources adults do to deal with the psychological distress. Work from those like Dr. Justin Baker, director of the Quality of Life and Palliative Care Division at St. Jude, pushes for “children’s engagement in the process of treatment [to reduce] the weight of uncertainty, anxiety and isolation for those who survive and those who do not and for their families as well.” (New York Times)

* Life expectancy predictions serve a purpose for recommending palliative care, but how accurate are those assessments? A University College London study looks at a 10-year study of clinician predictions regarding patient life expectancy. The 25,000 predictions showed that over half of patients outlived clinician expectations. “The search is on for more accurate ways to recognize when patients are dying,” says senior author Paddy Stone. (Medical Press)

* A new study in Health Affairs finds a lack of advance care planning, particularly in chronically ill patients. The research draws from 150 studies published from 2011 to 2016. It reports that only one-third of U.S. adults have advance directives, and chronically ill patients were “only slightly more likely” to create one. The difference in rates of planning of the two groups was 5.5 percent. This study, taking place before the start of the 2016 implementation of Medicare reimbursements for advance care planning counseling, will “serve as a benchmark to gauge improvement.” (KHN)

* Michel Accad uses the case of Charlie Gard to consider the ethical dilemma of withholding treatment. He sides with Kenan Malik’s New York Times argument for a “secular, utilitarian argument for the continuation of the child’s treatment.” He cites newly appointed U.S. Supreme Court justice Neil Gorsuch’s arguments in his 2009 book The Future of Assisted Suicide and Euthanasia, a book that makes the case that intentional death—whether a physician expedites death or withdraws care—is always wrong. The article concludes that “the correct stance for justice […] is not to consistently intend the death of the weak and disabled under the false argument of compassion or dignity, but to consistently say no to the culture of death.” (KevinMD)

* With RN shortages and an aging population of nurses (roughly 55 percent over the age of 50), recruiting and retaining top talent is an “epidemic” issue. Consultant Stephen Tweed’s research addresses "frontline caregivers" and concludes that the supply simply can’t meet the growing demand. Tweed notes that potential nursing students are turned away due to shortages in educational resources. And it is difficult for “nursing schools to attract faculty because a graduate degree nurse can earn more dollars working in a home health care company than they can being faculty at a nursing school.” For nurse recruiters, Tweed suggests creating a company culture that values individuals and community values. He advocates implementing systems to track, automate and pre-screen employees during the hiring practice to promote consistency. (Home Healthcare News)

* A Senate bill has been introduced that would reduce restrictions on telemedicine. The bill is the Evidence-Based Telehealth Expansion Act of 2017, and is sponsored by Doris Matsui (D-California) and Bill Johnson (R-Ohio). The bill “would give the Health and Human Services secretary the authority to waive Medicare restrictions on the kinds of telemedicine it covers—as long as the actuary at the Centers for Medicare and Medicaid Services concludes it would indeed save money.” (Mobihealth News)

Advance Care Planning Notes

* A prospective study in The Journal of Community and Supportive Oncology found common barriers to recruiting emergency patients with advanced cancer for palliative treatment. The authors were able to enroll only 49 percent of patients due to issues like patient refusal, symptom burden, and diagnostic disparities. (AJMC)

* Don Dizon relates the experience of treating a patient who, against a medical team’s advice, insisted on being listed as “full code.” He discusses the decision-making process, discussions and emotions of the experience. The article also delves into the assumptions that often go into care. “I assumed she had valued quality of life,” Dizon writes. “It is what we have been trained to think about during treatment decisions.” (KevinMD)

Other Notes

* An explicit focus on spirituality could improve person-centered approaches to well-being. A review of a 16-year study on religious service participation and health indicators suggests, “Participation may lead to enhanced social integration that promotes health behaviors.” The report encourages clinicians to integrate “spiritual health as part of obtaining a routine social history,” and “implement formal models for spiritual history taking such as the FICA model.” The article is online, free, for all to read. (The JAMA Network)

* How can hospitals adapt care to address the “explosion” in the number of older adults with chronic conditions? The director of the Center to Advance Palliative Care in New York City, physician Diane E. Meier, offers these strategies: “1. Identify the high-need group. 2. Assess and risk-stratify the high-need group. 3. Match services to needs. 4. Train your workforce. 5. Track outcomes.” (Hospitals & Health Networks)

* A doctor reflects on the practice of expressing condolences and says this is something he wasn’t taught in medical school. According to one study, 55 percent of doctors regularly express condolences, with only 4 to 5 percent offered in person. Yul Ejnes, MD, offers personal experiences to support the custom and its benefits. (KevinMD)

* “Cancer could not care less whether you are a fighter,” says Arthur Caplan. He uses John McCain’s widely covered glioblastoma diagnosis as a teachable moment on the misguided practice of encouraging patients to be “fighters.” (Medscape)


As a nurse, Amy Berman had never self-diagnosed. But as she examined the redness and dimpling on her right breast, she became convinced she had inflammatory breast cancer. “I knew the symptoms. I also knew the cancer had a very poor prognosis.” Rather than curative-intent therapy, Berman chose a course that relied on palliative care and a treatment to limit the hormones fueling her cancer. “Having time with my family, time with my friends, and as much time feeling as well as possible are my primary goals.” Read More


The Hospice and Palliative Nurses Association’s Aug. 3 newsletter announced, “Three additions have been made to our list of HPNA position statements, available online … The position statements and guidelines offer much-needed guidance on the nurse's role in urgent clinical decision-making.” The additions are in the documents “Physician Assisted Death/Physician Assisted Suicide (PAD/PAS),” “Guidelines for the Role of the Registered Nurse and Advanced Practice Registered Nurse When Hastened Death is Requested,” and “The Ethics of Use of Opioids in Palliative Nursing.” Read More


Southwest Florida’s published “Taking too long to die: Some ‘terminal’ patients can lose hospice benefits.” The subtitle of the article is “The Tagtmeir family didn’t know when John entered hospice care that Medicare coverage would be canceled if he didn’t decline fast enough.” The story of John Tagtmeir’s and his daughter’s struggle is the focus of Frank Gluck and Melanie Payne’s story. The article highlights the challenges some patients face when they are no longer deemed “terminal” patients. The article also includes utilization data, and explains how hospice patients can slip in and out of coverage. Read More


Charlie Gard, the terminally ill British baby, lived for 11 months with a rare and untreatable genetic disorder. Charlie’s life and death drew international attention. During his short life, his muscles weakened, and eventually he was unable to move or breathe on his own. When Charlie was placed on life support, his parents wanted him to be flown to the U.S. for an experimental therapy called nucleoside. This pursuit eventually led to a court case, where London doctors argued they saw no potential improvement for the baby’s condition. “The Death of a Child: Understanding the Grief Facing Charlie Gard’s Parents,” published in Newsweek, explores the aftermath of a “clash between the hospital’s policy and the parents’ opinions.” 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.