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Hospice News Nebraska, Oct. 19, 2017
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Oct. 24 (Tues) - Volunteer Coordinators Networking Conference Call

Oct. 26 (Thurs) - Chaplains Networking Conference Call

Nov. 3 (Fri) - The Nebraska Hospice-Veteran Partnership Annual Workshop and Meeting

March 20-21 (Tues-Wed) - 2018 NHPCA 'Living a Good Life... at the End of Life' Annual Conference


Nebraska News


Registration is now open for the Nebraska Hospice-Veteran Partnership Annual Workshop and Meeting on Friday, Nov. 3, 2017! Learn about the history of the hospice movement, as well as bed bug biology and treatment. Participate in a discussion on your hospice's activities related to pinning ceremonies, Vet-to-Vet volunteer programs, veteran-specific care needs, and more. The $20 registration fee includes education, handouts, break, lunch, roundtable networking, and the annual meeting. Register today!


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.


Each year, the Nebraska Hospice and Palliative Care Association hosts the "Living a Good the End of Life" Conference, which draws approximately 250 end-of-life professionals from across the region. The conference is scheduled for March 20-21, 2018.

Volunteers are needed to serve on the planning workgroup for the 2018 conference. The workgroup will meet two to three times in person or by phone between November and March. If you are interested in serving on the workgroup, contact Pam Truscott at 402-477-0204 or by Friday, Oct. 20, 2017.


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.


The U.S. Department of Health and Human Services’ Office of Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) provides a monthly newsletter, The Express. Read the October 2017 newsletter here.


“Defining Hope,” a new documentary following eight patients with life-threatening illness and the nurses who guide them, will be released in select theaters nationwide for special screenings on Nov. 1, in honor of National Hospice and Palliative Care Month. The film will have a screening at Aksarben Cinema at 6:30 p.m. on Nov. 1, hosted by the Nebraska Nurses Association and made possible by the generous support of local area partners. Click here for more information and to purchase tickets.

Jennifer Eurek, NHCA Vice President of Regulations and Guidance, will be part of a discussion panel following the viewing.

“Defining Hope” explores what makes life worth living and what to do for ourselves and our loved ones as we get closer to the end of life. Through the stories of patients, families, nurses, and health care professionals, the conversation around quality end-of life care is brought to the forefront.

Nurses will receive 1.25 free contact hours for watching the film and completing the evaluation.

To learn more about the film, visit


Effective Oct. 1, 2017 each Medicare Administrative Contractor (MAC) will begin the implementation of Targeted Probe and Educate for hospice providers, as required in Change Request 10249. Each MAC will use analysis of billing data to indicate aberrancies that may suggest questionable billing practices review of service-specific review error rate results, and could include those hospices already on targeted review. Each MAC will mail a letter to those hospices that are selected, which will outline the reasons for selection and provide an overview of the TPE process. There will up to three rounds of review, with a claim pull of 20-40 claims selected for each round. Check your MAC’s web page for more detailed information on the process.


Due to the New Medicare Cards initiative, previously known as the Social Security Number Replacement Initiative (SSNRI), pages 2A-8 and 2A-9 of the Hospice Item Set (HIS) Manual V2.00 have been updated for the affected item (A0600B Medicare number). The replacement pages with updated coding guidance are available in the Downloads section of the Hospice Item Set (HIS) web page.


To aid providers in compliance with Hospice Item Set (HIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) requirements, CMS has posted the following materials as Downloads on the HQRP Requirements and Best Practices web page.

  • Getting Started with HQRP: This document provides detailed information on the requirements of HIS and Hospice CAHPS. It is designed especially for new providers and staff, and gives comprehensive detail on the background of each requirement, data submission deadlines, possible exemptions, and tips for compliance.
  • HQRP Program Activities Checklist: This checklist can be used as a quick reference for hospice providers, outlining a checklist of HIS and Hospice CAHPS® reporting activities, and when each activity needs to be completed (e.g., annually, monthly, as needed).
  • HQRP Fiscal Year 2019 Fact Sheet: This fact sheet outlines the specific compliance requirements for HIS and CAHPS for the Fiscal Year 2019 reporting year (data collection period 1/1/17 – 12/31/17).
  • Hospice Compare Fact Sheet: Information on the Hospice Compare website, understanding your current quality ratings, and approaches to communicate with patients and family members.

For more information:


The Centers for Medicare and Medicaid Services has uploaded an audio recording and transcript for the Sept. 20 call on Reporting Hospice Quality Data: Tips for Compliance.


The Nebraska Department of Health and Human Services continues to take action to help prevent prescription drug overdose in Nebraska. The department developed and is now releasing a new opioid prescribing resource for providers. Read More


NET Nebraska recently posted a powerful video to their Facebook page. The video shares the story of Sharon, who was diagnosed with early-onset Alzheimer's, and her husband, Allan. 

The Nebraska Health Care Foundation is humbled to be a part of NET Nebraska’s “Now What?” series, which shines a light on memory issues and solutions for caregivers.


According to a recent press release, four national palliative care externship sites have been selected as part of the newly created Palliative Care APRN Externship, according to the program’s director, Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN. These locations and faculty are listed in the press release, and all expect to begin offering courses in 2018. The Medical University of South Carolina will serve as the clinical leadership site.

The Palliative Care APRN Externship is a weeklong mentored immersion course for APRNs, and is intended to provide primary palliative care education to APRNs from any setting. Read More


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

OMMRS/HPP/HCC LRA Committee Meeting
Friday, Oct. 20, 2017 | 1:00 p.m.
Hillcrest Grand Lodge
6021 Grand Lodge Ave., Papillion, Nebraska

Discussion with Jim Jenkins, Emergency Manager at the VA, on the upcoming full-scale evacuation exercise scheduled for Nov. 8, 2017, and how facilities can be integrated into the exercise. 

Please note: Due to the date of the exercise and the interest of facilities of being involved, only those at this meeting will be included in the exercise.


NHPCA 2017-16 - Guidance on RHC and SIA Rate Claims Adjustments
The Centers for Medicare and Medicaid Services has issued Special Edition article17029, “Process for Hospices to Submit a List of Claims Requiring Adjustments.” This guidance instructs hospice providers on claims adjustments when the rate for routine home care was inaccurately applied as a higher rate. The service intensity add-on payment may also be inaccurately paid for days that span two months. CMS and the Medicare Administrative Contractors have agreed to allow roster submissions until Oct. 20, 2017.

NHPCA 2017-17 - Nebraska Medicaid Hospice Fee Schedule
On Oct. 3, 2017, the Nebraska Department of Health and Human Services posted the Nebraska Medicaid Hospice Fee Schedule effective Oct. 1, 2017.

Hospice Notes

* The October Medicare Monthly Review shares information relative to hospice. Clarification on billing for Care Plan Oversight (CPO) is included. There is a detailed section in the included MLN Matters that outlines the “Process for Hospice to Submit a List of Claims Requiring Adjustments.” (Medicare Monthly Review)

* National Hospice and Palliative Care Organization President and CEO, Edo Banach, mourned the violence in Las Vegas, noting the hospice community can lead the country by moving “beyond simple ‘thoughts and prayers’” and providing not only “grief counseling – which we will most certainly do – but by modeling how even the most vexing, challenging problems can be managed when people come together. By demonstrating how a team is strengthened when it includes a diversity of perspectives. By embracing a philosophy that is rooted in dignity, respect, and compassion.” (NHPCO)

* NHPCO joined health industry stakeholders at the invitation-only “Cut the Red Tape Summit” hosted by the Department of Health and Human Services. Representatives from varying interests shared their perspectives on regulatory challenges. “HHS officials indicated that the hourlong event was only the first of what will be part of an ongoing conversation.” (Hospice Action Network)

* A new study, “Distressing Symptoms, Disability, and Hospice Services at the End of Life: Prospective Cohort Study,” was published by the Journal of the American Geriatrics Society. The study concludes, “Hospice services appear to be suitably targeted to older persons with the greatest needs at the end of life, although the short duration of hospice suggests that additional strategies are needed to better address the high burden of distressing symptoms and disability at the end of life.” (Wiley Online Library)

* A study from the Journal of Palliative Medicine is titled “Hospice Visit Patterns in the Last Seven Days of Life and the Service Intensity Add-On Payment.” The study provides estimates on the impact of the Service Intensity Add-on Payment (SIA). The study concludes, “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)

* The Fall 2017 issue of NHPCO’s Newsline features the introduction to LGBTQ-Inclusive Hospice and Palliative Care by Kimberly D. Acquaviva. The article argues that LGBTQ-inclusive practices begin with an active choice to welcome patients with dignity and compassion. Acquaviva says she has never met a hospice or palliative care provider “who consciously excludes LGBTQ individual and their families,” but stresses that without this intentional choice to embrace them, they are “by default, unintentionally choosing to exclude” them. (Newsline)

* In “To Give is to Receive,” Patti Moore encourages hospice providers to take every opportunity for community engagement – through consumer education, public library outreach, expanded offering, partnerships with high schools, and partnering with civic groups like the scouts. “We can simply do our jobs and wait for the community to remember us – or we can look for ways to expand our outreach and provide extra value to our community,” Moore says, and provides further suggestions for future reading. (The Watershed Group)

* Barbara Karnes, RN, shares “her wisdom as a pioneer in hospice nursing and the ‘new rules’ she teaches patients and their families about death and dying.” A recent interview with physician, Karen Wyatt, is online. (iTelesminar)

* When it comes to home-based care, what are the overlaps between primary care and palliative care? An article in NEJM discusses the implication of a Venn diagram slide that highlights issues like social needs, patient/family support, communication, symptom management, diagnostic and prognostic support, functional support, transitions/continuity, and safety in the home and in hospice care. (NEJM)

* The OIG issued “Enhancements Needed in the Tracking and Collection of Medicare Overpayments Identified by ZPICS and PSCS.” According to the report, home health and hospice overpayments are the second highest in dollars of all overpayments. But the collection rate is the lowest, with only 11 percent of overpaid dollars being collected. (OIG)

* New research supports previous findings that patients with chronic illnesses are referred to hospice late in the disease, giving those patients less chance to benefit from hospice services. The study examined patients with chronic liver disease and found they also have significantly longer hospital length of stay and annual health care charges when compared to other patients. (Healio)

* The National Coalition for Hospice and Palliative Care, also referred to as "the Coalition,” has launched a blog. The Coalition is comprised of nine national organizations representing clinicians, researchers, and hospice and palliative care programs. Its goals focus on four elements: cooperation, communication, coordination, and collaboration. Upcoming blog posts will detail the Coalition’s structure, core activities, and accomplishments. (NCHPC)

* Could end-of-life care be getting worse? Researchers at the University of Washington used survey data to study racial disparities in end-of-life-care, but offered the more general conclusion that “end-of-life care may be worsening for older people in general and … improvements are needed for all patients in the United States.” The study, published in JAMA, found that one in five patients did not report “very good” or “excellent” care. The study concluded that there were no significant differences in the reported quality of care based on race, but indicated that fewer black patients used hospice care and were more likely to die in the hospital, specifically the ICU. (UPI, McKnight’s)

* A Home Health Care News article uses data from a recent NHPCO report to provide “The Basics of Hospice.” Of the 1,381,182 hospice-enrolled Medicare beneficiaries in 2015, 46 percent of those were enrolled at the time of death. Medicare paid $15.9 billion for this care in 2015, with average cost per patient at $11,510. The article then lists about a dozen “Key 2015 Stats” including the number of hospices paid by CMS to provide care and the number of hospice patients younger than 65. (Home Health)

* Michael Giles, LMSW, is a hospice social worker who maintains a blog. In two recent blogs, Giles talks about making hospice social work visit notes easy and shares five tricks to completing documentation more quickly. The posts are online at his blog. (Hospice Social Work)

* “Beliefs regarding deactivation of left ventricular assist devices (LVADs) differ significantly between cardiologists and hospice and palliative medicine clinicians (HPMCs). These differences have lead to incoherent end-of-life care for some patients, according to a new study in the Journal of Cardiac Failure.” In this study, 26 percent of cardiologists and 59 percent of HPMCs reported they would be “comfortable” personally turning off the device. (Cardiovascular Business)

End-of-Life & Advance Care Planning Notes

* The Journal of Palliative Medicine published “Medication Use in the Last Days of Life in Hospital, Hospice, and Home Settings in the Netherlands.” The study found, “Patients who die an expected death receive many medications in the last week of life, part of which are preventive medications. Medication management in patients’ final days of life can be improved, especially in the hospital and home setting.” (Journal of Palliative Medicine)

* A combination of lorazepam and haloperidol may provide more effective control of agitation in patients with persistent delirium, according to a study published in JAMA. (JAMA)

* Two WWE wrestlers, Nikki Bella and John Cena, have an emotional discussion about their end-of-life wishes. The couple’s discussions, covered in Self, draws from industry experts to fill in details about an individual’s advance directive and durable power of attorney. (SELF)

* An Associated Press-NORC Center for Public Affairs Research survey finds that, of long-term caregivers, nearly half perform some kind of medical care, but only 47 percent say they have all of the training needed for those tasks. The AP article points out this lack of training and delegation of specialized work “highlights how long-term care remains a major unmet need for government programs and private health insurance.” (AP)

* In his Washington Post piece “I’m dying of brain cancer. I prepared to end my life. Then I kept living,” Jeffrey Davitz discusses his experience with aggressive brain cancer. After making preparations to die, Davitz recovered, living longer than anyone had projected. “I still believe in the fundamental right of self-determination through self-termination, but I now feel the weight of its complexity and uncertainty. It is a gamble: Avoid pain at the risk of missing life, or hold on to life at the risk of spreading pain.” (Washington Post)

* What do patients with serious illnesses experience when they turn to spiritual leaders for support after a diagnosis? A new study in the Journal of Palliative Medicine titled “Seeking and Accepting: U.S. Clergy Theological and Moral Perspectives Informing Decision Making at the End of Life” examined 35 clergy in five states and focused on their knowledge of end-of-life care. The study says, “Poor knowledge of EOL care may lead clergy to passively enable congregants with serious illness to pursue potentially nonbeneficial treatments that are associated with increased suffering.” Seventy-five percent of the clergy desired more EOL training. (Journal of Palliative Medicine)

* University of Houston College of Nursing has introduced a high-tech mannequin named Julia to help students practice end-of-life talks. The faculty controls Julia to simulate various medical conditions including panic and lack of oxygen, while a student responds and others learn from witnessing the simulation in another room through video and audio feeds. “This is the area that physicians and health care providers really have a difficult time with. How do we start the end-of-life conversation? It's one of the most needed requests from our hospital partners,” said Kathryn Tart, dean of the College of Nursing. “This research will not only educate our students, but it has far-reaching implications for the entire health care system.” (Medical Press)

* Playing a game related to end-of-life care may spur individuals to take action on creating real plans. Researchers at Penn State found that three months after playing a game called “Hello,” 75 percent of participants had completed some form of advance care planning. (Futurity)

* What does Dhamma - the teaching of the Buddha - teach about approaching the end-of-life? Ajahn Chah offers insights into principles, in topics including: “Keep mind and body separate.” “Don’t wish it were otherwise.” “Let go of all externals.” “Just be still.” And, “Find your real home.” (Lion’s Roar)

* What cancer stories do we want to hear? Renata Louwers writes about her husband’s process of dying from bladder cancer, and how people wanted to hear “about hope, courage, and positivity, not about how Ahmad was unlikely to survive or his ruminations on how to live well while dying.” The article takes issue with the word “survivor” in the context of cancer to counter the “cultural silence around death and dying.” Louwers and her new husband, who also lost a previous spouse to terminal illness, are starting a digital journal about “mortality, death, and dying.” Basic information on that is available at the second link below. (STAT, Months to Years)

* How should we be treated at the end of life? Karin Klein talks about the practice of displaying photos of patients in their young, vital years. Klein says this simple act can inspire empathy and understanding among the staff. The article touches on multiple patients’ stories and emphasizes the importance of following patients’ wishes. The denial of advance care directives and the “warehousing” of the elderly disturb her. She concludes “Maybe we’re getting better when it comes to allowing people to die, at least when they are savvy enough to know their options. What we haven’t found yet are ways to make the last months and years of the very sick more comfortable and meaningful.” (The Sacramento Bee)

Palliative Care Notes

* “The medical community, cancer patients, and their families routinely equate palliative care with hospice care,” says Theresa Sullivan Barger. Barger wrote “Palliative Care: To Live ‘The Best That You Can’,” and reminds readers that hospice and palliative care are not synonymous. Through the story of Wendy Van de Bogart, who struggled with breast cancer treatment, the article describes the misunderstanding by many that palliative care is essentially “the death squad,” as Dr. Henry Schneiderman of St. Francis Hospital and Medical Center in Hartford puts it. Barger details differences between the two and discusses the origins of the misconceptions. (Hartford Courant)

* A new study shows elderly patients with traumatic brain injury who are provided high-quality palliative and end-of-life care in place of aggressive treatment do not have increased mortality. Despite worries to the contrary, Dr. Elizabeth J. Lilley, one of the study’s authors, says, “Hospitals that had the lowest mortality actually had the best end-of-life care.” The study, titled “End-of-Life Care in Older Patients After Serious or Severe Traumatic Brain Injury in Low-Mortality Hospitals Compared With All Other Hospitals,” was published in JAMA in September. (Medscape, JAMA)

* A new study, “Assessing Palliative and End-of-Life Educational Needs of Pediatric Health Care Professionals: Results of a Statewide Survey,” studied providers in Connecticut. The authors say, “Participants who received palliative care education in the past five years had higher mean scores on all three factors of the End-of-Life Professional Caregiver Survey.” The article provides recommendations for future educational programs, including “developing systems to ensure continuity of care crossing all settings, addressing request for assisted suicide, meeting needs of staff and providers caring for the dying child (self-care), and describing cultural and ethical values specific to diverse populations in Connecticut.” (Journal of Hospice & Palliative Nursing)

* “Palliative Sedation: When Suffering is Intractable at End of Life” appears in the Journal of Hospice & Palliative Nursing. Its authors seek to clarify the practice of palliative sedation at the end of life, particularly for nurses who express concern that it hastens death. Palliative sedation, they argue, is an “ethically sound and legally sanctioned practice” that’s a “necessary option for patients who have intractable symptoms and are suffering when other palliative interventions have been ineffective.” (Journal of Hospice & Palliative Nursing)

* Politeness is among the most important factors associated with a caregiver’s satisfaction of a physician’s death pronouncement, reports a new study in the Journal of Palliative Medicine. The study extends previous research about physician behavior by examining pronouncements in palliative care units specifically. In the study, 86 percent of bereaved caregivers were satisfied with physician behavior toward death pronouncement when it was done politely. “Physician introduced himself/herself to the family,” for instance, was a key indicator. (Journal of Palliative Medicine)

* Medication management in patients’ final days can be improved, a study concludes. A retrospective chart review found that patients who die an expected death receive many medications in the last week of life, and that some of those are preventive medications. “The mean number of medications used per patient was nine during day seven before death and six on the day of dying. On the day of death, 48 (26.8 percent) patients used a preventive medication. This percentage was highest for patients dying in the hospital or at home.” (Journal of Palliative Medicine)

Other Notes

* NPR, in partnership with the Kaiser Health News and KQED, published “The Painful Side of Positive Health Care Marketing.” The story focuses on Lori Wallace, a cancer patient who does not expect to get well. The article focuses on the marketing campaigns of health care providers who make it seem as if patients are going to live forever. Wallace says, “It's frustrating to constantly hear messages in ads for hospitals that imply her cancer would go away if she were just more positive and tried harder.” (NPR)

* The Harvard Business Review argues for the importance of “Making Time to Really Listen to Your Patients.” It stresses active listening, which conveys respect and builds trust, but also prevents hurried encounters that can lead to missed information and ineffective treatment. Further, a hasty approach also contributes to physician burnout. “These consequences have clear human and financial costs,” the authors write. They conclude, “We must listen generously so that we nurture authentic, bidirectional relationships that give clinicians and patients a sense of mutual purpose that no best-practice guideline or algorithm could ever hope to achieve.” (Harvard Business Review)


For patients with serious illnesses, it can be a struggle to consider the real possibility of dying; yet, the difficult conversations with doctors and having the best prognostic information, is essential in order for individuals to make informed choices about their care near life’s end. For clinicians, finding the best way of navigating conversations with patients who might understandably be uncomfortable or fearful of direct talk about death poses a real challenge.

A new study in the Journal of Palliative Medicine proposes a dual framework that focuses on living well while still acknowledging the possibility the patient will die. Read More


In Florida, the non-profit Cornerstone Hospice decided to make the move from a standard workweek to a seven-day work model in order to provide improved care through the weekend. They made this change because they know that needs for provision of hospice care doesn’t change on the weekend. Read More


Advances in medical technology have meant longer lives, but also prolonged deaths. For decades, hospice care has served as a counterforce to the hyper-medicalization of death. Hospice gives value to the emotional needs of the dying. As a wave of baby boomers in the U.S. continues to age, researchers like Joan Teno, a geriatrician at the University of Washington, offer a stark warning: “The tsunami of frail elderly people with complex multiple illnesses is coming.” Read More


Hospice’s interdisciplinary teams are suited to providing care over the course of months during the end of life. Despite this, a recent report from NHPCO titled “Facts and Figures: Hospice Care in America” shows many patients do not receive the full benefits of that 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.