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Hospice News Nebraska, March 22, 2018
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Nebraska News



Tuesday, March 27, 2018

12:30-2 p.m. CT

During this webinar, learn about updated coding guidance for the Hospice Item Set and learn how to navigate the Hospice Quality Reporting Program websites. Subject matter experts will also provide an update on Hospice CAHPS.

For more information and to register, visit the Hospice Quality Reporting Training: Announcements and Registration web page



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

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



Hospice Compare was refreshed on Feb. 20 and included CAHPS for the first time. Providers are directed to more information about Hospice Compare on the CMS public reporting website.



The Centers for Medicare and Medicaid Services will be offering training to hospice providers quarterly. They will produce two educational series that will be released this month. The first of the series will be focused on navigating the newly redesigned HQRP website. The second will provide refined Hospice Item Set coding guidance with examples for each HIS item. The series will be in a self-directed video media format. There will be a webinar this month to introduce these resources. For more information, please visit NHPCO



To help prepare for the transition to the Medicare Beneficiary Identifier (MBI) on Medicare cards beginning April 1, 2018, review the new information about remittance advices.

Beginning in October 2018 through the transition period, when providers submit a claim using a patient’s valid and active Health Insurance Claim Number (HICN), the Centers for Medicare and Medicaid Services will return both the HICN and the MBI on every remittance advice. Here are examples of different remittance advices:

Find more new information on the New Medicare Card provider web page



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



Hospice provider preview reports and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey provider preview reports are available. These are two separate reports available in your Certification and Survey Provider Enhanced Reports (CASPER) folder.

Hospice providers are encouraged to review their Hospice Item Set (HIS) quality measure results from Quarter 3, 2016 to Quarter 2, 2017, and their facility-level CAHPS survey results from Quarter 3, 2015 to Quarter 2, 2017.

Providers have 30 days to review their HIS and CAHPS results (March 1-30, 2018).

Should a provider believe the denominator or other HIS quality metric to be inaccurate or if there are errors within the results from the CAHPS Survey data, a provider may request CMS review. Providers must adhere to the process outlined on the Public Reporting: HIS Preview Reports and Requests for CMS Review of HIS Data web page and the Public Reporting: CAHPS Preview Reports and Requests for CMS Review of CAHPS Data web page.

For more information on how to access these reports, view the HIS Preview Report Access Instructions and the Hospice CAHPS Provider Preview Reports Access Instructions.



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

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

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

For more information:

Fact Sheet
Overview web page
Provider web page



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


Palliative Care Notes


* How should you pronounce a patient’s death compassionately? Betty R. Ferrell, PhD, RN, writes that the “act of declaring that a patient has died is a long-held memory of the family.” But, she says, previous literature has documented deficiencies in this care. She discusses a study by Mori and colleagues that compares reactions to two video vignettes of death pronouncements—one a business approach, the other an approach enhanced with five compassionate additions. The result of waiting for family members to calm down, reassuring family members that the patient didn’t experience pain, and other measures raised outcomes for compassion scores, physician trust, and viewer emotions. (Medscape)


Hospice Notes


* An article in STAT titled “Long miles, lonely roads: In rural Texas, dying at home means little is easy,” explores the difficulties and challenges of providing hospice care in rural Texas. The article reveals the interconnected lives that overcome “nursing shortages, scheduling gymnastics, run-ins with wildlife, and the wear and tear of long days.” The state has nearly 500 hospice providers, but 60 percent of its counties don’t have any, according to Hospice Analytics’ Cordt Kassner. Kassner also notes that there are 254 counties in Texas, with the largest five counties, by population, having more than 40 percent of the population.

* What Are Your HIPAA Duties After The Patient's Death? Eli’s Hospice Insider responds to this question for hospice providers, noting that when a patient dies, “that doesn’t make his or her HIPAA agreement null and void. In fact, the HIPAA Privacy Rule protects a patient’s individually identifiable health information for 50 years after the date of death.” The HHS Office for Civil Rights says that during this half-century period, “the personal representative of the decedent (i.e., the person under applicable law with authority to act on behalf of the decedent or the decedent’s estate) has the ability to exercise the rights under the Privacy Rule with regard to the decedent’s health information, such as authorizing certain uses and disclosures of, and gaining access to, the information.” (Eli's Hospice Insider)

* The National Hospice Foundation has received a $25,000 grant from Legal & General America to create an online resource to help the public find information and community support services addressing grief and bereavement. “Grief is a part of life, but we can all benefit from help when we have to face it,” says Edo Banach, president and CEO of the National Hospice and Palliative Care Organization and the National Hospice Foundation. “This new resource will help countless consumers to access support from skilled professionals who are experts at helping people navigate grief and loss.” (National Hospice Foundation)

* “He’s selling his art. He’s stopped the cancer treatment. He’s finding peace in his relationship with his children. He said he’s ready to die.” Artist Arnold Edmondson is in hospice care, facing terminal cancer and COPD. It’s an expensive proposition that he meets with $750 a month from Social Security income. He has asked utility companies and others for help, but little has come. It’s a difficult financial situation, and Edmondson says, “I’m dying. I’ve got enough to worry about.” He’s now selling his art, which has accumulated over years in his home. (The Post and Courier)

* What are the costs of using antibiotics at the end of life? Antibiotics are among the greatest achievements in modern medicine, but overuse is a principle cause in the development of drug resistance. Once drug-resistant bacteria develops, the spread throughout a hospital or nursing home can be fatal. Health Affairs writes, “The vast majority of hospice patients who received antibiotics did not have a documented infection. In addition to being given to patients without infections, antibiotics may be misused at the end of life by being given to people who do have bacterial infections, but who are unlikely to benefit.” In some dying patients, antibiotics may even extend suffering unnecessarily, preventing a quick and peaceful death. The article concludes, “Physicians and patients must begin to think more critically about the role of these powerful medications at the end of life.” (Health Affairs)

* On A Life & Death Conversation podcast, Dr. Bob Uslander interviews Dr. Karen Wyatt, the founder of End-of-Life University. Wyatt discusses her father's suicide, and she shares how this led her to learn about hospice and into a career of educating people about end-of-life care. (ivoox)


Other Notes


* An article in McKnight’s reports on the MedPAC report to Congress as it relates to skilled nursing. Though MedPAC recommends cuts in payment, the article says, “Lawmakers appeared ready to shape payment reform themselves,” saying their proposed changes would “reduce Medicare spending by $750 million to $2 billion the next fiscal year and more than $10 billion over five years.” Lawmakers have formed “their own bipartisan caucus to look at value-based reform instead of waiting for the Centers for Medicare and Medicaid Services to roll out its changes.” “Skilled nursing providers are operating on razor-thin margins," American Health Care Association President and CEO Mark Parkinson reiterated Friday. "MedPAC's report that non-Medicare margins are negative 2.3 percent and total margins have plummeted to .7 percent should sound the alarms for policymakers across the country.’” (McKnights)

* C-TAC announced that Drs. Lucy Kalanithi and BJ Miller have joined its board of directors. “Lucy and BJ combine powerful personal narratives with years of experience in health care. They will help guide C-TAC as we continue to accelerate the movement to transform advanced care.” Miller is a practicing physician at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center. Kalanithi is the widow of Dr. Paul Kalanithi, author of the No. 1 New York Times best memoir "When Breath Becomes Air," and an assistant professor of medicine at the Stanford School of Medicine. (C-TAC)

* House Republicans failed to gain the votes to pass a federal “right-to-try” law, which was rejected by a 259-140 vote. The bill required two-thirds majority to pass under suspension of rules. In the lead-up to the vote, STAT published an opinion piece by Mark Harrington and Ellen V. Sigal arguing that the law would threaten patient safety; “Everyone wants to help those suffering from terminal illness. But rather than save lives, a right-to-try law would give patients false and fleeting hope, threaten patient safety, and impede the approval of therapies that are safe and effective.” (STAT, STAT, STAT, The Hill)

* Dr. Susan Tolle, director of the Oregon Health and Science University (OHSU) Center for Ethics in Health Care, wants to improve the way doctors talk to patients, especially in times of crisis. At her urging, OHSU’s medical school curriculum will include new lessons in – and standards for – communication, ethics and professionalism woven through the coursework. Tolle says this is critical. She notes that physicians of her generation were not taught how to give bad news. “So far as I know, there is no other school in the U.S. that has any such standard,” says Dr. Mark Siegler, director of the MacLean Center for Clinical Medical Ethics at the University of Chicago. (U.S. News & World Report)

* The webinar “Sharing Recent Oregon POLST Developments” will be held on April 30, 8-9 a.m. CT. This is a free webinar, but registration is required. Registered users will receive an email with a link to join. (POLST)

* A study published in JAMA, by researcher Erin Krebs, MD, and colleagues, finds that the “treatment with opioids was not superior to treatment with non-opioid medications for improving pain-related function over 12 months.” However, as Pain News Network writes, those findings were “widely and erroneously reported in the news media as meaning that opioids are ineffective for all types of chronic pain.” Beyond this, of the 108 individuals in the study who took opioids for a year, none were found to have developed signs of opioid misuse, abuse, addiction, or opioid-induced hyperalgesia. (Pain News Network)

* A study published in Children titled “Communicating Effectively in Pediatric Cancer Care: Translating Evidence into Practice” reviews a body of evidence that demonstrates the benefits of good communication for patients, families and health care providers. It then aims to “identify key communication skills that health care providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns.” The researchers hope to help health care providers better understand the value of mastering effective communication skills. (Children)

* Senator Claire McCaskill plans to introduce a bill that would require drug makers to disclose payments made to nonprofits and patient advocacy groups. This would extend the documentation of the Sunshine Act, created eight years ago in response to concerns of industry payments that might influence medical research and practice. The earlier law became part of the Affordable Care Act, and a federal database was launched in 2014 to record payments to physicians. (STAT)

* For Anne Fuqua, who in her late teens was diagnosed with a neurological disorder that causes involuntary movements and painful spasms, the “opioid crisis” isn’t just about abuse but also related to access for those with legitimate needs. She shares her perspective on the financial and logistical complications of prescription monitoring programs like those in Alabama. When her doctor left the field, he told her he could “no longer stand the paperwork and stress involved with being a pain specialist and trying to decide between protecting his ability to provide for his family and protecting his patients.” Fuqua, a former nurse, says she “never dreamed that our government would encroach to this degree” in relationships between patients and providers. “My opioid crisis is wondering whether each time I fill my medications will be the last time,” she writes. “I wonder how much longer I’ll be able to do the things I enjoy. I’m 38 years old. There’s so much that I want to do with my life. I want to go back to work part time, but I’m afraid to, because my future is so uncertain. I feel like I’m on death row.” (Washington Post)

* Though the Trump budget proposal is likely DOA, Eli’s Hospice Insider says, “Politicians looking for ways to raise funds for their initiatives are likely to cherry pick cost-cutting ideas from the plan.” For instance, the proposal suggests charging surveyed providers a user fee for survey revisits. More broadly, says the article, “The proposal would cut $554 billion from Medicare spending in the next 10 years,” according to the National Association for Home Care & Hospice. (Eli's Hospice Insider)

* End-of-Life University presents an interview with Cathy Zheutlin about her new documentary film “Living While Dying.” Zheutlin is a director and producer who has been the principal cinematographer on award-winning PBS documentaries. (End-of-Life University)



MedPAC issued its latest “Report to the Congress: Medicare Payment Policy” on March 15. In the introductory letter of the report, MedPAC says, “In light of our payment adequacy analyses, we recommend no payment update in 2019” for hospice providers, as well as for long-term care hospitals, ambulatory surgical centers, and skilled nursing facilities. They also recommend a 5 percent reduction in the base payment for home health and inpatient rehab facilities. Read More



A new report from the Department of Health and Human Services Office of Inspector General (OIG) puts a spotlight on abuses in the home setting that it says are a top priority in need of funding. The watchdog agency seeks to reduce fraud, waste and abuse, and points to the previous success with Health Care Strike Force teams. Read More



Delivering hospice in seriously rural areas is challenging. A story in STAT explores hospice care delivery in rural Texas. The long distances that patients live from nurses and hospitals complicate daily needs for both patients and caregivers, but so does the sense of individualism that often brings people to hospice in their very last days. Megha Satyanarayana examines end of this care in the article, “Long miles, lonely roads: In rural Texas, dying at home means little is easy.” The article shows the interconnected lives that overcome “nursing shortages, scheduling gymnastics, run-ins with wildlife, and the wear and tear of long days.” 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

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.