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Hospice News Nebraska, April 5, 2018
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Nebraska News



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 started 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

*A new study in the Journal of Palliative Medicine finds that “patients who received inpatient palliative care (IPC) were more likely to enroll in home-based palliative care or hospice (69 percent vs. 43 percent) and were less likely to die in a hospital (15 percent vs. 29 percent) or intensive care (2 percent vs. 9 percent) compared with controls.” The retrospective study looked at adult decedents who had at least one hospitalization (non-trauma) at 11 Kaiser Permanente Southern California medical centers in the 12 months prior to death between 2012-2014. (Journal of Palliative Medicine)

* Can psychosocial interventions ease discomfort in palliative care patients? A new study published in the Journal of Palliative Medicine concludes that after successive interventions, the level of suffering in complex patients decreased until it neared that of noncomplex patients. The authors say the “findings support the importance of assessing and treating patients’ psychosocial needs.” (Journal of Palliative Medicine)

* A study in the Journal of Palliative Medicine provides evidence of the reliability and validity of CAHPS Hospice Survey measure scores. “Development of Valid and Reliable Measures of Patient and Family Experiences of Hospice Care for Public Reporting” also highlights opportunities to improve hospice care, “particularly with regard to addressing symptoms of anxiety and sadness, discussing side effects of pain medicine, and keeping family informed of the patient’s condition.” The study examines data submitted by 2,500 hospices through CAHPS during 2015. (Journal of Palliative Medicine)

* Treating Body and Soul is a narrative anthology of accounts from medical clinicians about how they address both the physical and spiritual dimensions of care. In the book, each clinician attempts to describe how to define the “spiritual” elements of their work and whole-person care. “It is a special glimpse into how spirituality and spiritual care are currently understood by some in the health care field in the United Kingdom. It is also a rare read into how this dimension is being conceptualized across subspecialties. Because the reflections do not start from the more traditional health care chaplain's view or are constricted by primary assumptions about the topic, they appear to mirror the authentic and common hopes and challenges of their authors. Its strength lies in the diversity of perspectives and the interventions illustrated in its numerous case studies.” (Journal of Palliative Medicine)


End-Of-Life Notes

* End Well offers a video on Death Ed, a course for teenagers created by Drs. Jessica Zitter and Dawn Gross. The course seeks to take on the taboo subject, much like those faced in Sex Ed, and break down barriers in the conversation for young people. (Endwell)

* The Idaho Statesman provides a broad overview of the importance of hospice services and their long rise around the world and in the U.S. Within this, they touch on new options like the end-of-life doula, but point out that much hospice care is driven by Medicare coverage. Quoting experts, statistics, and examples, the article outlines the process of entering hospice and the value of “learning how to die.” (Idaho Statesman)

* For those nearing the end, music can be a gift. It can help pain to subside, and even when verbal communication ends, says an article, “Music is a way to remain in the aesthetic of this world and continue participating in living.” McKnight’s draws attention to the power of song and tells the story of Jose Reyes, a dancer who lived a vibrant life. Just two weeks before he died, Jose wrote the song “All We Have Is Today.” (McKnight's Long-Term Care News)

* Family caregiver satisfaction with the end-of-life care helps define what it means to share in a “good death” or “good dying process,” write Karen O. Moss, PhD, RN, CNL, and Sara L. Douglas, PhD, RN. They say that families of patients who die in their preferred locations are more likely to report satisfaction, as do those who receive less-aggressive medical care and earlier hospice referrals. “Encouraging patients and families to become comfortable with speaking about death can reduce psychological distress and bereavement and increase the likelihood that the medical care provided will be consistent with the patient’s personal preferences.” (Oncology Nursing News)

* Seniors are doing better with funeral planning than with planning end-of-life care, according to a study conducted by Home Instead, Inc. Its president and CEO Jeff Huber says, “Final years planning can be easily misconstrued, and many people think they only need to plan for their final days and after. Often, we forget about the fact that as we age we might want or need extra care in the final days, months or even years of our lives – care so we can stay in our homes, care so we can remain independent, care so we can be around for our families and more of life’s milestones. The gap we saw from our research shows a critical need for resources to help seniors and their families better plan for their final years.” (Home Care Daily)

* New York Times reporter John Leland talks about his experience following a group of people ages 87-92 and shares how this changed his view of death. When mortality is seen as something built into every day, he says, we can come to appreciate the meaning of giving our attention to movies, to friends, and to other pursuits. He shares the story of one man who reflects that he learned to see how “his days weren’t fleeting—they were saturated with pleasures of his own choosing.” Viewing death as antithetical to life “does a disservice to the days we have because we don’t know how to value them.” (PBS News Hour)

* STAT tells the story of Frank Ostaseki, the founding director of the Zen Hospice Project, who helped with the final hours of as many as 30 people each week during the AIDS crisis in San Francisco. Within Ostaseki’s experiences is one with a gay son who contracts AIDS, and his staunchly anti-gay father who would later contract AIDS from a blood transfusion. Their wife and mother, Agnes, cared for them. “Nobody is putting my sick husband and son in a nursing home. They belong at home,” she said. “That’s a promise I made to them both.” This is a promise she kept, though with much burden, and the father and son died within a few days of one another. (STAT)

Hospice Notes

* The number of hospice patients is increasing in Florida as the state ages, reports The Florida Times-Union. This increases the need for “compassionate end-of-life care,” they write. Florida is second only to California in its number of hospice patients by state, and currently has 48 hospices. (The Florida Times-Union)

* The balancing of hospice patient demographics is part of the latest edition of National Hospice and Palliative Care Organization’s annual report "Facts and Figures: Hospice Care in America." Among Hospice Medicare beneficiaries, those with a cancer diagnosis dropped to 27.2 percent while those diagnosed with Alzheimer’s or dementia rose 1.5 percent to 18 percent. Other demographics include those with a cardiac or circulatory diagnosis (18.7 percent) and those with a respiratory illness (11 percent). When hospice first became available to Medicare patients in 1983, the majority of patients had cancer, notes NHPCO President and CEO Edo Banach. The changes represent a “more complex patient population” that requires continued outreach to help guide and provide services. (NHPCO)


Advance Care Planning Notes

* Centers for Medicare and Medicaid Services data from the first half of 2017 show that ACP billing code utilization continues to grow for Medicare beneficiaries consultations with physicians on their end-of-life wishes. Such billing is 70 percent higher than the same period in 2016, and the number of beneficiaries per provider rose from 16.2 to 19.3. The data shows 9 percent more claims per beneficiary, but the length of time for those services has held steady around 31 minutes. (C-TAC)

* In California, a team of UCLA nurses seeks to get hundreds of homeless people to complete and carry advance care directives. The project secured a $10,000 grant from the non-profit Coalition for Compassionate Care of California, but it faces a big task as the homeless population in Los Angeles County has grown 23 percent in the past two years. (Undark)

* C-TAC released its 2017 annual report, available in its entirety online. In its opening letter, co-chair and co-founders Tom Koutsoumpas and Bill Novelli write that 2017 was a historic and successful year. “Our membership grew by 25 new members and we are honored to have esteemed hospices, health systems, health plans, and others join our coalition.” The document gives insights into the organization’s campaigns, policy, research, and events. (C-TAC)

* The Five Trajectories: Supporting Patients During Serious Illness, by Jennifer Moore Ballentine, is available as a free eBook from The California State University Institute for Palliative Care. The book offers a framework for how to best serve patients and families experiencing five common trajectories of dying: Sudden Death, Terminal Disease, Major Organ Failure, Frailty, and Catastrophic Event. The book emphasizes the importance of advance care planning along each trajectory. The book describes key practice points for providers and outlines palliative and supportive approaches beyond the initial crisis. The book also provides tools such as advance directives, POLST, and other forms. (CSU Institute for Palliative Care)

* Even if you’ve detailed your last wishes, doctors might not see them when they are most needed. Daniela Lamas, MD, tells the story of working overnight when she was called into the ICU. A man with cancer arrived pale, feverish, and too confused to communicate. He’d done everything he could have to prepare for this moment in his life. “He’d been brave enough to talk with his doctors about his cancer and acknowledge that time was short. He had designated a health care proxy.” Now, however, strangers surrounded him. Those important conversations were “buried in his electronic record.” Luckily, this patient didn’t receive care he didn’t want, but not by the virtue of a systematic approach. She concludes, “Looking back, I realize that we were just lucky — and that’s not enough.” (New York Times)

* “In our society, particularly among the medical community, death is often seen as failure,” writes Timothy J. Babineau, MD, President and CEO of Lifespan. “‘Battling’ cancer has a noble connotation while hospice and palliative care are associated with throwing in the towel. We have a psychological bias toward longevity over quality of time remaining.” He advocates for more planning, pointing to successes like southwestern Wisconsin, where 95% of seniors have advance directives that are abided 98 percent of the time. (Lifespan)

* A new study published in the Journal of Palliative Medicine finds that asking hospitalized patients to make videos describing their advance care plans was “feasible and acceptable.” Of the 16 participants with a mean age of 60, most described their wishes surrounding CPR and intubation. Still, the researchers state that “a fair amount of uncertainty remained.” “Further research is needed to support patients in describing their wishes clearly and test the effectiveness of video declarations.” (Journal of Palliative Medicine)


Other Notes 

* With Republican support, the House approved a “right-to-try” bill with a vote of 267-149. The bill allows a new pathway for dying patients to sidestep FDA rules and request experimental drugs or treatment. “House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), in consultation with FDA Commissioner Scott Gottlieb and other interested groups and companies, added additional provisions to limit the types of patients who can access the pathway and to give the FDA more insight into the use of the pathway.” The bill now moves to the senate, where Sen. Mitch McConnell not yet given comment on whether or when he might advance the legislation. New York Times features an article on the issue and explores the issues that pharmaceutical companies face. (STAT, NYT)

* Human Rights Watch is investigating the treatment of chronic pain patients in the United States. The New York-based nonprofit is an internationally recognized organization known for its reports on human rights violations around the globe. Pain News Network (PNN) writes about the efforts of the group “The impetus for the investigation began when researchers were studying the treatment of cancer and palliative care patients – and began to see poorly treated pain as a human rights issue.” Diederik Lohman, Director of Health and Human Rights for the organization, says that in interviews, those who lacked of appropriate medications were “essentially giving testimony that was almost exactly the same as the testimony we were getting from the victims of police torture.” Human Rights Watch will focus on the role of opioid guidelines from the Centers for Disease Control and Prevention. Since the guidelines, 85 percent of patients surveyed by PNN say their pain and quality of life was worse. (Pain News Network)

* Virtual reality (VR) distracts from the pain of medical procedures, according to a review published in The Clinical Journal of Pain. Researcher Paola Indovina, PhD, from the Institute for High Performance Computing and Networking, ICAR-CNR, in Naples, Italy, along with his colleagues, conducted a literature review of VR as a distraction intervention. They found that VR reduced procedural pain even in patients subjected to extreme pain. The authors write that future studies should not only self-report measures but account for physiological variables. (Physician's Briefing)

* Cutbacks to opioids have left many chronic pain patients without help. Marian Wilson, an associate professor at Washington State University’s College of Nursing, says that she is “hearing from people in need of opioids that it’s harder and harder to get somebody to prescribe for them what they’ve had for years.” Wilson is concerned that those people reliant on opioids are being forced to cut back in many cases without being offered alternatives. Wilson’s research focuses on chronic pain, which she hopes will show the success of non-pharmacological options that don’t get the same kind of attention or funding. (The Spokesman-Review)


The move to include hospice in Medicare Advantage plans is gaining momentum. The Medicare Payment Advisory Commission (MedPAC) has long argued that leaving hospice out of Medicare Advantage plans causes fragmentation rather than unified care for patients. Now, those like Andrew MacPherson, principal with Washington, D.C.-based Healthsperien, a consulting and legal services firm, say the change is nearly a “political inevitability.” For those in the hospice industry, it’s vital to understand the impact of this change and, as Health Market Resources says, “deciding if it is a threat or opportunity.” Read More



In coverage of the widespread impact of opioid crisis, the complexities of grief can often go overlooked. Larry Beresford, writing on The Lancet Blog, talks about the importance of these emotions—the “shame, stigma, guilt, anger, blame, shock, and isolation” that come after an overdose death. The ripples of that death impact friends and family members in many ways. Read More



Lynn Randolph is an artist in residence in the palliative care unit at MD Anderson Cancer Center in Houston. She visits with dying patients and their caregivers, entering their “sacred space” to share her artistic gifts. Her work is sponsored by a nonprofit called Collage: The Art for Cancer Network, which was founded by oncologist Dr. Jennifer Wheler. Read More



Hospice providers often get high marks on CMS satisfaction surveys presented through the Hospice Compare website, but how well do they truly reflect the sentiment of surviving families? Modern Healthcare addresses this question in a recent article by Maria Castellucci. The CMS survey is a requirement for over 4,000 hospice providers around the country. The survey is publicly reported as part of the larger Hospice Quality Reporting Program mandated under the ACA, intended to move towards a value-based payment system. (Read More)



Palliative care accounts for 25 percent of Medicare expenditures, but those services are rendered to just 4 percent of Medicare beneficiaries, says an article in Healthcare Dive. In an attempt to address its costs, HHS’ Physician-Focuses Payment Model Technical Advisory Committee has recommended testing two value-based payment models for palliative care under Medicare. The two models consist of the Patient and Caregiver Support for Serious Illness (PACSSI) model and the Advanced Care Model (ACM). (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.