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Hospice News Nebraska, May 3, 2018
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Nebraska News



NHCA Senior Vice President Tracy Rathe has submitted her resignation. Tracy began as a team member of NHPCA before the association joined the Nebraska Nursing Facility Association, Nebraska Assisted Living Association, and Licensed Practical Nurse Association of Nebraska in the NHCA family. She has served, in one capacity or another, for 12 years. Tracy has played a key role in growing the NHCA team, programs, membership, strategy, and brand for NHCA and its affiliates. She will continue with the association family until Monday, May 7. Tracy looks forward to time with her active family.

Christine Laughlin submitted her resignation as Professional Development Coordinator. She has accepted a position planning events in the collegiate setting. For three years, Christy has served the members with creativity and attention to detail, especially in her work related to coordinating events. She was instrumental in the NNFA/NALA/LPNAN Fall Convention’s transition to Pinnacle Bank Arena. Christy’s last day with NHCA is April 20.

Ashlee Fish will join NHCA as Advocacy Coordinator on May 7. Ashlee has supported NHCA as an intern during the current legislative session. This month, she will graduate from the University of Nebraska-Lincoln with a Bachelor of Science degree in Business Administration. She currently works as an assistant in the Legislature’s bill room, providing her with insight into the legislative bill process and the opportunity to build relationships with senators and their staff. Prior to that, she worked as a page for the Legislature, where she supported the Health and Human Services Committee hearings and kept up-to-date on current issues. Ashlee is excited to begin serving you! 



On April 27, the Centers for Medicare and Medicaid Services issued a proposed rule that would update fiscal year 2019 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. This rule also proposes changes to the Hospice Quality Reporting Program.

Proposed Rule Details:

• Advancing My HealthEData: Request for Information from stakeholders
• Burden reduction
• Meaningful Measures
• Routine annual rate setting changes
• Hospice regulations text changes due to the Bipartisan Budget Act of 2018
• Improving transparency for patients

For More Information:
Proposed Rule: CMS will accept comments until June 26
Press Release

See the full text of this excerpted CMS Fact Sheet (issued April 27).



Fourth quarter fiscal year 2017 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for hospices, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), inpatient psychiatric facilities (IPFs), critical access hospitals (CAHs), and long-term acute care hospitals (LTCHs). These reports summarize provider-specific data statistics for Medicare services that may be at risk for improper payments. Use your data to support internal auditing and monitoring activities.

Hospices, LTCHs, and free-standing SNFs and IRFs: For instructions on obtaining your PEPPER, read the Secure PEPPER Access Guide CAHs, IPFs, and SNF and IRF units of hospitals: Your PEPPER was distributed via the QualityNet secure portal.

For More Information:

•Visit the PEPPER Resources website for guides, recorded training sessions, QualityNet account information, frequently asked questions, and examples of how other hospitals are using the report
•Visit the Help Desk if you have questions or need help obtaining your report
•Send us your feedback or suggestions



SUBJECT: Enhancements to Processing of Hospice Routine Home Care Payments I.

SUMMARY OF CHANGES: The purpose of this change request (CR) is to create new fields on the hospice pricer output to display the number of days paid at the high and the number of days paid at the low routine home care rates. This CR also instructs the Fiscal Intermediary Shared System (FISS) to create an output record to match the updates to the hospice pricer output and for the Common Working File (CWF) to store with FISS the number of prior days retained for the life of the claim.

EFFECTIVE DATE: Oct. 1, 2018. Unless otherwise specified, the effective date is the date of service.




Medicare is a continuously changing program, and it is important that we provide correct and accurate answers to your questions. To better serve the provider community, the Centers for Medicare & Medicaid Services (CMS) allows the provider contact centers the opportunity to offer training to our customer service representatives (CSRs). Read More



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.


NHPCA 2018-2 - Updates in Coverage of Opioid-Containing Products and Children
Due to Food and Drug Administration safety guidance, Nebraska Medicaid limited the coverage of codeine and tramadol in children to youth aged 12 years and older in 2017. Due to Food and Drug Administration safety guidance, Nebraska Medicaid will also limit the coverage of cough and cold formulations containing codeine and hydrocodone to persons 18 years and older on May 1, 2018.


Palliative Care Notes


*A study published in the Journal of Palliative Medicine examines the effects of using “palliative,” “supportive,” or “hospice” care terminology. This experimental study was conducted at major U.S. hospitals, offering health materials with the various terms. It gathered rates of selection and rejection of care. The researchers found that the terminology had a large impact. “Information labeled as being about ‘supportive’ care was significantly more likely to be selected” by patients. (Journal of Palliative Medicine)

*The Journal of Palliative Medicine published a Meta-analysis that suggests psychotherapy in palliative care populations reduces depression and anxiety. The study included 32 randomized controlled trials with over 1,500 participants undergoing psychotherapy. (Journal of Palliative Medicine)

*Although physicians agree that patients use too many medications at the end of life, they regularly prescribe medications for chronic diseases for only “debatable” benefits, concludes a new study in the Journal of Palliative Medicine. The research used questionnaires to gather data, and 73 percent of physicians who responded agreed with the statement that patients who are in the last phase of life use too many medications. When presented with a vignette of a patient with end-stage COPD, they found, “For medications to treat (chronic) illnesses, there was a huge interphysician variability.” (Journal of Palliative Medicine)

* How will an aging population impact end-of-life care? In the coming 15 years, the world can expect a rise from 13 million to 70 million deaths worldwide each year. Researches at the Cicely Saunders Institute at King’s College London estimate that deaths occurring in care homes could more than double within 25 years. These researchers say that complexities of illnesses are also increasing, as patients live with multiple illnesses and frailty at the end of life. They cite studies that show an increased demand for palliative care and they are advocates for testing “new approaches to care” like project ECHO, “in order to ensure that we address this growing need of our population." (OUPblog)


End-Of-Life Notes


*Though end-of-life care is important, there are “only a limited number of funders” who really are engaged in end-of-life care. Paul Karon, writing for Inside Philanthropy, writes about the history and current status of funding and grants to support this critical issue. Noting the enormity of the need and the lack of more significant funding from private grants, Karon concludes, “The scarce attention to end-of-life care issues reflects a broader shortcoming of philanthropy, which is that aging is not a popular focus for foundations….” He calls for special attention to, and gives information about, the Patient-Centered Outcomes Research Institute (PCORI) and the end-of-life care projects it funds. PCORI was created as a part of the ACA, and funding comes from Congress and insurers. (Inside Philanthropy

*Modern medical technology is changing the end of life, Scott Tilley writes. He discusses the death of his father after years of suffering with Parkinson’s, arthritis, a triple bypass surgery, COPD, and finally dementia. This technology has allowed us to “keep a body alive far longer than even a few decades ago, but it hasn’t really been able to provide the quality of life that sharply defines who we are.” He urges others to not put off end-of-life discussions that must be held “before your loved one slips into their memories.” (Florida Today)

*Baylor College of Medicine writes about end-of-life choices, “Letting go may be best for your loved one.” The article follows the death of Barbara Bush, noting her decision to seek comfort care. Dr. Ursula Braun, associate professor of medicine – geriatrics, and director of Palliative Care at the Michael E. DeBakey VA Medical Center, elaborates on options for the end of life. “Hospice care is a segment of palliative care. It is a service delivered to patients with chronic serious illness and distressing symptoms, regardless of life expectancy. It is focused on the quality of life of that person and his or her family.” While the decisions and conversations are difficult, the article urges understanding and empathy. (Baylor College of Medicine)

*Patti Singer, a reporter who has covered health care from the patient’s perspective since 2009, talks with the Healthy Life podcast about the need to bring hospice discussions into everyday conversation. The 11-minute conversation talks about the late Barbara Bush, and urges people to have conversations that lead to good deaths. (Democrat & Chronicle)

*Five physicians have been awarded the 2018 Hastings Center Cunniff-Dixon Physician Awards for exemplary care of patients nearing the end of life. Each recipient made contributions in one or more of the four areas: medical practice, teaching, research, and community. (The Hastings Center)

*1A, an NPR program, offers a 47-minute segment about where to start when it comes to end-of-life decisions. They pivot from the news of Barbara Bush’s decision to seek comfort care to hear stories from listeners. Since airing, the segment has garnered nearly 200 comments online. (The 1A)

* Hospitalist Robert M. Wachter reflects, in a New York Times opinion article, the “wrench” that has been thrown in the “way we treat patients with advanced cancer.” In “The Problem with Miracle Cancer Cures,” he explores the emergence, success and problems with immunotherapy. Immunotherapy is a new generation of cancer care, works in a small percentage of cases, is costly, and comes with some terrible side effects. Wachter reminds readers that the American Society of Clinical Oncology, in 2016, recommended palliative and active cancer care be available—together—to advanced cancer patients. (New York Times)


Hospice Notes


*“If a loved one were diagnosed with a terminal illness, which option would you choose – to extend their life as long as medically possible or to give them pain medication and let nature take its course?” Forty percent of American adults chose the latter option in a survey conducted by Pulse Opinion Research, LLC. The polling comes after Barbara Bush’s death, when her family announced that she had pursued “comfort care.” (Rasmussen Reports)

*More than 260 hospice advocates visited Capitol Hill on April 25 as part of the Hospice Action Network’s annual Advocacy Intensive. The goal was to meet with lawmakers and staff to reinforce the value of the Medicare Hospice Benefit to 1.43 million beneficiaries served annually. The National Hospice and Palliative Care Organization reports, “Attendees from 44 states across the country spoke with 300 lawmaker offices about legislation supported by NHPCO to improve the delivery of hospice and palliative care.” Legislative efforts supported by NHPCO include the Rural Access Hospice Act, Palliative Care and Hospice Education and Training Act, Patient Choice & Quality Care Act, and the Safe Disposal of Unused Medication Act. (NHPCO)

*A hospice carve-in for Medicare Advantage is “inevitable,” writes Amy Baxter for Home Health Care News. “What the MA structure creates is a bifurcation,” claimed Julia Driessen, assistant professor of health policy and management at the University of Pittsburgh, when speaking at the National Hospice and Palliative Care Organization management leadership conference in Washington, D.C. She sees MA providers on one side and hospice on the other. “The bifurcation isn’t helping improve one major problem with hospice care: late utilization,” writes Baxter. One obstacle, Driessen says, is that Medicare Advantage plans are not familiar with the benefits and overall costs of hospice. This limited knowledge is cause for concern among plans when considering a carve-in benefit for MA. (Home Health Care News)

*The National Hospice and Palliative Care Organization introduced its My Hospice campaign “to reinforce the value of the Medicare hospice benefit among policy and health care decision makers to foster a policy environment that will support patient access to high-quality, comprehensive hospice and palliative care.” The effort “aims to demonstrate what hospice means to each unique individual and family it serves.” The campaign is based on three principles – that hospice offers integrated care that works; that Americans must have access to hospice; and that ongoing health care reforms should expand “access to comprehensive, coordinate care and person- and family-centered care to all patients with serious, advanced and life-limiting illness.” The launch of the campaign includes an online site, (NHPCO)

*Humana and two private equity firms plan to purchase Curo Health Services. The groups are already in the midst of securing Kindred at Home, the country’s second-largest provider of hospice care. With the 1.4 billion-dollar acquisition of Curo, which serves in 22 states, and a merger with Kindred, the acquisition will create the country’s largest hospice provider. The acquiring consortium includes Humana, TPG Capital, and Welsh, Carson, Anderson and Stowe. (Home Health Care News)

*Consumer Reports issued a brief guide to choosing hospice care. The information covers hospice basics, the makeup of a hospice team, the right time to look to hospice, and considerations for caregivers or patients who need respite care. (Consumer Reports)

*The Centers for Medicare and Medicaid Services has developed a Market-Saturation and Utilization Data Tool that includes hospice care. This interactive map visualizes state and county data including the number of fee-for-service beneficiaries, number of providers, average number of users per provider, total payments, and more. “The seventh release of the data tool includes a quarterly update and also includes federally qualified health center and ophthalmology data.” CMS reports that this is one of many tools used to help prevent potential fraud, waste, and abuse. (CMS)


Other Notes 


*On April 27, the Centers for Medicare and Medicaid Services published “Announcement of Calendar Year 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter.” CMS notes that they received many letters of comment from Part 1 and Part 2 Advance Notices Letter, published in December 2017 and February 2018. Because of and in response to these comments, CMS made multiple changes. These changes, they say, improve flexibility for providers to create and implement creative ways for provision of Medicare benefits. The changes include capitation rates for each MA payment area for 2019. CMS has posted “supportive data on the CMS website. The announcement reviews the key changes, and lists the “Final 2019 Normalization Factors.” (CMS)

*Fifteen million Americans are caring for someone with Alzheimer’s disease. CBS News aired a segment from chief medical correspondent Dr. Jon Lapook that looks at the societal and personal consequences this kind of care can bring. The story focuses on one man’s care for his wife, who says the toll is killing him. “I’m dying. I really think I am. My blood pressure is like 200/100. I can’t go to a hospital. Who watches Carolyn? What happens to Carolyn?” (CBS News)

*Opioid prescriptions dropped 12 percent last year, the biggest reduction in 25 years. The news comes from a report prepared by the IQVIA Institute for Human Data Science (formerly IMS Health and Quintiles) titled "Medicine Use and Spending in the U.S.: A Review of 2017 and Outlook to 2022." This reduction equates to 23.3 billion fewer morphine milligram equivalents (MMEs). (Medscape)

*CMS Administrator Seema Verma has announced a new Data Driven Patient Care Strategy, an initiative that strives to make CMS data more accessible and usable, including Medicare Advantage encounter data. Year 2015 MA encounter data will be released first, followed by updates later this year and subsequent releases on an annual basis. The move follows a JAMA Viewpoint urging CMS to release MA claims data. (Healthcare Dive)

*Medical Press offers five ways to help cancer patients avoid the emergency room, derived from research published in the Journal of Oncology and Practice. The five strategies: “1) Identify patients at high risk of unplanned acute care; 2) Enhance access and care coordination among health professionals; 3) Standardize clinical pathways for symptom management; 4) Develop urgent cancer care tactics, and 5) Employ early palliative care.” The strategies may help to combat visits that are debilitating for patients, far too common, and very costly. (Medical Press)

*The U.S. Drug Enforcement Administration (DEA) continues to adjust manufacturers’ quotas to address IV opioid shortages. “In recent months, the largest U.S. manufacturer of these injectable products has slowed production at one of their manufacturing facilities in order to perform necessary and required upgrades,” DEA said in a statement on April 10. “As a result, this company voluntarily surrendered a portion of their quota allotment and DEA reallocated these amounts to three DEA-registered manufacturers of [Food and Drug Administration]-approved injectable products in accordance with DEA regulations. It is important to note that an increase in DEA procurement quotas to various manufacturers cannot alone prevent future shortages as DEA does not control the quantity or the speed by which manufacturers produce these or any of their products. DEA is communicating actively and directly with all entities impacted and is committed to making further adjustments to individual procurement quotas as necessary and will also consider other measures that may be necessary to address potential shortages for these products.” (American Hospital Association)

*The New York Times discusses Bob Carey’s Tutu Project. The project is a fundraising effort that gives awareness of caregiving by offering photographs of Carey wearing nothing but a tutu. Carey started the photos after his wife’s breast cancer diagnosis to maker her laugh. “Wit is one of the most treasured characteristics of thoughtful caregiving,” says writer Susan Gubar. Her piece speaks to the power of imaginative caregiving for cancer patients, who often have to wade through not only medical traumas, but also “inane comments” that add to loneliness. (New York Times)

*Senator Elizabeth Warren (D-MA) and the Ranking Member of the House Oversight and Government Reform Committee Representative, Elijah E. Cummings (D-MD), have introduced the Comprehensive Addiction Resources Emergency (CARE) Act. CARE would provide resources to “begin treating the opioid crisis like the critical public health emergency it is.” It would provide states and communities with $100 billion in federal funding over 10 years. The CARE Act is modeled directly on the bipartisan Ryan White Comprehensive AIDS Resources Emergency Act, enacted 30 years ago to support federal investments and local decision-making to tackle the HIV/AIDS epidemic. (Elizabeth Warren)

*Serving as a caregiver takes a big toll, especially as the caregiver ages. Experts urge training, support, and rest for aging caregivers as the trend of seniors providing care for other seniors continues to rise. Kiplinger tells the story of Joe Searles, 76, who has been caring for his wife, Jane, 74, since she developed Lewy body dementia. While Medicaid pays for an aide eight hours a day, Searles—who is being treated for a spinal condition—still performs painful tasks during care. The article advises outreach to the local Area Agency on Aging and associations that focus on their loved one’s medical conditions. (Kiplinger)



On April 27, the Centers for Medicare and Medicaid Services published online the “FY 2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements,” dated April 16. The document shares proposed updates to the hospice wage index. It also notes and explains the changes that, beginning Jan. 1, 2019, recognize physician assistants and “designated hospice attending physicians” as being able to confirm terminal diagnosis. The rule also proposes “changes to the Hospice Quality Reporting program.” Read More



Many in the U.S. medical system have come to expect care that is disconnected, inefficient and adds a new layer of stress to medical issues. In this “increasingly broken and fragmented health care system, hospice care – the nation’s first coordinated care model – shows how health care should and can work at its best for patients at the end of life,” writes NHPCO president and CEO Edo Banach. His opinion piece, “Coordinated Care Is More Than a Buzzword for Hospice Providers,” appearing in the Morning Consult, details the long road of the hospice model that grew out of grassroots efforts to shape end-of-life care. Read More



Just days before the former first lady Barbara Bush’s death, her family announced that she was “not to seek additional medical treatment and will focus on comfort care.” Barbara Bush was 92, and had been suffering from congestive heart failure and chronic obstructive pulmonary disease, when she died at her home in Houston. While many applaud the decision to seek comfort care, it also raised questions about the term and its full implications for patient care. Read More



Reimagine End of Life is a weeklong series of events that draws thousands of attendees into conversations around the taboo topic of death. The festival entered its second year this April, drawing more than 7,000 people to over 175 events taking place during one week in San Francisco. Subsequent gatherings are scheduled for Cleveland and New York later this year. 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.