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03/18/2010

Hospice E-News Volume 15, Issue 11 March 18, 2010

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WHAT DO MEDICAL MIRACLES AT END OF LIFE COST?

In the second of a five-part series, Kaiser Health News looks at the high cost of end-of-life care. The article, "What Price for Medical Miracles? High Costs at End of Life Still Part of National Health Debate," concedes that heroic treatments sometimes work - "miracles" do seemingly occur. Click here to read the full article.
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RESEARCH & RESOURCE NOTES

  • Exit Wounds: A Survival Guide to Pain Management for Returning Veterans and Their Families is now available in print. Both the book and the website offer information about pain syndromes that affect veterans, the importance of early treatment of pain, treatment options, self-advocating for pain care, and resources for pain management. (American Pain Foundation Website)
  • The Texas Pain Advocacy and Information Network, in collaboration with the Nurse Oncology Education Program, is offering a free CNE resource where nurses in any state can take CNE programs online.  Programs offered include "Nursing Principles of Pain Management," and a four-part series, "Every Nurse's Guide to Pain Management." The four sections of the Nurse's Guide are "Introduction to Pain Management & Nursing Assessment," "Pharmacologic and Nonpharmacologic Management of Pain," "Pain Management for Culturally Diverse, Elderly and Substance Abuse Populations," and "Pain Management at the End of Life & Ethics." (Nurse Oncology Education Program Website)
  • The Hospice Foundation of America's Annual National Teleconference, on Cancer and End-of-Life Care, will be held on March 24. The conference will deal with care options related to cancer, loss and grief, psychosocial aspects of cancer, pain management, and ethical issues. Information is available at the HFA website. (Hospice Foundation of America Website)
  • Researchers from Mt. Sinai School of Medicine have found that most hospices do not ask patients if they have a defibrillator implanted, and only 10% discussed deactivating the device. According to the article, NHPCO "recommends identifying every individual with a defibrillator who is seeking hospice care and discussing the option of deactivating the device." (McKnight's Long-Term Care News, 3/8)
  • Larry Beresford, author of The Hospice Handbook, writes an occasional blog on hospice topics at growthhouse.typepad.com. Growth House advertises itself as "the Internet's leading portal for information about end-of-life care." The website "gives you free access to over 4,000 pages of high-quality education materials about end-of-life care, palliative medicine, and hospice care, including the full text of several books," and provides education both for healthcare professionals and the general public. Several of his recent posts discuss whether hospice enrollments are declining, palliative care grand rounds, AIDS and end-of-life care, hospice and health reform, and others. (Larry Beresford Blog)
  • "Difficult Questions for Pediatric Palliative Care Providers," in a recent Journal of Palliative Medicine, explores the reluctance of both parents and healthcare providers to recognize when the time has come for aggressive treatment of children to stop, and for the child to be allowed to die in peace.  Author Amy L. Getter, of the Hospice of Kitsap County, acknowledges the impossibility of imagining signing a DNR order for your child. She asks, however, "Shouldn't it be more impossible to shove a tube down their throat, continue the thousands of needle pricks, and inject multiple doses of toxic chemicals in the hope that those final days can be prolonged?" (Journal of Palliative Medicine, 2010;13(3):239:240)

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PUBLIC POLICY NOTES

  • The Idaho House State Affairs Committee recently passed the Health Freedom of Conscience bill, which allows "all Idaho health care professionals to ignore end of life care and treatment at any time they feel it violates their ‘conscience.' The press release says, "The bill's vague language will mean any end of life service could be denied, irregardless of the patient's living will and advance directives, which provide instructions for exactly how to address end of life care issues." The bill has already passed the Senate, and now goes to the full House for a vote. (PR Newswire, 3/11)
  • A Missouri state representative, Cynthia Davis (R), has sponsored a bill requiring mandatory feeding tubes for terminally ill patients who have said that they don't want them. Click here to read the full article. (St. Louis Post-Dispatch, 3/7)
  • Sheldon Smith isn't afraid of dying, but he does worry about pain, and he wants a lethal prescription that he can use to end his own life. Click here to read the full article. (Hartford Courant, 3/7)

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END-OF-LIFE NOTES

  • An article by Barbara Coombs Lee, of Compassion and Choices, encourages readers to find doctors who "put the ‘care' in healthcare." She, and Compassion and Choices, suggest interviewing your doctor about what he or she would do if you wanted to forego heroic treatment for a terminal disease, how the doctor would handle a situation such as the family squabbling over Terri Schiavo, and whether enough pain medication would be prescribed to keep you comfortable even if it shortened your life. (The Huffington Post, 3/11)
  • In West Virginia, The Journal recently published an article by Kathie Campbell of Hospice of the Panhandle and the West Virginia Center for End-of-Life Care. Campbell says that she used to blame doctors when patients were kept alive for months with aggressive care that was obviously futile, but has come to see that each person has the responsibility to determine what kind of care he or she would want at the end of life. The article suggests a number of questions for patients and families to discuss with doctors, and recommends that the discussion take place before a crisis occurs, if at all possible. (The Journal, 3/8)

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OTHER NOTES

  • In "Shock Me, Tube Me, Line Me," ER physician Bruce Veysman tells the story of resuscitating an elderly patient brought into the ER, only to find that the patient is in the last stages of cancer and has both DNR and DNI (do not intubate) orders. (Health Affairs, 2/2010)
  • Country music singers Randy Travis and Collin Raye will headline an April 11 concert in Indianapolis commemorating the 5th anniversary of Terri Schiavo's death. The goal of the concert, sponsored by the Terri Schindler Schiavo Foundation, is to encourage families going through similar situations as the Schindlers, Schiavo's brother Bobby said. Click here to read the full article. (CNS News, 3/9)
  • There for a while, Sandy McBride thought it was going to cost her an extra $179 to die. That's the early termination fee that Verizon was going to charge her to cancel her phone, cable and Internet service. Click here to read the full article. (The Oregonian, 3/7)
  • An article in the Estes Park Trail Gazette profiles the work of Rebecca Hazlitt, music thanatologist. Hazlitt is a graduate of the Chalice of Repose Project School of Music Thanatology in Missoula, Montana.  According to the article, there are two kinds of visits from music thanatologists - processing ones, where a patient has just received a terminal diagnosis and is assisted in processing their feelings, and imminent vigils, where the patient is actively dying. (Estes Park Trail Gazette, 3/9)
  • The Seattle Times recently looked at the terminally-ill patients who wanted to use Washington's Death With Dignity law, but were unable to for various reasons.  Some did not realize that the process took time, and got started too late. Others mistook an assurance from their doctor that their pain would be managed for agreement to prescribe lethal medication, when the doctor did not agree to that. Others had difficulty finding two physicians who could agree that they were terminal and on the amount of time they had left. Compassion and Choices of Washington estimates that half the patients who came to them for help came too late. (The Seattle Times, 3/6)
  • Susie Mann was determined to live life to the fullest after a diagnosis of cancer. In the process, she became known as "the daredevil granny." Click here to read the full article. (The Baltimore Sun, 2/28)
  • The Muskegon News recently featured the work of Parents with Angels, a grief support group for parents who have lost children. Click here to read the full article. (Muskegon News, 3/7)

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NHPCO COMPLIANCE, ADVOCACY AND REGULATORY UPDATES

Notes from CMS Home Health, Hospice, and DME Open Door Forum
CMS provided clarification about uses related to CR 6440 and CR 6778 on Wednesday (03/10/10) during the CMS Open Door Forum call. The next Home Health, Hospice & DME Open Door Forum is scheduled for Wednesday, April 14, 2010 from 2pm-3pmET. If you wish to participate dial 1-800-837-1935 Conference ID 61772075. Please mark your calendars. (CMS, 3/11/10)

  • CR 6440 Clarifications: Social worker phone calls clarification - CMS stated that clarification about what types of calls to record on the claim form was issued under Q&A ID 9970 posted on February 19, 2010.
    • Social worker phone calls when patients are receiving GIP level of care - calls are to be reported if they meet the criteria outlined for social worker calls in CR 6440. (Criteria:  phone calls that are necessary for the palliation and management of the terminal illness and related conditions as described in the patient's plan of care.
    • Recording visits for a patient who is a resident in a hospice residence under Routine Home Care - CMS recommends that hospice staff record only the visits that are necessary for the palliation and management of the terminal illness and related conditions as described in the patient's plan of care . NHPCO has requested that CMS issue a Q&A on this verbal guidance.
    • Interrupted care - service is recorded as one visit (ie:  RN assesses patient and needs to return to the med cart for medication and then administers the medication.)
  • CR 6778 : Brief verbal clarification about the proper use of site of care Q codes was reviewed and CMS stated that due to questions from hospice providers. At NHPCO's request, a Q&A for clarification is currently under development and will be available soon.

Medicare Fraud Strike Forces Expanding
In testimony before a House Appropriations Subcommittee on Medicare fraud, waste and abuse, the OIG stated that the President's budget for FY 2011 proposes a $65 million funding increase in health care fraud and abuse programs which includes $40 million in new funding to support the OIG's Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative. Medicare Fraud Strike Force teams will be created in 13 new locations by 2012. On 3/4/10, three OIG officials testified before two House Committees. Links to the testimony follow. 

OIG Successful Fraud and Abuse Activities
Testimony delivered by Daniel R. Levinson, Inspector General, before the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the House Committee on Appropriations on efforts to combat health care fraud, waste, and abuse in Medicare and Medicaid. To see the written testimony, click here. (OIG, 3/4/10)

OIG Fraud Referral Process and Success
Testimony delivered by Timothy J. Menke, Deputy Inspector General for Investigations, Before the Subcommittee on Crime, Terrorism, and Homeland Security of the House Committee on the Judiciary on law enforcement activities to combat Medicare and Medicaid fraud. To see the written testimony, click here. (OIG 3/4/10)

OIG Investigation of South Florida and Success
Testimony delivered by Omar Perez, Special Agent, with the Office of Inspector General before the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the House Committee on Appropriations on investigative efforts to combat Medicare and Medicaid fraud in South Florida. To see the written testimony, click here. (OIG, 3/4/10)

Decision Reached on Hospice ‘Cap' Case in Texas
A number of providers have gone to federal court and challenged their hospice cap repayment demands on the grounds that a portion of the Medicare regulation used to calculate the demands fails to follow the statutory requirement to allocate cap allowances for each patient across years of services. The most recent case in Texas, along with two others - California and New Mexico - were decided in favor of the hospice program and set aside the cap repayment demands for those programs. At this juncture, it is unclear how this will impact Cap regulations for the hospice community. NHPCO will provide additional information when available. (NHPCO, 3/11/10)

2010 Economic Impact Survey Launched
Last year, NHPCO conducted an economic impact survey that yielded invaluable information and assisted us in making your voice heard in Washington DC. Now NHPCO needs your help again. We ask that you continue to advocate for the resources needed to serve our patients and families by completing the 2010 Economic Impact Survey. The survey can be completed in about 10 minutes or less. The deadline for completion is Monday, March 22, 2010. If you are the Primary Contact for your Organization and did not receive a link to the 2010 Economic Impact Survey, please email research@nhpco.org. (NHPCO, 3/11/10)

National Data Set: Online Data Submission Begins March 15
Online data submission for the 2009 National Data Set will begin Monday, March 15, 2010. Data submission is through the NHPCO DART system which can be accessed from the NDS page of NHPCO's website at nhpco.org/nds. Prior to availability of the 2009 NDS Survey, please utilize the 2008 Survey, available online, to compile your data. Changes to this year's form are indicated by the following symbol: ▲.  The NDS represents a comprehensive compilation of information on hospice operations, including: who provides care; who receives care; and the range, cost and quality of hospice services. NDS summary results provide useful information to hospices for defining strategic goals, setting operational targets, and improving care delivery. Should you have any questions, please email nds@nhpco.org. (NHPCO, 3/11/10)

The Annual National STAR Report has Shipped!
The upgraded National STAR Report includes a summary of STAR results from October 2008 through October 2009. The report allows national level comparisons of individual hospice report results .It also includes salary and demographic information that help administrators with strategic planning and budget preparations. If you haven't ordered your copy, please contact our Member Service Center at 1-800-646-6460 or you may view the order form at the website.

NHPCO 2009 FEHC National Summary Report Available
NHPCO is pleased to announce the release of the 2009 FEHC National Summary Report. (NHPCO, 3/11/10)
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CMS NEWS AND HAPPENINGS

President Obama Likes the RACs and Wants More
On March 10, 2010, President Obama issued a memorandum to all heads of executive departments and agencies regarding finding and recapturing improper payments. As part of continuing efforts to combat fraud, waste and abuse throughout the government, President Obama is expanding the the use of "Payment Recapture Audits."    Payment recapture audits are what recovery audit contractors (RACs) do to earn their contingency fees. Given that the RAC program is already established and functioning for CMS, the directives of this memorandum may not require anything additional for the Medicare and Medicaid programs. The memorandum directs the Office of Management and Budget to provide guidance within 90 days regarding what actions executive departments and agencies of the government must take to fulfill the requirements of the memorandum. At that time it will be clearer whether this new initiative has implications for further expansion of CMS' current RAC program.(White House, 3/10/10)

Revised Ambulance Fact Sheet
The revised Ambulance Fee Schedule Fact Sheet (January 2010), which provides general information about the Ambulance Fee Schedule including how payment rates are set for ground and air ambulance services, is now available. (CMS, 3/13/10)

PECOS System Down for One Week
Due to scheduled maintenance, Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will be unavailable from Monday, March 29, 2010 through Monday, April 5, 2010.  Internet-based PECOS allows physicians, non-physician practitioners, providers, and other suppliers (except suppliers of durable medical equipment, prosthetics, orthotics, and supplies [DMEPOS]) to enroll or make a change to their existing Medicare enrollment information over the Internet. If you would like to enroll or make a change to your existing Medicare enrollment record, you can do either of the following:

  • Use Internet-based PECOS prior to March 29, 2010 or after April 5, 2010. For more information about Internet-based PECOS, see the appropriate "Getting Started" guide available in the Downloads Section by clicking here. There is a "Getting Started" guide for physicians and non-physician practitioners and one for provider and supplier organizations.
  • Complete and submit the paper Medicare provider enrollment applications(s) (CMS-855) along with any required supporting documentation and mail the application(s) to the appropriate Medicare carrier, fiscal intermediary, or A/B MAC. The CMS-855 forms are downloadable from the CMS forms page.

If you need assistance or have questions, contact the Medicare fee-for-service contractor serving your State. (CMS, 3/10/10)

Health Professional Shortage Areas
Have you wondered how the bonus that physicians receive if they provide care in a Health Professional Shortage Ares (HPSA)? CMS has just release the NEW Health Professional Shortage Area (HPSA) Fact Sheet (March 11, 2010). This fact sheet provides general requirements and an overview of the Health Professional Shortage Area (HPSA) payment system. (CMS, 3/11/10)

Revised Physician Fact Sheet
The Medicare Physician Fee Schedule Fact Sheet (March 2010) has been revised to include information about the two month zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) effective for dates of service January 1, 2010 through March 31, 2010.(CMS, 3/10/10)
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STATE NEWS

New Managed Care Provider Complaint Link
A new web address has been created for the managed care provider complaint form at mcp.ohio.gov. The new website is much more user friendly, and will automatically redirect the provider to the original web address where the provider complaint form is housed. The provider frequently asked questions (FAQs) document located on our website will be updated to reflect this as well. (ODJFS, Bureau of Managed Care, 3/10/10)

Ohio Medicaid to Get$750 Million From Feds
The federal bill that would extend unemployment benefits includes a provision that would give Ohio's Medicaid program an additional $600 million to $750 million in federal funds. Click here to read the full article. (Ohio Health Policy Review 03/12/2010)

HB 314 Passes in House
HB 314 authorizing registered nurses to deterimine and pronounce death was passed in the House on 3/10/10 by a vote of 93 to 3. The bill now goes to the Senate where it is expected to languish. The OSMA has indicated they will not support the bill and Representative Ujvagi will be leaving the General Assembly to take a position back in Toledo and there does not appear there is another champion for this piece of legislation. (Barnes & Thornburg)
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PALMETTO GBA NEWS

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Thanks to Don Pendley for contributions. Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2010.  Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division.  Ask your insurance agent to visit their website at www.hccis.com. Hospice News Network is published 45-47 times a year by a consortium of state hospice organizations.  Copyright, 2010.  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.  (Volume 14, Number 11, March 16, 2010)