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03/11/2010

Hospice E-News Volume 15, Issue 10 March 11, 2010

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TWO FREE QAPI COACH ONLINE TRAININGS

The Midwest Center's QAPI Coach project will be holding an encore of its January webinar trainings for individuals planning to participate in the QAPI Coach benchmarking project for 2010. These trainings wiwill be held:

  • April 6, 1-2:30 pm: Introduction to QAPI Coach & QAPI Coach Core Indicator Data Set
  • April 7, 1-2:00 pm: QAPI Coach Dedicated Inpatient Unit Data Set

To sign up for the webinars, email susan@ohpco.org and indicate which webinar you want to participate in and the number of individuals that will be participating from your organization. For more information on QAPI Coach or to sign up for the QAPI Coach benchmarking project, contact Susan Wallace, QAPI Coach Coordinator by calling 614-763-0036 or emailing susan@ohpco.org.
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STUDY OF HASTENING DEATH OF CHILDREN DYING OF CANCER

A study was published Monday in the March edition of Archives of Pediatrics & Adolescent Medicine. It was based on interviews with parents of 141 children who had died of cancer and were treated at three hospitals, in Boston and Minnesota. Click on the following links to read about the study and additional articles:

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RESEARCH & RESOURCE NOTES

  • Focus group interviews with the parents of children who had died of brain tumors revealed three themes: 1) The "progressive neurologic deterioration" characterized the disease progress, and loss of the child's ability to communicate was a turning point; 2) Parents struggled to balance other responsibilities, and also with speaking with the child about death; and 3) "Barriers to achieving a home death included suboptimal symptom management, financial and practical hardships, and inadequate community support." The article is titled "Palliative Care of Children With Brain Tumors". (Archives of Pediatric & Adolescent Medicine, 2020;164(3):225-230; HemOncToday, 3/2)
  • "Factors Associated with Congruence Between Preferred and Actual Place of Death" is a literature review of the relationship between the preferred and actual place of death. The specialized home care studies found 59%-91% congruence, while a physician-led home care program reported 91%.  Several studies showed the "physician support, hospice enrollment, and family support improved congruence." (Journal of Pain and Symptom Management, 2/2010)
  • "Reformulation of the Sedation Continuum" explores several risks in the current practice of sedation, including the "inherent subjectivity in identifying and quantifying a patient's response to verbal or tactile stimulation," "lack of consensus between specialty societies about which specialists, what resuscitation skills, and which sedatives are appropriate at specific sedation depths," and "the implicit need to repeatedly stimulate the patient to assess and monitor sedation depth." The authors encourage moving away from such subjective criteria to "objective physiologic monitoring" to define sedation depth, and call for "focused research" to define the levels of depth and the parameters to assess each level of depth. (JAMA, 2010;303(9):876-877)

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PALLIATIVE CARE & END-OF-LIFE NOTES

  • Hospice volunteers who sit with dying patients are nothing new, but hospitals are beginning to embrace programs such as No One Dies Alone. The program criteria for calling in a volunteer to sit with a dying patient are "imminent death, a do-not-resuscitate order, and no family present." In Colorado Springs, Dr. Roger Nagy, medical director of trauma at Penrose Hospital, said of one volunteer, "As soon as Jill came, a weight was lifted off me because I knew she was there. And I could just focus on the medical side. We could work on the clinical side and Jill was there to concentrate just on the human side. From my perspective, it was wonderful." (AP State & Local Wire, 2/27)
  • Oregon's The Daily News profiled the work of the David C. Wright Supportive Care program, the new palliative care program at St. John Medical Center.  The program also received a grant from Blue Cross Blue Shield Association's Regence Foundation which is being used for education and training for the hospital staff. (The Daily News, 2/24)
  • The Sacramento Bee videoed Ilse Laudi as she talked about her family's decision to enroll her husband, Gunter, in hospice. The video is part of the Second Opinions Winter Forum, sponsored by The Sacramento Bee and Capital Public Radio. Their son, Pete, said that his goal was to keep his father at home so that he wouldn't have to die "in a sterile environment." (The Sacramento Bee, 2/25)
  • The Thibodeaux Daily Comet profiled Chad and Theresa Bellanger as they cared for their baby daughter, Aubrie, with the help of St. Joseph Hospice. Aubrie was born with Zellweger syndrome, and her parents faced the choice of leaving her in the hospital in New Orleans or bringing her home to care for her until her death. Hospice nurse Cathy Bowen, who is also the Hospice's administrator and director of nursing, was formerly a pediatric intensive care nurse, often spent the entire night with Aubrie to give her parents a break. The Bellangers were very pleased with the Hospice's services, and have offered their own services as volunteers. (The Thibodeaux Daily Comet, 3/3)
  • The Philadelphia Inquirer is beginning a new series of occasional articles on health care. The first, "A Look at the New Field of Palliative Care," and the second, "Dennis Mucerino: Aggressive Care Until the End," document the decision-making power of the patient's families in the kind of care given, and contrast palliative and aggressive care. (The Philadelphia Inquirer, 2/28; Kaiser Health News Daily Report, 3/1)

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IRS 1099 QUESTIONS

NAHC posed the question of 1099s to the Financial Manager's Forum. The respondents advised that the amount stated on 1099s should not be submitted to the IRS as revenue. Rather, actual revenue received should be reported. As stated by one financial manager: "We get hundreds of 1099s from the various payers and use none of them. We do our 990s from the earned statements. We have never had a problem with that." Apparently concerns have been raised because CMS changed the reporting of revenue on this year's 1099 from reflecting net revenue to reflecting gross to be in compliance with IRS requirements. This change brought to light the fact that, in prior years, agencies may have been inappropriately using 1099s to reflect their income for IRS purposes. According to a May 2009 CMS Transmittal 498, Change Request 6466: FISS, MCS and VMS shall comply with Form 1099 rules, regulations, procedures and instructions in reference to computing "Gross Payment" as published at www.irs.gov.

*For NGS: You may call the customer service line 1-877-702-0990 or write. 

*For Palmetto: If an agency feels their 1099 is in error, please have them request a reconciliation report. Include the agency Tax ID, PTAN and NPI in the request. Requests can be made by calling 1-888-782-2350, via email at: tax.admin@palmettogba.com or by mail: Palmetto GBA Finance Mail Code AG-260, PO Box 100277, Columbia SC 29202-3277(NAHC, 3/5/10)
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NHPCO NEWS AND UPDATES

MedPAC Released 2010 Report to Congress
On Monday, March 1, the Medicare Payment Advisory Commission (MedPAC) released their 2010 Report to Congress. In the "March Report," MedPAC released its recommendations for annual rate adjustments for provider types in fee-for-service (FFS) Medicare.  These payment update recommendations are based on an assessment of payment adequacy for each provider type, taking into account beneficiaries' access to care, supply of providers, quality of care received and Medicare margins. 

As reported in a 01/15/2010 news, when the MedPAC commissioners voted on the recommendations for the March Report, the payment update recommendations for hospice are detailed below. MedPAC is recommending a full hospital marketbasket update, projected to be 2.4%, minus an adjustment for the productivity factor, making the recommended actual amount of increase to be 1.1% for FY2011.  Congress would have to make this change because CMS does not have authority to do so on its own. Assuming Congress directed CMS to make the reduction, no payment adjustment is final until the proposed and final wage index rules are released by CMS. If this recommendation is reflected in the final wage index rule, the amount of increase would go into effect on October 1, 2010 for FFY 2011.

MedPAC's Hospice Recommendations - Hospice - 2010 Recommendation:
The Congress should update the payment rates for hospice for 2011 by the projected rate of increase in the hospital market basket index less the Commission's adjustment for productivity growth (a net update of approximately 1.1%).

The Commission also reiterated its hospice recommendation from the March 2009 Report to Congress:

  • The Congress should direct the Secretary to change the Medicare payment system for hospice to have relatively higher payments per day at the beginning of the episode and relatively lower payments per day as the length of the episode increases; include a relatively higher payment for the costs associated with patient death at the end of the episode; and implement the payment system changes in 2013, with a brief transitional period. These payment system changes should be implemented in a budget neutral manner in the first year.
  • The Congress should direct the Secretary to require that a hospice physician or advanced practice nurse visit the patient to determine continued eligibility prior to the 180th-day recertification and each subsequent recertification and attest that such visits took place, require that certifications and recertifications include a brief narrative describing the clinical basis for the patient's prognosis, and require that all stays in excess of 180 days be medically reviewed for hospices for which stays exceeding 180 days make up 40 percent or more of their total cases.
  • The Secretary should direct the Office of Inspector General to investigate the prevalence of financial relationships between hospices and long-term care facilities such as nursing facilities and assisted living facilities that may represent a conflict of interest and influence admissions to hospice, differences in patterns of nursing home referrals to hospice, the appropriateness of enrollment practices for hospices with unusual utilization patterns (e.g., high frequency of very long stays, very short stays, or enrollment of patients discharged from other hospices), and the appropriateness of hospice marketing materials and other admissions practices and potential correlations between length of stay and deficiencies in marketing or admissions practices.
  • The Secretary should collect additional data on hospice care and improve the quality of all data collected to facilitate the management of the hospice benefit. Additional data could be collected from claims as a condition of payment and from hospice cost reports. (NHPCO, 3/2/10)

To read the Appendix, click here.

What's Next for Health Care Reform and What Exactly is Reconciliation?
Last week's Health Reform Summit hosted by President Obama does not seem to have bridged the divide between Republicans and Democrats. After nearly seven hours of bipartisan statements and debate, the Administration and Congress appear to be no closer to working together to reignite the reform effort. However, President Obama is expected to release an updated version of his proposal today that incorporates some of the areas of agreement between the parties. Either way, Democrats have signaled that will move forward with health care reform this year, and they hope to wrap it up prior to their Easter break.

The Path Forward
The path that Democratic leadership appears to be pursuing is one that involves a legislative process called . Here's a brief overview of what that process would involve:

  • Congress and the White House have signaled that the underlying health reform bill that they wish to move forward is the Senate-passed Patient Protection and Affordable Care Act.
  • The House would need to pass that legislation with a simple majority, or 218 votes. The Democrats will have to keep the bill exactly as is, allowing for no amendments or modifications, in order to avoid having to send the bill back to the Senate for an additional vote.
  • Any changes that the House requires from the health reform package would have to be bundled into a reconciliation bill, which will be subject to a simple majority vote in both chambers and a different set operating rules governing the floor consideration.

NHPCO has prepared a Reconciliation Q & A document for members who are interested in an overview on the unique rules that govern this process.  

End-of-Life Care and Reconciliation
As you may have seen, the national media has been covering the political controversy currently surrounding the proposal to finish health reform through reconciliation. Politics aside, reconciliation has been an often-used procedure by both parties to pass legislation, both sweeping and small. In fact, the 1982 reconciliation bill actually added the hospice benefit to Medicare! Additionally, a 1990 reconciliation bill required Medicare providers to notify patients about advance directives and living wills.

What Can You Do?
For the time being, general Hospice Advocacy outreach is best. In the coming days, providers may need to ramp up with some specific requests of Congress as they move forward with the legislative process, so stay tuned! (NHPCO, 3/3/10)
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OCTOGENARIAN HAD PLANNED FOR EVERYTHING UNTIL A STOKE PUT HER IN LIMBO

When 87-year-old Bunny Olenick suffered a massive stroke in December 2008, doctors told her family there was no chance she could recover fully, although her limitations probably wouldn't be known for months. A neurologist told her sons that if she did survive, her ability to communicate would be diminished, and she would likely need around-the-clock care for the rest of her life. What would Bunny want her sons to do?

This article published by Kaiser Health News on 3/5/10, tells the journey and support her sons received during her last days. (Kaiser Health News, 3/5/10)
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STATE NEWS

Home First Legislation Waits
Between bad weather and partisanship, legislators have not completed many measures during the weeks since their year-end holiday recess.  Among those in the pipeline are the two Home First bills, Senate Bill (SB) 214 and House Bill (HB) 398. These similar bills would revise the waiting list provisions of the PASSPORT and Assisted Living programs, letting Medicaid eligible older adults who live in the community receive home and community based care rather than having to accept more expensive nursing facility placement when waiting lists exist. SB 214, sponsored by Senator Carey (R-Wellston) and Senator Dale Miller (D-Cleveland), passed out of committee by unanimous vote on February 9 but the full Senate is not yet considering it. HB 398 is sponsored by Representative Debbie Newcomb (D-Conneaut) and Representative Peggy Lehner (R-Kettering). The Aging and Disability Services Committee is holding hearings to consider it. At the March 2 Committee meeting, questions arose about an amendment allowing a facility in Madison County to transfer 15 beds to a facility in Franklin County. Committee members agreed to consider HB 398 again at the next committee meeting on March 9. (OAAAA Bulletin, 3/5/10)

LTC Satisfaction Survey Results Released
On Thursday, March 4, the Ohio Department of Aging (ODA) released results of a satisfaction survey completed by residents of Ohio nursing facilities and assisted living facilities. The 2009 Long-term Care Resident Satisfaction Survey showed that residents are generally satisfied with the care they receive. The average satisfaction score for nursing facilities statewide was 85.85 (out of 100). Of 955 participating nursing facilities, 506 scored above the statewide average of 85.85. Scoring above the average makes a nursing facility eligible for a higher reimbursement rate. Of 558 participating assisted living facilities, 317 scored above the statewide average of 92.07.  Ohio is the only state in the nation to conduct a consumer satisfaction survey in assisted living facilities. The full survey results are available on the Ohio Long-term Care Consumer Guide website. (OAAAA Bulletin, 3/5/10)

Mini-COBRA Benefits Extended House Bill 300 Gives Three Additional Months
Ohioans who lost their jobs and were in danger of losing their health insurance received some relief on Thursday, said Ohio Department of Insurance Director Mary Jo Hudson. Governor Ted Strickland signed House Bill 300 (H.B. 300) into law, providing temporary extensions of Ohio continuation (mini-COBRA) coverage from twelve months to fifteen months to permit Ohioans who lose their jobs to take full advantage of the federal subsidies available to help pay for the cost of mini-COBRA, or state continuation, coverage. Effective immediately, all small employer-sponsored group insurance policies issued, delivered or renewed on or after February 25, 2010, increase continuation coverage from 12 to 15 months. 

The extension is temporary and lasts only as long as newly terminated employees are eligible for federal premium subsidies for mini-COBRA coverage. When those federal subsidies are no longer available to newly terminated employees, the temporary law will end, and the Ohio law will return to 12 months of continuation coverage. H.B. 300 affects only the duration of continuation coverage provided by Ohio insurance law. All other provisions of these statutes remain in effect. The Department is issuing a bulletin offering guidance to insurance companies concerning this change to the Ohio continuation law. That bulletin, as well as the complete version of H.B. 300, can be found on the Ohio Department of Insurance website. Ohioans with questions about the new law can call the Department's consumer hotline. (ODI, 2/26/10)
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ONLY 85 DAYS REMAIN BEFORE THE MEDICARE COST REPORT IS DUE!

The Medicare Cost Report is due 5 months after the end of the fiscal year. That means May 31, 2010 for a December 31, 2009 year end. This year, the due date will actually be June 1, 2010 since May 31 is Memorial Day.

New this year is the method by which providers will obtain the Medicare PS&R report. As you should be aware, the PS&R reports will no longer be mailed by the FI's/MAC's. Providers were notified to register in the new IACS system. Providers will then be able to download their own PS&R reports at any time. 

While the registration process began late last year, many providers have had difficulty in getting properly registered to be able to download these reports that are needed to prepare the cost report. It has been reported through the industry that only about 20% of home health agencies and hospice providers are properly registered. With about 80% of providers not registered, there could be major problems over the next couple of months in getting these reports. The registration takes 3 to 4 weeks and requires certain IRS documentation.

If you are not registered, providers are encouraged to do so immediately. If you have any questions or need assistance with this process, please feel free to contact either Dave Macke or Michelle Reilly at 859-331-3300 as they have assisted numerous providers in completing the registration process and demonstrating how to download the reports. (VonLehman & Company, 3/1/10)
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PALMETTO GBA NEWS

PGBA In Columbus
PGBA will be in town on 3/23/10 to do its annual hospice update of changes in policies and billing. Be sure to sign up for this ½ day class.  Click here for more information and to register! See you there!

Services Denied for Provider Not Eligible/Deactivated: Liability for Charges
Click here to read the full article. 

The 'Temporary Extension Act of 2010' Extends the Zero Percent Medicare Physician Fee Schedule Update and the Therapy Cap Exception Process
Click here to read the full article.

Preview the New Palmetto GBA Web Site
Click here to read the full article.

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Thanks to Don Pendley and Melanie Ramey 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 statedhere. (Volume 14, Number 10 , March 9, 2010)


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