MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Hospice Blog' source. Mon, 17 Nov 2008 22:46:12 +0100 http://www.hospiceblog.org/2008/11/sign-of-what-is-to-come.html I concluded a post recently by saying that the big corporate hospices had won another battle, and that it was going to be even harder for the small guy to make it. Guess, I may have overestimated the health of the big hospices. Trinity Hospice, which is a subsidiary of Sunrise Senior Living (NYSE: SRZ), is shutting it's doors. Here is the "announcement" within their most recent financial report:In October 2008, the Company determined not to provide any additional funding for ongoing operations to our Trinity subsidiary due to the continued losses experienced by that subsidiary. As a result, the Company expects to write-off the remaining goodwill and other intangible assets related to Trinity of approximately $9.8 million in the fourth quarter of 2008. As a result of this decision to cease ... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1951821 Tue, 11 Nov 2008 18:01:00 +0100 1951821 http://www.hospiceblog.org/2008/11/interesting-research-numbers.html NHPCO has published its latest statistical compilation on hospice care in America. It is the 2007 numbers on hospice care and covers a lot of information. Good stuff to know when looking at the industry as a whole. (I think it's a free link, but if not, it's just another reason you may want to consider membership.)Palmetto GBA, one of the handful of Medicare Intermediaries that work with hospices, has released a PowerPoint presentation that contains Non-Cancer Length of Stay information for the states it covers. This is a trove of information that can help inform the Medicare Hospice Cap discussion. The general feeling is that Non-Cancer Length of Stay is one of the leading culprits in hospices who have cap issues, and Palmetto covers most, if not all, of the states that are best known for... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1939013 Wed, 05 Nov 2008 15:18:00 +0100 1939013 http://www.hospiceblog.org/2008/11/new-hospice-billing-changes.html Medicare has released its next round of billing changes, and this one won't be fun. (The last one wasn't fun either, but that's beside the point.) You can find the information here. (Click on the zip file to read the .pdf explanation of the proposed changes.) Clearly, there will be more on this as comments are made and the final rule is posted, but here is my quick gut take.The biggest change in terms of implementation is that we will now be reporting the time of visits in 15 minute increments. For many hospices, this won't be a big deal at all. As usual, this rule will be much more painful for smaller hospices than large ones. The small hospices across the nation are going to have a hard time meeting both the new Condition's of Participation and these new billing rules without converting ... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1930207 Mon, 03 Nov 2008 14:44:00 +0100 1930207 http://www.hospiceblog.org/2008/10/medicare-hospice-cap-update.html I gave an impromptu lesson in government in my recent update on the Medicare Hospice Rate Cuts post, and figured I should extend that to what is going on with the Medicare Hospice Cap issue.In the prior post, I discussed the fact that congressional fights are much easier won when your side can claim victory through congressional inaction. Doing nothing is a strong suit of our folks in Washington. In the rate cut debate, to have the rate cut stopped Congress must pass a bill, thus inaction has allowed the rate cut to take effect.In the Medicare Hospice Cap issue, those on the side of a cap moratorium are in the unfortunate position of needing Congress to pass a bill to help them out. The Hospice Cap is the law. It has been in the law for years. The moratorium, or flat out end of the cap for... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1911333 Mon, 27 Oct 2008 16:32:00 +0100 1911333 http://www.hospiceblog.org/2008/10/rate-cut.html I guess I may have left some of you hanging on the subject of the Medicare Hospice rate cut. Sorry about that, I haven't updated, because there hasn't been any motion.One of the big lessons I picked up along this adventure is that Congress' strength is inaction. Whoever is on the side of inaction usually wins when it comes to our government. In this instance, the rate cut was sent down from on high at CMS, so congress would have had to act to stop it. They did not act, so it was not stopped. The concept of congressional inaction being a strength is so accepted (and true) that congress itself uses it as a tool. The example of our times is the "Bush Tax Cuts". If you take a peak back into the history of those tax cuts, the Democrat Party told the Republican Party that they would go along som... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1891948 Mon, 20 Oct 2008 13:53:00 +0100 1891948 http://www.hospiceblog.org/2008/10/till-death-do-us-part.html There is an interesting article on MSNBC.com about long time married couples dying within a few months of each other. It gives research evidence that the phenomena does exits and a mixture of medical and psychological factors that may explain the phenomena. If nothing else, reading it may just tug at your heart.As someone who has seen their share of hospice patients, I sure can't deny that it is possible that a spouses death "causes" the surviving spouses death. We have, no doubt, had instances where the second one was referred for our services shortly after the first one's death, but I always wrote that off to coincidence and a family's appreciation for how great hospice can be. More than anything, I know enough about death to know that I don't understand it. Do I believe spouses can "die... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1886349 Fri, 17 Oct 2008 13:38:00 +0100 1886349 http://www.hospiceblog.org/2008/09/bills-introduced-to-stop-rate-cut.html Bills have been introduced in both the House and Senate to stop the Medicare hospice rate cuts. Follow the link to find out the history of the rate cuts, who sponsored the bills, what the bill actually does, and (most importantly) what you NEED to do to support this legislation. Time is very short to make this happen!update:Here is the text from the Senate floor when the bill was introduced.Here is the text from the House. (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1794376 Mon, 15 Sep 2008 15:56:00 +0100 1794376 http://www.hospiceblog.org/2008/09/nhpco-files-suit-against-medicare.html The National Hospice and Palliative Care Organization is suing Medicare to stop the rate increase.Guess that will silence all the people who have complained over the years that NHPCO wasn't aggressive enough. Personally, I'm not sure that they haven't been too aggressive in this instance, but I don't really know enough about the inner working of the process or the lawsuit to know for sure. I hope it turns out well, and assume NHPCO thinks they have a good shot at winning or they wouldn't have picked this fight. (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1775532 Mon, 08 Sep 2008 16:58:00 +0100 1775532 http://www.hospiceblog.org/2008/09/stories-of-hospice-nurse.html I was recently introduced to a blog written by a full-time hospice on-call nurse, and wanted to point you to one of her stories. I spend most of my time talking about the business of hospice, but we should never forget how hard hospice is. Everyone understands that we work with death and dying everyday, but what many don't remember is the fact that we work with families who are under great stress. The best of families show some dysfunction during these types of hard times, so just imagine what happens when you put a dysfunctional family under stress.Check out these two links (1 and 2) to read a rather tame example! (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1763875 Thu, 04 Sep 2008 16:09:00 +0100 1763875 http://www.hospiceblog.org/2008/09/shaping-minds-of-americas-youth.html In my last post I said, "It is not an overstatement to say that we are reaching the goal of changing the way our nation views and faces the end of life." Now, I have proof.The Beloit College Mindset List, which is "a look at the cultural touchstones that shape the lives of students entering college", has provided me with my proof. I found the list very interesting since it is full of pearls of wisdom such as, "For these students, Sammy Davis Jr., Jim Henson, Ryan White, Stevie Ray Vaughan and Freddy Krueger have always been dead." If you want to feel old, you should read the whole list.The part that makes this list news on hospice blog is that the list reports that, "All have had a relative--or known about a friend's relative--who died comfortably at home with Hospice." Think about that fo... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1750077 Mon, 01 Sep 2008 14:13:00 +0100 1750077 http://www.hospiceblog.org/2008/08/tale-of-vanishing-hospice-chaplain.html I have been writing lately about the changes our industry is going to have to deal with in the future, and what needs to happen now. In this post, I want to deal with the scary future of hospice if these changes are not made. Currently, hospice as a business is at a crossroads. Where it will end up is anybody's guess. My guess (or prayer) is that we end up being what hospice was created to be. We have become so much more than any of the original hospice pioneers ever dreamed we would become. It is not an overstatement to say that we are reaching the goal of changing the way our nation views and faces the end of life. Even more, we have become a driving force behind the national movements to increase awareness and access to pain management and grief counseling. What the hospice movement has... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1739058 Wed, 27 Aug 2008 16:59:00 +0100 1739058 http://www.hospiceblog.org/2008/08/what-is-main-thing.html I have no clue who first said, "The main thing is keeping the main thing the main thing", but I owe them a debt of gratitude. That odd little line has helped keep me focused through the years, and it is very timely advice for the hospice industry. My last couple of posts have dealt with the necessity of hospices moving from the relaxed business practices of the past to the world of having very serious best practices in place to ensure operational efficiency. I'm sure it isn't the most popular stuff I've ever written, but I am also sure that it is something hospices must face.Today I want to deal with what, exactly, the main thing is. Hospice, as defined by the Hospice Medicare Benefit, is the main thing.Hospices today often do so much more than what they did twenty five years ago. Just bec... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1723422 Thu, 21 Aug 2008 16:07:00 +0100 1723422 http://www.hospiceblog.org/2008/08/financial-efficiency-its-no-longer.html As I mentioned earlier, I believe there has been a real resistance within the hospice community to accept the fact that hospice is a business and that we need to adopt best business practices. In my mind, Andrew Reed of Multi View Incorporated has been the industry's John the Baptist as he has been carrying this message through the wilderness for years. He has been preaching financial accountability, visit tracking, and benchmarking for a dozen years now, and we have finally reached the time where listening to the message is no longer an option. In this post I want to explain why I think having less than solid business practices is no longer an option. First, burying your head in the sand and wishing for the days when hospice was an all volunteer movement was never a good idea. Some have d... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1709025 Fri, 15 Aug 2008 20:16:00 +0100 1709025 http://www.hospiceblog.org/2008/08/hospice-is-business.html A commenter on the previous post about the Medicare Hospice Benefit rate cut asked if, "the 'average' profit margin for hospice has a lot of built in inefficient and wasteful hospices"? In his mind, if the average profit margin of hospices is being dragged down by a lot of hospices that are not being run well, then those inefficient hospices are the ones who will go away, and that's not such a big loss.I agree 100%. There is no doubt in my mind that there are a lot of hospices that run their organization poorly. In fact, I believe there are some hospices who wear their inefficient (or poor) business practices like a badge of honor. Often, when I hear non-profit hospices talk about the evil practices of for-profit hospices, their examples of evil are the for-profit's focus on efficiency or ... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1696134 Mon, 11 Aug 2008 16:06:00 +0100 1696134 http://www.hospiceblog.org/2008/08/medicare-cuts-hospice-payment-rates.html Medicare has published the wage index and payment rates for FY 2009, and the announcement is the finalization of one part of the feared rate cuts. Of course, that isn't quite how CMS sees what it has done. They actually put out a press release that packages the whole thing as hospices getting a pay raise. Let me explain what's happening and then tell you why this is really bad timing.First, to understand how hospices can claim their rates have been cut while the government claims they gave hospices a pay raise, you must understand that there are two parts to the formula used to figure hospice payment rates. This explanation is overly simple, but good enough for our purposes. The first part of the formula is the national hospice payment rate. It is the amount of money that Medicare pays for... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1679335 Mon, 04 Aug 2008 15:41:00 +0100 1679335 http://www.hospiceblog.org/2008/07/how-to-choose-hospice-why-doctors.html Dr. Sinclair at Pallimed has written a very informative post to add on to my series on How to Choose a Hospice. This post is titled How to Choose a Hospice: Why Doctors Matter. Dr. Sincleiar is a full-time hospice doctor, so he brings a point of view and set of experiences to his writing that is different from my own. The subject of hospice doctors is one that I have been thinking about quite a bit lately, and one that will grow more important with the new Medicare Conditions of Participation. Click the link and read on. (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1671476 Thu, 31 Jul 2008 13:10:00 +0100 1671476 http://www.hospiceblog.org/2008/07/how-to-choose-hospice-why-some-things.html (This post is part of a series of posts. To read from the begining of the series go here.)This is my final post in the How to choose a hospice series for now. As time goes on, I'll think of other suggestions, but nine is enough for now.In this post I'll tell you a few of the things that don't matter and some that do. Most of this post is in response to other websites that have lists of things that are important when choosing a hospice. Some have good suggestions, some are silly, and some are downright self serving. Here's my list of what is and is not important:What doesn't matter:The for profit/not-for-profit status of a hospice. You will hear non-profit hospices preach that for-profit hospice is the most evil thing in the history of civilization, but it just isn't true. There are bad non... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1593792 Mon, 07 Jul 2008 14:02:00 +0100 1593792 http://www.hospiceblog.org/2008/06/how-to-choose-hospice-why.html (This post is part of a series of posts. To read from the begining of the series go here.)There is little better than the recommendation from someone who has experience with a specific hospice. If you have friends that have used hospice in the past, you should talk to them. Be warned though that hospice is overwhelmingly popular with families who have used it, so one glowing recommendation doesn't mean you have found the best hospice. Again, most hospices are good at caring for the average patient, so if your friend's loved one was an average patient, you should expect a positive review. Ask your friend the questions from the other posts and see what you learn.If your loved one lives in a nursing home, I'm going to assume that you have followed the instructions from part 2 that says that y... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1556274 Mon, 30 Jun 2008 14:02:00 +0100 1556274 http://www.hospiceblog.org/2008/06/how-to-choose-hospice-why-staffing.html (This post is part of a series of posts. To read from the begining of the series go here.)In "Why Size Matters", I talked about how many patients each nurse has. This time I want to talk about how much attention you should expect and who you should expect to get it from.First, frequency of visits. Your nurse should visit at least twice a week. Any nurse that thinks they can keep up on a hospice patient's condition by visiting once a week is delusional. Find a hospice that promises a minimum of two nursing visits a week. It shouldn't be too hard.Second, find out who makes the visits. The question you should ask is if the same nurse will visit every time. There are two different theories on how to use nurses. As with everything in hospice one is best for the patient and one is best for the p... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1537893 Mon, 23 Jun 2008 14:02:00 +0100 1537893 http://www.hospiceblog.org/2008/06/how-to-choose-hospice-why-size-matters.html (This post is part of a series of posts. To read from the begining of the series go here.)No matter what they tell you, size does matter. To be honest, I can't decide how much it matters. That means that while this post is good advice, it is not as important as many of the other suggestions you'll receive in this series.You don't want a hospice that is too big. You don't want a hospice that is too small. You want a hospice that is just right.What is too big? I'd say anything over 90 patients in any given office. Make sure you find out how many the office closest to you has, because there are companies that have one huge office and many other offices that are a better size. You should only care about the office that you will be working with. As a hospice grows larger there is no way to avoi... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1522031 Mon, 16 Jun 2008 14:02:00 +0100 1522031 http://www.hospiceblog.org/2008/06/how-to-choose-hospice-why-pharmacies.html (This post is part of a series of posts. To read from the begining of the series go here.)My thoughts on this subject have changed quite a bit since I first wrote this series in March of 2005. Then I was not a fan of hospices that use the large "mail order" hospice pharmacies, now I believe that those pharmacies may be the best option for some hospices.Your hospice is in charge of providing all medications that are needed to control the symptoms associated with your hospice diagnosis. With that charge comes a lot of responsibility. Your goal is to have your pain controlled. The hospices goal is to control your pain in a cost effective manner. I used to think that a hospice that was willing to hire an out of state pharmacy was a sign that the hospice was more focused on the cost control sid... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1502520 Mon, 09 Jun 2008 14:02:00 +0100 1502520 http://www.hospiceblog.org/2008/06/hospice-conditions-of-participation.html This is not the first time where my membership in NHPCO has made it hard to know what I should or should not say on this blog. In theory, everything that I know to date about the new Medicare Hospice Conditions of Participation is from publically accessible information. In reality, there is no way that I would know everything that I know without the help of the National Hospice and Palliative Care Association. NHPCO has done a great job of getting insight and information out to its membership about the new COP's. They are in the middle of a two day workshop in Baltimore that is being webcast at no charge to NHPCO members. While the subject matter is dry, it is somewhat amazing to get to hear the people from CMS who actually drafted these rules talk about them. There are two women from CMS ... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1494295 Thu, 05 Jun 2008 01:12:00 +0100 1494295 http://www.hospiceblog.org/2008/06/how-to-choose-hospice-why-location.html (This post is part of a series of posts. To read from the begining of the series go here.)For part three of this series I want to deal with the most important question - location, location, location.I want to say from the top that I am not talking about where the office is located. Many hospices operate out of some really dumpy buildings in really bad locations. Hospice is one of the few businesses where the client almost never visits the office, so many hospices save some money by operating out of spaces that should be condemned. Many hospices operate out of houses instead of office buildings. All of this is to say that you should pay zero attention to what the office looks like or where it is.Before I explain myself please know that of all the words I spill and all the advice I give in t... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1484862 Mon, 02 Jun 2008 14:01:00 +0100 1484862 http://www.hospiceblog.org/2008/05/conditions-of-participation-reaction-to.html Clearly I am nowhere near finished digesting the 757 pages of the final Medicare Hospice Conditions of Participation, but, since I have read until my eyes can't take it any longer, I figured I'd give you my first impression. I reserve the right to change my mind, but, at this point, I'm impressed with what Medicare has done.Shockingly, I believe Medicare has done a good job here. Perfect? Of course not. Good? Yes. What has impressed me is the thoughtfulness Medicare has shown in dealing with the comments submitted by people within the industry when they published the proposed rules a few years ago. Over 400 of the 757 pages deal with comments made during that period and Medicare's reaction to them. From what I have read so far, Medicare listened to and understood the concerns of the hospic... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1477885 Thu, 29 May 2008 20:22:00 +0100 1477885 http://www.hospiceblog.org/2008/05/conditions-of-participation-link.html Here is a link to the .pdf of the new Medicare Hospice Conditions of Participation. I've gotten to page three of 757, so no great insight from me. The thing I was scanning for was the implementation information, and I was very happily surprised when I found it. Most were expecting a sixty day implementation period and hoping for ninety. We got 180! That gives us six months to figure out what the other 754 pages say and how to deal with them in our hospice programs. That is a relief. (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1472442 Wed, 28 May 2008 14:43:00 +0100 1472442 http://www.hospiceblog.org/2008/05/new-cops-are-published.html One of my first posts on this blog was about my dreams and requests for the upcoming changes in the Medicare Hospice Conditions of Participation. Well, a few years have gone by, and I'm finally going to get to see if my dreams have come true. According to NHPCO, the newly revised final COP's have been posted at the Federal Register. They are not available on the internet yet, but should be tomorrow. Of course, the document is 800 pages, so it may take some time to sort through. We should know most of what is in them, but there are still a lot of people who are holding their breath hoping there are no surprises.This is a huge moment in the history of hospice in America, but it is going to take us a few weeks to actually understand what happened today. (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1472443 Tue, 27 May 2008 20:30:00 +0100 1472443 http://www.hospiceblog.org/2008/05/how-to-choose-hospice-why-management.html (This post is part of a series of posts. To read from the begining of the series go here.)Part three is an easy follow up question to the one you asked in part 2. Now that you know who owns the company, you need to know how many offices they have, where the offices are, and which one is the home office. You now need to know if the "big cheese" works out of your local office. (I use "big cheese" because this could be different people with different titles for different hospices. If the owner actually works for the company, then clearly the owner is the big cheese. The big cheese's desk is the place where the buck stops. You need to know who the big cheese is and where he/she works.You need to understand three things to understand why this question is important.First, most states limit how m... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1467831 Mon, 26 May 2008 14:01:00 +0100 1467831 http://www.hospiceblog.org/2008/05/how-to-choose-hospice-why-ownership.html (This post is part of a series of posts. To read from the begining of the series go here.)As I said in the previous post, the differences between hospice companies are often small and usually hard to find. This post deals with one thing that I feel is a huge difference; Ownership. Who owns the hospice is a very important question, because it gets to the very core of the reason the company exists. If a company is listed on the stock exchange, then the stockholders are the owners. Do you think they invested in the company because they wanted to own the stock of a company that takes good care of people? Do you think Charles Schwab advises their clients to invest in HCR Manor Care (the owner of the national chain Heartland Hospice) because they treat people right? No, investors buy stock becau... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1451777 Mon, 19 May 2008 14:01:00 +0100 1451777 http://www.hospiceblog.org/2008/05/another-hospice-blog.html In case you have not found it yet, the Hospice Foundation of America has started a Hospice and Caregiving Blog. There is some great content there for professionals and families; bookmark it. (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1449301 Fri, 16 May 2008 18:31:00 +0100 1449301 http://www.hospiceblog.org/2008/05/how-to-choose-hospice-why-it-matters.html This is the first in a multi part series on how to choose a hospice. The later posts will go into detail about what you need to know and how to find out, but before I get into all of that I wanted to talk about why it matters. If you pump truth serum into most hospice workers they will tell you that there isn't much difference between their company and the others, and in reality there isn't. We all work under the rules of the Medicare Hospice Benefit. Medicare tells us what staff we must have, what we must pay for, who does and does not qualify for hospice, how often we can or can't do certain things, who we contract with to provide certain services, and even who we can't contract with. The Medicare Hospice Benefit rules hospice in the United States today. With that fact in mind, I'm going... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1436828 Mon, 12 May 2008 14:01:00 +0100 1436828 http://www.hospiceblog.org/2008/05/how-to-choose-hospice-updated.html Over the next few weeks I will be publishing an updated set of posts on how to choose a hospice. This is a series I posted first in March of 2005. The format will remain the same and much of the content will remain the same. My thoughts on some issues have changed over the past couple of years (I may have even been wrong about a few things.) and the industry has changed quite a bit. I think this series, out of all the rambling I have done, is probably the most important, so I wanted to try to keep the series updated to the current trends in hospice. There are also many people reading this blog who didn't read it in 2005, and I hope you will all feel free to give your thoughts and advice in the comments section. Argue with me when you think I'm wrong; Lord knows many of you probably know mo... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1426310 Wed, 07 May 2008 21:40:00 +0100 1426310 http://www.hospiceblog.org/2008/05/if-you-think-price-of-gas-is-hurting.html The price of gas has been making headlines for a while now, and has become a political football. There are all kinds of ideas being put out there by the President and those who want his job. We could have a gas tax holiday, drill for our own oil, punish the oil and gas companies, ride our bikes more… In the end I expect that our "leaders" in Washington will probably point their fingers at the other party and do absolutely nothing.I'll stay out of the political side of the issue, and just say that if gas is going to cost $3.75 a gallon, Medicare needs to seriously consider giving rural hospices a little extra money. Every delivery you get these days has a "fuel surcharge", and hospices need to get into that game also. Rural hospices cover a lot of ground, and that is becoming very hard on... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1418433 Sat, 03 May 2008 16:39:00 +0100 1418433 http://www.hospiceblog.org/2008/04/medicare-officially-begins-hospice-rate.html I have focused quite a bit in the past on the proposed hospice rate cuts, and have probably done a poor job of explaining the different fronts on which this battle is taking place. One of those fronts has heated up quite a bit.The Centers for Medicare and Medicaid Services has now officially proposed a rule change that will change the wage index that is used to figure hospice payment rates. This change, if it takes effect, will be phased in over a three year period and will reduce the daily rate that hospice can bill Medicare. The wage index is different for different portions of the country, so the exact effect for each hospice will vary. For my hospice, our rates will be reduced by exactly 5%. The fun part about this is that CMS can make the rule change without going to congress for appr... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1409700 Wed, 30 Apr 2008 15:01:00 +0100 1409700 http://www.hospiceblog.org/2008/04/my-hospice-cap-conclusion.html Conclusion:I do not want congress to focus on changing the hospice cap. Instead, I want Medicare to focus more on enforcement of the cap.My reasoning:The government, especially Medicare, is well aware that there is abuse and corruption in the hospice industry, and they will be forced to address it at some point. As best I can tell, they have three opportunities on the horizon to address these problems.The hospice reimbursement issues that are currently before congress. An across the board cut of hospice reimbursement has the ability to reduce the services hospice patients receive. Yes, if you cut the rates deeply, those companies that are only in hospice for the money will leave, but it will also force those who stay in the industry to reduce services to match the income. Even with that, ... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1391007 Tue, 22 Apr 2008 15:09:00 +0100 1391007 http://www.hospiceblog.org/2008/04/pallimeds-take-on-hospice-budget-cuts.html As you know, I have been trying to raise some awareness about the hospice reimbursement cuts in the proposed federal budget. Christian at Pallimed has jumped on the bus with a post that is much more informative than anything I have written. Make sure and read his post to gain a solid understanding of what the issues are and then do something about it by contacting your congressman. Another good idea that Christian made is that you put in the comments of his post what you have done so that we can begin to see what effect the hospice blogosphere may be having.(It doesn't hurt that Christian says a lot of nice things about me in his post. He is clearly a good judge of character, which must translate into a good judge of when it is time to start acting to keep these cuts from sneaking through ... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1379377 Thu, 17 Apr 2008 18:13:00 +0100 1379377 http://www.hospiceblog.org/2008/04/nhpco-legislative-campaign.html I've written a bit recently about the Medicare hospice payment changes proposed in the president's budget, and now NHPCO has a tool to help you let our legislators know about your feelings on this issue.If you are like me, the effort you must go through to write your Senators or Representative a letter about any subject isn't worth the minuscule impact that the letter will have. Seriously, do you really think your senator is going to read your letter and change their mind based on what you say? Maybe I'm jaded, but I don't really think my elected officials really care what I think.With that in mind, NHPCO has made it much easier to send a letter to the people you helped elect. Go to their Cap Wizard, click on " Help Protect the Hospice Reimbursement Rate", write your letter, put in your zi... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1360549 Wed, 09 Apr 2008 15:38:00 +0100 1360549 http://www.hospiceblog.org/2008/04/hospice-sky-is-falling.html I can't believe I haven't written anything in a month! To make it even worse, it has probably been the busiest month in the industry since I started writing this a few years ago. While it seemed everything hit hyperdrive within the industry it also hit hyperdrive in my life. Wow.It is almost midnight as I write this, so I'm not even going to attempt to give any type of detail to the things that have been going on. Thanks to all of you who have sent e-mails recently asking my opinion on subjects or making sure that I hadn't missed any of the big news. I've been keeping up with the news, but haven't been able to keep up with the writing.The quick run-down of things that are happening in the hospice world:As I blogged recently, President Bush's budget calls for what will amount to a 15% reduc... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1344197 Wed, 02 Apr 2008 04:15:00 +0100 1344197 http://www.hospiceblog.org/2008/02/hospice-in-federal-budget-revisited.html I wrote a quick post earlier this month about the budget proposal that President Bush sent to congress. On first look, it was a little worse for the hospice industry than last year's proposal, but not a big deal. Well, your lowly hospice blogger missed something big in that post. Before telling you what I missed, I'd like to say that this is the precise reason that I encourage you to become a member of the National Hospice and Palliative Care Association. That little portion of the submitted budget that I overlooked is much more than a little issue, and I would have never known about my oversight if it weren't for the alert that NHPCO sent out to all of its members. More than that, when they sent out the alert they had excel spreadsheets already worked out so I would know just how much pai... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1263381 Wed, 27 Feb 2008 22:24:00 +0100 1263381 http://www.hospiceblog.org/2008/02/hospice-recommendations-in-president.html Excuse me if I'm not up in arms about the new budget proposed by President Bush. I thought about cutting and pasting my post from almost exactly 365 days ago here, because the proposal is largely the same.When President Bush sent his proposed budget to congress, it called for a zero percent rate increase for hospice in 2009-2001. In 2012 & 2013 we would get our normal rate increase minus .65%. Now, going three years with rates not changing at all would be a big deal. I can promise my employees will be expecting pay raises in 2009, 2010, and 2011. Employee salary is often around 80% of a hospice's costs, so giving everyone a 3% "cost of living" raise three years in a row while our rates are not increasing would make a company that is currently making an 8% profit lose money. (Yes, that ... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1219448 Fri, 08 Feb 2008 22:21:00 +0100 1219448 http://www.hospiceblog.org/2008/02/tom-hoyer-hospice-cap.html Briefly, I wanted to mention a section of the gaming portion of the article I've been writing about that I skipped. It is the section on the Medicare Hospice Cap. (My earlier posts on this article are here and here.)Mr. Hoyer does not devote a lot of time to the cap, but what he says is priceless. First, let's review his credintials. He, as a CMS employee, was the person in charge of drafting the original hospice medicare regulations. If anyone on the face of the earth knows what the original purpose of the cap was, it is Tom Hoyer. With that in mind, we'll look at a couple of quotes. "The cap was introduced by hospice's initial advocates as a guarantee that the hospice principle would not exceed the cost of conventional care. At present, it is the only effective check on abuse of the bene... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1199824 Mon, 04 Feb 2008 15:54:00 +0100 1199824 http://www.hospiceblog.org/2008/01/caring-article-part-ii.html I wrote a post about an article in Caring Magazine a couple of weeks ago, and want to continue working through the article today. (You should go back to post number one to understand what the article is about and who wrote it.)As promised, today I want to discuss Mr. Hoyer's thoughts on the "gaming" that is currently going on in the Medicare Hospice world. First, none of these things are new to this blog. In fact, they are a big part of why I started this blog in the first place. There are hospices across the nation who are "gaming" the system, cherry picking patients, and focused on finding ways to increase profits while paying as little attention as possible to patient care. Gaming, as Mr. Hoyer calls it, is the basis of my argument that non-profit hospices are focusing on the wrong thin... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1160981 Fri, 18 Jan 2008 21:07:00 +0100 1160981 http://www.hospiceblog.org/2008/01/just-say-die.html The awesome folks at Pallimed (if you are a hospice clinician and not reading this blog, then you are missing out on some great education and insight) pointed out a recent journal article advocating for the use of the word "die" when doctors talk to their terminally ill patients.Good stuff. (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1130972 Fri, 04 Jan 2008 16:40:00 +0100 1130972 http://www.hospiceblog.org/2007/12/payment-change-discussion-in-caring.html The National Association for Home Care and Hospice puts out a very good magazine called Caring. As far as I can tell, it is not available on-line which is too bad, because the November edition had a great article titled "The Future of Hospice". The article was written by Tom Hoyer who worked for Medicare for thirty years and was "assigned to work on implementing the Medicare hospice benefit and was responsible for producing the regulations that have governed the benefit." He also "continued to maintain responsibility for hospice benefit policy…until his retirement." I guess that makes him very qualified to discuss the future of the Medicare hospice benefit from the Medicare prospective, which is what he does in the article. I really wish the full text was available online.This is the fir... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1119232 Thu, 27 Dec 2007 15:54:00 +0100 1119232 http://www.hospiceblog.org/2007/12/merry-christmas.html Luke 21In those days Caesar Augustus issued a decree that a census should be taken of the entire Roman world. 2(This was the first census that took place while Quirinius was governor of Syria.) 3And everyone went to his own town to register.4So Joseph also went up from the town of Nazareth in Galilee to Judea, to Bethlehem the town of David, because he belonged to the house and line of David. 5He went there to register with Mary, who was pledged to be married to him and was expecting a child. 6While they were there, the time came for the baby to be born, 7and she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger, because there was no room for them in the inn.8And there were shepherds living out in the fields nearby, keeping watch over their flocks at ... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1115064 Tue, 25 Dec 2007 14:40:00 +0100 1115064 http://www.hospiceblog.org/2007/12/office-of-inspector-general.html The OIG released the first of two reports today looking at the differences between hospice care provided in nursing homes and hospice care provided somewhere else. (Thanks to NHPCO for pointing this report out to its members.)The basic conclusion reads:In our comparison of Medicare hospice beneficiaries who reside in nursing facilities to hospice beneficiaries who reside in other settings, we found that beneficiaries in nursing facilities tended to be older and more likely to have ill-defined conditions. Also, their time in care was longer and more costly. A second study will assess the appropriateness of payments for hospice care for beneficiaries in nursing facilities.I hope "appropriateness of payments for hospice care" means they will assess the differences between the care provided to... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1108587 Thu, 20 Dec 2007 22:52:00 +0100 1108587 http://www.hospiceblog.org/2007/12/but-doctor-certified-them.html ConclusionThese are two examples of why doctor certification isn't always to be trusted. Is this the core of the cap problem? Not even close! My point here is that the argument that we should be trusting doctors to make certification decisions without any oversight or system abuse indicators just doesn't hold water. The patient's attending physician is, in my mind, the only logical person to certify hospice appropriateness, but that doesn't mean the system is perfect. Oversight is still necessary, and that was the point of the hospice cap from day one. (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1093047 Thu, 13 Dec 2007 20:06:00 +0100 1093047 http://www.hospiceblog.org/2007/11/new-york-times-hospice-cap-article.html I don't have a lot of time today to comment on this article about the hospice cap issue in the New York Times. It quotes the NAHA group that has been a part of all the other press on this issue, but it also seems to have a bit more reporting to it than other articles on the subject. It does not manipulate patients as I have felt other articles have, so, on that front, it seems that while the discourse is moving to a national level it may be moderating its tone also. (At least that is my hope.)The most interesting part to me is that, while I found out about the other articles from a couple of readers in Oklahoma or from NAHA's website, NHPCO was the one who sent a link to this one. The link was part of a set of somewhat vanilla talking points about the cap. There was no mention of NAHA in t... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1058273 Wed, 28 Nov 2007 17:14:00 +0100 1058273 http://www.hospiceblog.org/2007/11/oklahoma-cap-press-release.html Below is a copy of a press release that was sent to me by someone in Oklahoma (whom specifically asked to remain anonymous). It is, if I understand correctly, a press release from the Oklahoma Hospice Association dealing with the news stories about the Medicare Hospice Cap. The person sending it to me included a note that said in part, "felt that you should know that not all hospices in Oklahoma share the philosophy of NAHA".It is a strong response and deals with the issues that have bothered me in my last few posts on this subject. (Click on the image to read the press release.) (Source: Hospice Blog) Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1047563 Fri, 23 Nov 2007 15:16:00 +0100 1047563 http://www.hospiceblog.org/2007/11/hospice-cap-madness.html I finally got a chance to check out the web site of the group that is producing all of this press about the Medicare Hospice Cap. They call themselves the National Alliance for Hospice Access, and their web site does a good job of making it seem like fighting against the Hospice Cap is a no brain decision. As usual, I think only half the story is being told, but they do a very good job of telling their half of the story. I might talk more about that later; this post is written to address an article that slipped past me until now.There is a link to this article in the Daily Oklahoman on the NAHA website. The article really makes me mad. (Thus the title of this post.) I mean really, really, really makes me MAD! The article makes me more sure than ever in my thought that the television news s... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=1021256 Mon, 12 Nov 2007 21:07:00 +0100 1021256 http://www.hospiceblog.org/2007/10/my-problem-with-tv-news-story.html I posted here about a story on a local news channel about the Medicare Hospice Cap issue. In that post I said that something about having an actual hospice family interviewed made me a bit uneasy, but I "couldn't put my finger" on why. I've put my finger on it now.A comment left on that post said:I think using a real hospice patient makes this important story easier to understand and relate to at a personal level.That's when my brain clicked on what was bothering me, the patient, or more specifically his wife, didn't seem to actually understand the hospice cap. Here's the offending part of the transcript as best I could transcribe it:(narrator) - Al is just one example of a hospice patient that has lived longer than [the] time Medicare allows hospice funding.(Al's wife) - It makes me angry... Hospice Blog blogs http://www.medworm.com/rss/comments.php?id=998605 Mon, 29 Oct 2007 21:45:00 +0100 998605