AHPCO is an Affiliate Member of NHPCO and encourages Arizona providers to promote an ethical culture involving both internal and external relationships and to provide services which are grounded in core ethical principles and concepts.

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By Roseanne Berry, MSN, RN roseanne@hospicefundamentals.com

Reprinted with permission.

In July the Office of the Inspector General (OIG) released Vulnerabilities in the Medicare Hospice Program Affect Care and Program Integrity: An OIG Portfolio. The document is a synthesis of the “numerous evaluations and audits of the hospice program” conducted since 2005 and intended by the OIG to highlight “key vulnerabilities” and to make recommendations “for protecting beneficiaries and improving the program.”

The document zeros in on areas that the OIG believes negatively impact quality of care and program integrity and includes 15 recommendations to the Center for Medicare and Medicaid Services (CMS) to address them.  Although CMS concurred with only six of the fifteen, the OIG notes that they will continue to work toward implementation anyway.

The recommendations are organized into 7 broad areas:

1.       Strengthen the survey process to better ensure that hospices provide beneficiaries with needed services and quality care

2.       Seek statutory authority to establish additional remedies for hospices with poor performance

3.       Develop and disseminate additional information on hospices to help beneficiaries and their families and caregivers make informed choices about their care

4.       Educate beneficiaries and their families and caregivers about the hospice benefit 

5.       Promote physician involvement and accountability to ensure that beneficiaries get appropriate care

6.       Strengthen oversight of hospices to reduce inappropriate billing

7.       Take steps to tie payment to beneficiary care needs and quality of care to ensure that services rendered adequately serve beneficiaries’ needs, seeking statutory authority if necessary

Take the time to read the report and to consider the CMS response. It provides insight into the thinking of the OIG and hints on what may be coming next.  

Note that the OIG again draws distinctions between for-profit and non-for-profit hospices. When detailing the 43% growth in number of hospices between 2006 and 2006, they comment that the growth was due primarily to the for-profit sector and this sector had longer lengths of stay leading to a $4,000 higher per-beneficiary expenditure as well as higher frequencies of fraud. They describe a number of the schemes – knowingly admitting beneficiaries that are not eligible, billing for care never provided, and providing and billing for poor quality care.

The report goes on to describe a number of fraud schemes; beneficiaries not eligible and billing for services never provided.

What now?

1.       Read the portfolio in its entirely. You’ll find it here.

2.       Review your compliance program and your annual compliance work plan to see that it covers the risk areas from the OIG portfolio as well as any that are unique to your hospice.

3.       If you don’t have a comprehensive compliance program, you are putting your program at great risk, especially if you are a for-profit hospice.  Get on it now. 

NOTE:  The FY2018 Medicaid rates are slightly different that the FY2018 Medicare rates.  Please ensure that billing staff note the difference.

Two issues of note with the FY2018 Medicaid rates.

• There is no allowance in the Medicaid hospice rates for the co-pay for respite care.
• There is no allowance in the Medicaid hospice rates for the co-pay for drugs.

Learn More*

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**Requires Member Login. 

Originally published June 10, 2015 by NHPCO. 

(Alexandria, Va) – More and more Americans are facing advanced illness, aging with multiple chronic health conditions, and lack the resources to plan for their care and obtain the support they need for themselves and their families.  The Care Planning Act of 2015, legislation that includes provisions to assist in navigating complex health care needs and address challenges in advance care planning, has been introduced by Senator Johnny Isakson (R-GA) and Senator Mark Warner (D-VA).

The National Hospice and Palliative Care Organization enthusiastically supports this legislation and applauds the leadership of Senators Isakson and Warner.

“NHPCO has long championed the need for Americans to discuss their healthcare preferences with their loved ones and have the support of an interdisciplinary team in seeing those preferences realized,” said J. Donald Schumacher, NHPCO president and CEO. “Self-determination is at the core of the hospice philosophy and care model, and we believe that The Care Planning Act will allow some of our most vulnerable patients to have much more support and direction in their health care.” 

The Care Planning Act creates a new Medicare benefit called Planning Services for those with advanced illness, allowing for a team-based approach of care planning discussions with doctors, nurses, and other healthcare professionals. It also creates a pilot program for Advanced Illness Coordination Services to allow for home-based support of patients with multiple and complex chronic conditions.

In introducing the legislation both Senator Warner and Senator Isakson talked about their own personal experience with family members dealing with advanced illness. 

“I know firsthand just how easy it is to put these conversations off because it’s incredibly painful to imagine a loved one becoming so ill that he or she is unable to make decisions about her own medical care,” said Sen. Warner, whose mother, Marjorie, passed away from Alzheimer’s disease in 2010 at the age of 81. “This bill takes a patient-centered approach by making sure more information is available to patients and their families, and by ensuring that patients have an opportunity to discuss their treatment options, plan for their future care, and make their choices known.”

“I’m proud to join Sen. Warner in introducing the Care Planning Act today to provide individuals who have been diagnosed with a serious or life-threatening illness and their loved ones an opportunity to have face-to-face conversations with their doctors, nurses and religious advisors to develop plan for care,” said Sen. Isakson. “I know from my own family’s experience that having a plan makes a world of difference in ensuring a high quality of life during a loved one’s last days.

As an organization committed to increasing awareness of advance care planning, NHPCO provides free information and tools to the public. NHPCO’s Caring Info has state-specific advance directive forms and information on advance care planning that can be downloaded from its website www.caringinfo.org/stateaddownload.   Each state’s advance directive is legally reviewed on an annual basis and meets each state’s statutory requirements.

Originally published June 25, 2015 by NHPCO. 

The Supreme Court of the United States announced its much-anticipated decision on King v. Burwell today. The case questioned the legality of federal subsidies to low- or middle- income individuals in 34 states that participated in the federal health insurance marketplace and did not set up a state health insurance exchange as established in the Affordable Care Act (ACA).

The Court ruled, in a 6-3 decision, that the ACA allows federal healthcare subsidies to continue to be available to residents of states that have not set up a state health insurance exchange and enroll in a federal or federal-partnership exchange. At risk were subsidies that an estimated 6.4 million Americans have received through the federal exchange, Healthcare.gov.

Currently, this decision does not impact the hospice community or the Medicare Hospice Benefit. NHPCO and the Hospice Action Network will continue to monitor any fall-out from this decision and its potential effects on hospice. If you have any questions, please contact the NHPCO Department of Public Policy at policy@nhpco.org.

Background of King v. Burwell

The Affordable Care Act (ACA) states that federal subsidies can be awarded in marketplaces “established by the state.” Sixteen states established their own state health insurance marketplaces; the remaining states were placed in the federal marketplace, Healthcare.gov.

Challengers alleged that the federal government did not have the authority to provide subsidies to residents in the 34 states that are part of the federal marketplace. The main argument came directly from the text of the law: the provision regarding subsidies only references the provision of the ACA that establishes state exchanges. The subsidy provision does not reference the section establishing federal and federal-partnership exchanges. The challengers maintained that subsidies should therefore only be eligible to residents of the 14 states that established a state exchange.

The government defended the subsidies with multiple arguments: 1) The ACA says that when a state does not establish its own exchange, the federal government “shall establish and operate such exchange.” The government argued that in this case, the federally-facilitated exchange operates in the role of the state exchange. (2) Federally-facilitated exchanges, or marketplaces, are the functional equivalent to a state marketplace. (3) Access to affordable healthcare is the core principle of the ACA. Therefore, the subsidy question must be considered within the broader context of the law.

Originally published April 16, 2015 by NHPCO

On March 26, NHPCO notified members that legislation, H.R. 2 - the Medicare Access and CHIP Re-authorization Act of 2015, overwhelmingly passed the House of Representatives. Last night, the Senate passed H.R. 2 with broad bipartisan support, and moved the bill to President Obama’s desk for his signature. The new law will permanently correct the flawed Medicare reimbursement formula for physicians (known as the SGR or "doc fix”).

Congress has been passing temporary SGR patches (17 since 2002) to prevent physician reimbursements from cuts up to 21%. Fortunately, hospice has been able to keep from being targeted in these patch offset packages. This permanent fix is a unique effort by Congress since its costs are only partially offset. Medicare providers will provide relatively minimal contributions to the offsets without worry of more cuts through short-term patches in the future. One of these offsets by an across-the-board reimbursement cut to post-acute-care providers, including hospice, in FY2018. The cut will come in the form of an inflationary adjustment, or “market basket,” cap of 1% (before statutory reductions) for that fiscal year.

The NHPCO Office of Health Policy will keep you informed as details of the law’s enactment are rolled out, and as other legislation important for hospice providers, patients, and families moves through Congress. 

Originally published Dec 27, 2014 by NHPCO.

(Alexandria, Va) –   In an article appearing in today’s Washington Post, “Dying and profits: The evolution of hospice,” examination of federal hospice cost report data points out differences among provider types. It may be inferred that tax status influences the quality of care a hospice provider delivers to patients and their families. The National Hospice and Palliative Care Organization is concerned that this article –  like others in the Post’s “The Business of Dying” series – may confuse the public seeking care at the end of life. Assessing quality is not as simple as identifying whether a hospice provider is a non-profit or for-profit organization or looking at a single statistic.

The hospice community has grown and evolved in the last thirty years in the United States. As the need for hospice and the awareness of the services hospice provides has increased, the number of both non-profit and for-profit providers has grown. This mix in corporate structures is reflected in the entire U.S. healthcare sector. Hospice is no exception.

What makes hospice care unique is delivery of care by the interdisciplinary team addressing medical, psycho-social, and spiritual needs of the patient and family caregiver.

For every patient, as required by regulations, an individual plan of care is developed by the hospice team, in consultation with the patient and family. Depending on the patient and family's needs and desires, appropriate personnel from the hospice team are assigned and deliver care to the patient. One patient may receive more hospice aide visits than nursing visits – care is delivered, based on need, rather than a formula, as the article might imply.

“Focusing solely on medical care ignores the holistic approach that is the center piece of hospice care that encompasses clinical, social, psychological, and spiritual components,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. “Looking at one aspect of care, like nursing visits, to paint a broad picture of care fails to tell the whole story of hospice.”

As the Medicare hospice benefit is designed, and has been administered for almost 40 years, it is a risk-based model of care, which means some patients need a greater number of services, and others, not as many. The payment, at roughly $160 per day, is spread out to take into account both the more expensive (high number of necessary services) and the less expensive (low level of services).

“All hospices, regardless of tax structure, must submit to the regulations and standards put forth by the Centers for Medicare and Medicaid Services, the hospice community’s principal regulator, as well as state licensing and regulatory requirements. NHPCO has strongly and consistently maintained that every hospice program must have the capacity to not only meet but exceed the CMS requirements and the needs of the patient and family,” said Schumacher.

NHPCO has long called for additional oversight and more frequent surveys and applauds the legislation that will increase survey frequency beginning in 2015.

In October, Congress passed and the President signed into law the “Improving Medicare Post-Acute Care Transformation Act of 2014” (IMPACT Act) that includes provisions creating greater oversight and increased transparency within the hospice community. The law will mandate surveys of Medicare certified hospice providers at least every three years for the next ten years.

In serving the nation’s hospice community, NHPCO has a long standing interest in and focused its efforts on strengthening hospice program integrity, developing quality measures, supporting quality reporting, the establishment of quality partners programs, and ongoing work with improving the delivery of care. NHPCO, on behalf of the hospice community, continues to work closely with both MedPAC and CMS to identify potential problems and fashion responsible and reasonable safeguards to correct gaps in the regulations.

Millions of families have benefited from hospice care over the last thirty years because of the hospice community’s dedication to providing the highest quality of care. Patients and families choose hospice because they want to be free of pain, at home or in their chosen setting, and surrounded by their loved ones.

Data from the Family Evaluation of Hospice Care, a post-death survey sent to families who have had a loved one in hospice care, shows that family satisfaction has remained high and consistent. The survey shows that 93.5% of the 228,000 respondents rated the care the patient received as “excellent” or “very good” and 97.3% of respondents indicated that they would recommend their hospice to others.  

“Focusing solely on the tax status of providers is an affront to every hospice professional working as a nurse, social worker, physician, hospice aide, allied therapist, bereavement or spiritual counselor, volunteer, administrator or other hospice team member,” stressed Schumacher. “Hospice professionals are dedicated to providing compassionate care, whoever their employer might be.”

NHPCO has created a free worksheet on choosing a quality hospice for consumers. This and other resources are available at the Moments of Life: Made Possible by Hospice website, launched by NHPCO to help people better understand all that hospice does to support patients and families facing life-limiting illness.

Originally published Jan 29, 2015 by NHPCO.

Congress.gov, the website for the Library of Congress, has printed a summary of the IMPACT Act of 2014 with an error about the hospice face-to-face requirement. The summary description of the IMPACT Act of 2014 that appears on Congress.gov states that the law “Repeals the requirement that a hospice physician or nurse practitioner have, and attest to having had, a face-to-face encounter with the individual to determine the individual's continued eligibility for hospice care before the 180th day recertification and each subsequent recertification.” This is not correct. The IMPACT Act, which was enacted in October 2014, did not repeal or alter the face-to-face visit requirement for certain hospice patients that has been in place since 2011. Instead, the IMPACT Act did make changes to another provision of the law, which was passed at the same time as the face-to-face visit requirement and appears in the same area of the statute, that requires CMS to undertake medical review of claims for certain long stay patients in hospices that have a high percentage (to be specified by CMS) of long stay patients. NHPCO has already requested that the error be corrected and expect to see the correction appear on the website within the next few days.

Originally published October 23, 2014 by NHPCO.

NHPCO Releases New Hospice Facts and Figures Report

NHPCO's annual publication, Facts and Figures: Hospice Care in America, reports on hospice trends and provides updated information on the growth, delivery, and quality of hospice care in the US. Click Here to view the report. 

Originally published October 16, 2014 by NHPCO.

NHPCO Rural Task Force Meeting

On Tuesday October 14, the NHPCO Rural Task Force and invited guest from the NHPCO Regulatory Committee met with Carol Blackford, Randy Throndset, and Zinnia Harrison from the CMS Chronic Care Policy Group to discuss rural issues in hospice. The meeting focused on the large challenges rural hospice providers have with attending physicians who are employed by rural Health Clinics throughout this country. Representatives from the Rural Task Force were able to provide real-life examples of how difficult it is for patients and families to not be able to continue the relationship with their attending physician when electing hospice. CMS agreed to look at the issue for possible solutions and appreciated the input from hospice providers. This is another conversation in a series of conversations with CMS and the the Office of rural Health Policy on rural hospice issues. 

Originally published October 9, 2014 by NHPCO.

Extension Granted to Contract Nurses Related to Nursing Shortage

CMS Survey & Certification posted Memorandum 15-01 which allows hospice providers to contract for nursing staff which are unable to hire nurses related to the nursing shortage. The memo extends this allwance through September 30, 2016. Read the memo for contract requirements on the CMS website.

Originally published October 2, 2014 by NHPCO.

Read Carefully to Ensure that Your Claims Meet the NEw Diagnosis Coding Requirements

When CMS issued CR8877 to implement the FY2015 Hospice Wage Index Final Rule, they also issued a list of “Invalid Hospice Diagnosis Codes” which should not be used as a primary diagnosis for a hospice patient for dates of service beginning October 1, 2014 or later.  CMS has implemented a Medicare Code Editor which will send claims with any diagnosis on this list back to the provider (RTP) for recoding. Pay special attention to Attachment A from CR8877, posted at the end of this Alert.

ICD-9-CM/ICD-10-CM Coding Guidelines:

The principal diagnosis reported on the claim is the diagnosis most contributory to the terminal prognosis. Hospice providers must follow the ICD-9-CM/ICD-10-CM Coding Guidelines. CMS will implement a Medicare Code Editor edit beginning October 1, 2014 as a “Manifestation code as principal diagnosis” edit in the Integrated Outpatient Code Editor (IOCE). Additionally, new edits for the codes in Attachment A will be implemented, as these codes are part of sequencing or other coding convention in ICD-9-CM/ICD-10-CM coding guidelines.

ICD-9-CM/ICD-10-CM Dementia Coding Guidelines

Attachment A. Hospice Invalid Principal Diagnosis Codes Oct 1, 2014

Originally published September 19, 2014 by NHPCO.

NHPCO Applauds Passage of IMPACT Act

Hospice provisions added to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) will create increased transparency within the hospice community. 

(Alexandria, Va) – This week, the U.S. House of Representatives and Senate passed the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), legislation which includes hospice integrity provisions that are backed by the hospice community.  The National Hospice and Palliative Care Organization supports this legislation and the additional oversight it will bring to end-of-life care providers.

The IMPACT Act (H.R. 4994) requires more frequent surveys of hospice providers – a measure the hospice community and the National Hospice and Palliative Care Organization has championed for more than a decade. The bill mandates that all Medicare certified hospices be surveyed every three years for at least the next ten years.

 A 2007 HHS Office of the Inspector General report found that current survey measures for Medicare-certified hospices was not providing sufficient oversight.

“Currently, hospices can go eight years or more without ever being surveyed, which is far too long,” said J. Donald Schumacher, NHPCO president and CEO. “More consistent surveys, and the process providers go through to prepare for them, will help hospices and ultimately benefit the patients and families in their care.”

Additionally, the new legislation will facilitate medical reviews for select hospice programs with a soon to be determined percentage/number of patients receiving care for more than 180 days. The specific patient load that would trigger this medical review is yet to be set by CMS.

Such a medical review of what are known as “long stay” patients will help ensure that hospices are appropriately caring for individuals with life-limiting illnesses that are often harder to prognosticate than in the earlier days of hospice provision when most patients had a cancer diagnoses.

NHPCO has supported this provision since it was originally recommended by MedPAC in 2009.

The legislation also includes a provision that would align hospice reimbursement and the hospice aggregate financial cap to a common inflationary index.

“Under NHPCO’s leadership, the hospice community has been on the frontlines of advocating for increased transparency, program integrity, and accountability. We believe that the hospice provisions included in the IMPACT Act are critically important steps in this direction,” stressed Schumacher.

NHPCO reports that more than 1.5 million dying Americans receive care for the nation’s hospice providers every year.

To learn more about hospice and how it helps patients and families or to find a hospice in your community, visit the website Moments of Life: Made Possible by Hospice.

Originally published august 21, 2014 by NHPCO.

GAO Posts Report about Duplicate Postpayment Claims Review

Several types of Medicare contractors conduct post-payment claims reviews to help reduce improper payments. Questions have been raised about their effectiveness and efficiency, and the burden on providers. In an assessment of this process the GAO recommends that CMS take actions to improve the efficiency and effectiveness of the contractor's post payment review efforts, which include providing additional oversight and guidance. Review the GAO report.

Originally published September 4, 2014 by NHPCO.

CMS Prohibited from Awarding New RAC Contracts

A federal court of appeals prohibited CMS from awarding new RAC contracts pending an appeal by RAC (CGI) to the court of appeals in the federal district which could take up to 12 months to settle. As of late August 2014, CMS reports that a contract modification allows the current RAC's to restart some reviews in Regions A, B, C, and D. Most reviews will be done on an  automated basis, but a limited number will be complex reviews of topics selected by CMS. 

Originally published September 4, 2014 by NHPCO.

Hospice Cost report Form Instructions Posted

CMS posted Transmittal 1 - New Cost Reporting Forms and Instructions on August 29, 2014. The Hospice Cost Report changes are effective for cost reporting periods begining on or after October 1, 2014. This transmittal introduces Chapter 43, Hospice Cost Report (Form CMS-1984-14) which replaces the existing form CMS-1984-99. 

NHPCO Offers Comments on research Published in Journal of Palliative Medicine

Provisions of FY2015 Hospice Wage Index Final Rule

On August 4, 2014, CMS posted the FY2015 Hospice Wage Index final rule on public inspection with the Federal Register. The official publication of the final rule is now scheduled for August 22, 2014, with an effective date of October 1, 2014.  The detailed summary below outlines the changes for hospice practice that will be important for providers to read for ongoing compliance, once the changes become effective on October 1, 2014.

Summary of Final Rule : Effective October 1, 2014


1.The hospice Notice of Election (NOE) and Notice of Termination/Revocation (NOTR) must be filed within 5 calendar days.

2.The penalty for not filing the NOE timely is “provider liable” days where the hospice is responsible for providing care and services to the patient from effective date of election until the date the NOE is filed.

3.The patient or their representative must choose their attending physician and indicate that choice on the NOE.  The hospice must provide a “change of attending physician” form for the patient/representative to complete when the attending physician changes.

4.Quality reporting requirements remain as proposed.  HIS implementation July 1, 2014 and CAHPS survey implementation in 2015.

5.Hospices will be required to self-report the aggregate cap 5 months after the end of the cap year, or March 31 of each year.  Overpayments will be required to be paid when the report is submitted, although options for an extended repayment plan are available.

6.FY2015 rates include an increase of 2.1%, slightly higher than the 2.0% in the proposed rule.  The wage index values have also been updated.  The NHPCO state/county rate charts and the Medicare calculator will be available from NHPCO in the coming days.

Filing of Notice of Election (NOE) and Notice of Termination/Revocation (NOTR)

1.Timely filing of NOE and NOTR:  Effective October 1st, hospices will have a maximum of 5 days to have the NOE and/or the NOTR submitted and accepted by their Medicare contractor.

2.When to submit the NOE or NOTR:  CMS strongly encourages hospices to file the NOE as soon as possible after the election or the revocation/discharge, not waiting until the fifth day. 

3.Late filing penalty for NOE:  Late filing for NOE will incur “provider liable” days – from effective date of election until date NOE is filed.

4. Provider liable days:  This new term applies when the hospice fails to file the NOE within 5 calendar days.  The hospice remains responsible for providing all care and services to the patient as detailed in the plan of care, without reimbursement from the Medicare Hospice Benefit.

4.Exceptions to the timely filing of an NOE or NOTR:
CMS lists the following exceptions to the timely filing requirement:

• fires, floods, earthquakes, or other unusual events that inflict extensive damage to the hospice’s ability to operate;
• an event that produces a data filing problem due to a CMS or Medicare contractor systems issue that is beyond the control of the hospice;
• a newly Medicare-certified hospice that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its Medicare contractor; or,
• other circumstances determined by CMS to be beyond the control of the hospice.

6.Documentation of exception: The hospice must document the circumstance to support a request for an exception, which would waive the consequences of filing the NOE late. Using that documentation, the hospice’s Medicare contractor will determine if a circumstance encountered by a hospice qualifies for an exception to the consequences for filing an NOE more than 5 calendar days after the  effective date of election.

7.Exceptions not allowed:  CMS states that exceptions to the timely NOE filing requirement will not be allowed for “personnel issues; internal IT systems issues that the hospice may experience; the hospice not knowing the requirements; and failure of the hospice to have back-up staff to file the NOE.”  In these circumstances, the hospice may incur “provider liable” days.

8.Establish contingency plans for timely filing:  CMS encourages hospices to establish “contingency plans for situations where administrative staff who normally file the NOEs or NOTRs are on vacation, unavailable due to illness, or are unexpectedly unavailable.”  CMS will be monitoring the timely filing issue and may consider shortening the timeframe in future rulemaking.

9.Direct Data Entry (DDE):  While NHPCO requested a review of options other than the DDE entry of the NOE, CMS determined that there would be “significant implementation challenges …. for creating an interface for a new non-claim format in the Medicare claims processing system.”  CMS agreed to explore options in electronic batch submission of hospice NOEs. 

Patient designation of attending physician

1.Attending physician defined for the Medicare hospice benefit:  In the Medicare hospice benefit, “attending physician” has a specific definition found in the Social Security Act at 1861(dd)(3)(B) that the term means, with respect to an individual: "the physician (as defined in subsection (r)(1)) or nurse practitioner (as defined in subsection (aa)(5)), who may be employed by a hospice program, whom the individual identifies as having the most significant role in the determination and delivery of medical care to the individual at the time the individual makes an election to receive hospice care.
We define it as either 1) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he or she performs that function or action; or 2) a nurse practitioner who meets the training, education, and experience requirements described elsewhere in our regulations."

2.Patient’s right to choose his or her own attending physician:  The hospice patient (or his/her representative) has the right to choose their own attending physician.  The Medicare Hospice Conditions of Participation specify, at §418.52(c)(4), that the patient has the right to choose their own attending.

3.Intent of provision:  CMS states that the intent of this new requirement is to safeguard and protect the patient’s choice of attending physician.

4.Non-compliance risks for the hospice:

• ​Hospice changes the patient’s attending physician when the patient moves to an inpatient setting for GIP care, often to a nurse practitioner.
• Hospice assigns an attending physician to the patient, based on whoever is available
• Hospice does not get the signature of the attending physician on the initial certification, unless attending is a NP.

Hospices who do not change their practice to ensure that the patient’s right to choose their own attending physician may be at risk for survey deficiencies or non-compliance audits.

5.Hospitalist as patient’s attending:   We are pleased that CMS has clarified the option of the hospitalist as the patient’s attending physician.  CMS states:  “We do not prohibit a patient (or representative) from choosing a hospitalist as the attending physician, though we suggest that the hospice explain to the patient (or representative) that a hospitalist only follows patients who are hospitalized.”  However, CMS notes that often the hospital will assign a hospitalist to be the patient’s “attending physician” for purposes of the hospital’s inpatient care.  The hospitalist does not meet the hospice definition of “attending physician” unless the patient chooses the hospitalist to be their attending physician.

6.Choosing an attending physician:  CMS states that “there are many legitimate reasons for the patient to change their attending physician.   However, the choice…. Belongs solely to the patient/representative.  A patient cannot be required or coerced to change the attending physician.”

7.When the attending physician is no longer willing or available to serve:  The hospice should use the medical record to document instances where the attending physician is no longer willing or available to follow the patient.  In those situations, the hospice should then inform the patient (or their representative) that they may choose someone else to serve as their attending physician.  The information should include that the patient/representative can choose a physician or nurse practitioner from the hospice or from the community.

8.Hospital privileges and the attending physician:  If a patient is admitted to an inpatient setting where the attending physician does not have privileges, or does not wish to continue to care for a patient in an inpatient setting, the Medicare Hospice Conditions of Participation apply.  Based on §418.64(a)(3), the hospice physician or NP must provide any needed physician services. 

9.Attending physician added to Notice of Election (NOE) form:  CMS now requires the name of the attending physician on the NOE, along with an acknowledgment that the identified attending physician was his or her choice.  The new regulation can be found at §418.24(b)(1).  CMS states that hospices have “the flexibility to include this information on their election statement in whatever format works best for them, provided the content requirements in §418.24(b) are met.”

10.New “Change in Attending” form required:  CMS envisions that the “Change of Attending Physician” form would be developed by the hospice.  The patient/representative must provide the hospice with a signed document when the patient chooses to change the attending physician.  Changes are detailed in a new section at §418.24(f).  The statement, developed by the hospice, should include information as follows:

• Physician’s full name
• Office address
• NPI number
• Date change is to be effective (Effective date can be no earlier than the date the statement is signed)
• Date statement is signed
• Patient/representative’s signature
• Acknowledgement that this change in attending physician is the patient’s/representative’s choice
  
  CMS states that more information on the role of the attending physician, as well as information regarding billing physician services, will be developed and shared with hospice providers.
  

Quality Reporting

1.Quality Measures:  CMS reiterates that the 7 quality measures announced in the FY2014 final hospice wage index rule remain in place for FY2015.  They are:

• NQF #1617 Patients Treated with an Opioid who are Given a Bowel Regimen
• NQF #1634 Pain Screening
• NQF #1637 Pain Assessment
• NQF #1638 Dyspnea Treatment
• NQF #1639 Dyspnea Screening
• NQF #1641 Treatment Preferences
• NQF #1647 Beliefs/Values Addressed (if desired by the patient) (modified)

2.Hospice Item Set:  Hospices are required to complete and electronically submit an admission HIS and a discharge HIS for each patient admission and discharge, regardless of payer or patient age. Hospice programs will be evaluated for purposes of the quality reporting program based on whether or not they submit data, not on their substantive performance level with respect to the required measures.  Failure to report quality data via HIS in 2014 will result in a market basket update reduced by 2% in FY 2016.

3.Hospices certified before November 1:  Hospices that receive their certification before November 1 of the calendar year before the fiscal year for which a payment determination will be made must submit data for the calendar year.  This provision is codified in the Hospice Conditions of Participation at §418.312.

4.Extraordinary Circumstances and Quality Reporting:  Hospices could request extensions/exceptions for extraordinary circumstances beyond the control of the provider.  When an extension/exception is granted, a hospice will not incur payment reduction penalties.

5.New Measures:  CMS confirms that no new measures are being proposed at this time.  Future measures should expand measures already in use in other quality reporting programs that could apply or develop new measures if no suitable measures are ready for implementation or expansion.

6.Public Reporting:  Data collected by hospices during Q1-3 CY 2015 will be analyzed starting in CY 2015 and decisions about reporting will be based on findings and analysis of CY2015 data.  CMS also states that public reporting may occur during FY2017.

7.CAHPS® Hospice Survey:  The CAHPS® Hospice Survey is a component of CMS’ quality reporting program which emphasizes the experiences of hospice patients and their primary caregivers listed in the hospice patients’ records. Measures from the survey will be submitted to the National Quality Forum (NQF) for approval as hospice quality measures.

8.CAHPS Survey Vendors:  Hospices are required to contract with a third-party vendor that is CMS-trained and approved, which ensures that the data are unbiased and collected by an organization that is trained to collect this type of data.  A list of approved vendors will be provided on the CAHPS® Hospice Survey website closer to national implementation.  Applications for survey vendors are available at www.hospicecahpssurvey.org.  Vendor applications are due by August 7, 2014.  No information is yet available on the list of approved vendors. 

9.Start date for CAHPS:  Every hospice must conduct a one month “dry run” during the first three months of CY2015.  Beginning April 1, 2015, all hospices are required to participate in the survey on an ongoing monthly basis. This means hospices need to contract with a survey vendor to conduct the survey monthly on their behalf.

10.Meeting Quality Reporting Requirement for Payment Update:  Participation for at least 1 month during the dry run, plus monthly participation for the 9 months between April 2015 and December 2015 (inclusive) is required to meet the pay for reporting requirement of the Hospice Quality Reporting Program (HQRP) for the FY 2017 APU.

(Alexandria, Va) – Forty years ago, President Richard Nixon declared the first National Volunteer Week to recognize Americans who give of their time and talents to benefit others. This was the same year, 1974, that the Connecticut Hospice – one of the first hospices in the country – opened its doors changing the way dying persons were cared for in the U.S.

During National Volunteer Week, April 6 – 12, the National Hospice and Palliative Care Organization celebrates the work of all the dedicated hospice volunteers who provide support, companionship and dignity to patients and families being served by hospice.

More than 400,000 trained volunteers provide 29 million hours every year to help care for patients and families and to support hospice programs in their mission to serve.

Hospice volunteers often serve patients and families at the bedside but they also assist in the office, help raise awareness, contribute to educational programs, and provide fundraising support and more.

The National Hospice and Palliative Care Organization reports that every year, an estimated 1.6 million patients and their family caregivers receive the high-quality, compassionate care that hospice provides.

“Hospice volunteers help the people they serve live every moment of life to the fullest and enable the organizations they work with to achieve their mission in the community,” said J. Donald Schumacher, NHPCO president and CEO. “Most hospice volunteers choose to give their time helping others because of their own experience with the compassionate care hospice provided to a dying loved one.”