Medicare Revises Hospice Drug Policy, Local Providers Relieved

Medicare Revises Hospice Drug Policy, Local Providers Relieved

Posted on Tuesday, July 22nd, 2014 at 7:39 am by lifemediamatters

Under nationwide pressure from hospices experiencing financial and administrative strain due to a newly implemented policy, the Centers for Medicare and Medicaid Services is revising its own guidance that was intended to help avoid duplicate payments for prescription drugs. This change of course comes two months after the CMS rule’s effective date, months in which providers say the policy jeopardized patient access to end of life care.

SyringeIn May, CMS began to require a prior authorization process for hospices and Medicare Part D providers in order to determine responsibility of drug coverage. Hospices were charged with covering medications not related to the hospice, or terminal, diagnosis. Previously, hospices paid only for drugs needed for symptom management, and Part D policies covered medications for hospice patients’ unrelated conditions.

“Based on discussions with stakeholders, we are adjusting our rules so that beneficiaries enrolled in hospice will continue to have access to their medications while balancing recommendations by the Inspector General meant to safeguard the Medicare program,” said Raymond Thorn of the CMS Office of Communications.

The Office of the Inspector General had recommended the policy’s implementation to minimize mistakes in which Part D plans covered hospice drugs. However, the more than 40 healthcare organizations and hundreds of hospice providers that have lobbied against the rule in recent weeks maintain it unduly burdened beneficiaries, requiring dying patients to navigate payer disputes.

“CMS listened when they convened all the various stakeholders, and heard a unified message focused on protecting beneficiaries from an onerous and insensitive prior authorization process,” said Jonathan Keyserling, Senior Vice President of the National Hospice and Palliative Care Organization. “The announcement of significant modifications in the previous guidance will greatly relieve the stress that patients and families, as well as providers, were experiencing under the prior flawed process.”

Under the revised policy, CMS expects Part D sponsors to use hospice prior authorization only on four drug catagories typically covered under the hospice benefit. They include analgesics, anti-nauseants, laxatives and anti-anxiety medications.

“Barriers to access should be minimized,” Thorn said, as the number of these claims are expected to be minimal.

Providers say the original guidance lengthened admission processes; they maintain it often deterred patients from hospice support if medications taken for decades, psychiatric drugs for example, would not be covered upon enrollment.

“We had changed our admission documentation, and we were starting to have those conversations with new admissions,” said Greg Zrazik, Chief Financial Officer of Angels Grace Hospice in Chicago’s southwest suburbs. “We have been looking at the drugs, trying to determine what we felt we would pay for, what would be paid for by Part D and aggressively looking at things they could consider stoping or could pay for themselves.”

Angels Grace has experienced a 30 percent uptick in drug costs since the rule took effect. Serving 45 patients a day, the hospice experienced a “huge burden” that threatened its financial future; average daily Medicare hospice reimbursement is $160.

“This puts things back to if hospices are doing the right thing, we would certainly recommend a patient come off of drugs that aren’t appropriate,” Zrazik said. “But we don’t have to be aggressive, or make patients make difficult decisions.”

Hospices may realize instant efficiency as a result of this revision, providers say.

“We don’t have to be focused so much on the rigamarole of all the paperwork, and instead we can think more about what the patient and family needs and spend time with them,” said Martha Twaddle, medical director of Journeycare, a hospice serving 500 patients daily across northern Illinois.

Time and personnel are the most important resources a hospice has, said Twaddle, and the extra work the guidance required was threatening the long-term sustainability of quality bedside care.

The tone of the CMS guidance and the agency’s willingness to reverse course are encouraging to end of life care providers.

“If we are going to do good care for Americans, we have to be working together, changing models of delivery and be willing to change ourselves,” Twaddle said. “This is a fabulous sign.”


The Future Of Robot Caregivers

Posted on Monday, July 21st, 2014 at 6:50 pm by lifemediamatters

Caregiving is hard work. More often than not, it is tedious, awkwardly intimate and physically and emotionally exhausting. Sometimes it is dangerous or disgusting. Almost always it is 24/7 and unpaid or low wage, and has profound adverse health consequences for those who do it. It is women’s work and immigrants’ work, and it is work that many people either can’t or simply won’t do (The New York Times).


Fiction: Last Meal At Whole Foods

Posted on Monday, July 21st, 2014 at 6:46 pm by lifemediamatters

I’m having dinner at the Whole Foods on Center Boulevard with my mother, who is dying. My poor mother, whom I’m trying not to sob over, is sitting across from me in the booth, transfixed by her cardboard plate, eating, with a strange and elegant enthusiasm, broccoli cake and something or other, as if any of this mattered (The New Yorker).


Musicians On Call Bring Music For The Soul To Patients’ Beds

Posted on Saturday, July 19th, 2014 at 9:14 am by lifemediamatters

This piece was first published in Reuters Health. Daniel Gaitan is a contributor.

Musicians On Call, a nonprofit providing live music to the seriously ill, hopes to aggressively expand to other major cities across the U.S. next year.

For more than a decade, volunteer artists with Musicians On Call have given bedside performances to patients undergoing treatment or unable to leave their hospital beds.

full_1369063989“It’s a very tangible way to give back,” Pete Griffin, president of Musicians On Call, told Reuters Health. “We are not music therapy, because that is its own medical profession. What we do is bring live music, and what a lot of research shows is that that does decrease patients’ stress levels and lowers blood pressure.” Family members may also benefit from seeing their loved ones enjoy a “moment of normalcy.”

Since 1999, Musician On Call volunteers have performed for more than 415,000 patients in hospitals, nursing homes and hospices – but only in a handful of states.

Griffin said the organization hopes to aggressively grow throughout 2015 and expand beyond its seven “hubs” where most Music On Call programs are located: New York, Philadelphia, Baltimore, Washington, D.C., Miami, Nashville and Los Angeles.

For hospitals without the bedside concert program, Musicians On Call provides a collection of albums.

“We create ‘music pharmacies.’ We have supporters and record labels who donate CDs, and then hospitals go on our website and request a ‘music pharmacy,’ a box of 200 CDs and CD players for their patients to listen to,” Griffin said. Nearly 800 hospitals have requested them.

Dr. Melinda R. Ring, an assistant professor of clinical medicine at Northwestern University’s Feinberg School of Medicine in Chicago, said she believes music helps provide the seriously ill a sense of peace.

“Music touches us. Music has the ability to transform the mood that we’re in, the way we’re perceiving things,” Ring told Reuters Health. “For somebody who has fears about death, pain or other end-of-life issues, listening to something that can bring them joy in the hospital doesn’t necessarily change the outcome of what will happen, but it changes their experience.”

Loretta Downs, past president of the Chicago End-of-Life Care Coalition and a hospice volunteer, said she would like to see more medical centers supporting Musicians On Call.

“Music is a form of reminiscence, and if a family member or a patient can request a song that brings back positive memories, it’s a great thing,” Downs told Reuters Health. “We want to remember the things that made us happy.”

Downs founded Chrysalis End-of-Life Inspirations, an effort aiming to equip hospitals and nursing homes with “Chrysalis Rooms,” private spaces where seriously ill patients can gather with family and friends and listen to music, among other things.

Many artists visiting hospitals through Musicians On Call find themselves playing requests for upbeat pop songs. Currently, the most popular request from young people is “Let It Go,” the Oscar-winning anthem from the animated film “Frozen.”

“When we go into the children’s hospitals, a lot of them know the Disney songs,” Griffin added. “With the older populations, blues and classic rock are popular. Country music is popular around Nashville, rock in the Northeast.”

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The CPR We Don’t See On TV

Posted on Thursday, July 17th, 2014 at 5:41 pm by lifemediamatters

The first time I saw a patient who had received CPR, the experience wasn’t what I expected.

Sure, I thought she wouldn’t look well. After all, her heart had just stopped beating. But I wasn’t prepared for the scene before me: a frail woman in her mid-80s, barely conscious, vomiting, with broken ribs and a bruised lung. Her stomach was bloated and her chest was bleeding. She looked more like a survivor of CPR than of cardiac arrest, I thought to myself (The New York Times).