Hospice Accountability Legislation Headed To Obama’s Desk

Hospice Accountability Legislation Headed To Obama’s Desk

Posted on Monday, September 22nd, 2014 at 7:21 am by lifemediamatters

Medicare Sample Card, Courtesy WikiMedia Commons.

Medicare Sample Card, Courtesy WikiMedia Commons.

Health legislation that supporters say would increase transparency and accountability among hospice providers has been woven into a Medicare bill, passed by both houses of Congress and now headed to President Obama to be signed into law.

In a rare bipartisan display, particularly for health legislation given Affordable Care Act clashes, the U.S. House of Representatives and Senate have passed the “Improving Medicare Post-Acute Care Transformation Act,” or “IMPACT Act,” which includes key elements to bring increased quality, transparency and accountability through more frequent surveys to hospice providers. Obama is expected to sign the legislation.

The hospice industry, which supported the legislation, maintained the language in the IMPACT Act includes “pretty much the same things” that were in the Hospice Act pushed by U.S. Reps. Tom Reed, a New York Republican, and Mike Thompson, a California Democrat. The legislation comes in the wake of mounting criticism that called the safety of hospice patients into question.

“This bill is about strengthening accountability and transparency at hospice facilities so that patients receive the highest quality care possible,” Thompson said in a statement to Life Matters Media. “By putting these accountability measures in place, we can help give patients and their families the peace of mind that they will be able to depend on the care they receive.”

Tomorrow Reed, R-Texas

Rep. Tom Reed

To be sure, the hospice industry has been shaken by government watchdog reports and a recent Washington Post series, “Business of Dying.” Last year, a report by the U.S. Department of Health and Human Services’ Office of Inspector General uncovered evidence that hospice providers would go years without surveys; they are among the few ways watchdogs say patients and families can find an independent record of a facility’s quality.

The language in the IMPACT Act would allow the Centers for Medicare & Medicaid Services (CMS), which holds the purse strings to much of the industry’s funding, to have more clout. All Medicare-certified hospices would be surveyed at least every three years. The three-year cycle is consistent to recommendations in the OIG report.

The hospice industry’s lobby and trade group, National Hospice and Palliative Care Organization (NHPCO), acknowledged the survey problem and maintains that it supports the IMPACT Act, also known as HR 4994. It would dramatically increase the cycle frequency from what has been six to eight years or longer.

Here’s the specific language on the survey:

“Any entity that is certified as a hospice program shall be subject to a standard survey by an appropriate State or local survey agency, or an approved accreditation agency, as determined by the Secretary, not less frequently than once every 36 months beginning 6 months after the date of the enactment of this subparagraph and ending September 30, 2025.”

“Currently, hospices can go eight years or more without ever being surveyed, which is far too long,” Donald Schumacher, NHPCO president and chief executive officer said in a statement.

Hospice is generally considered medical care provided for those facing illness near the end of their lives. It can be provided in a patient’s home, in a center specifically for such patients, or in hospice located in a hospital, nursing home or other long-term care facility. NHPCO figures estimate more than 1.5 million dying Americans receive hospice care each year.

“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,” Schumacher added.

The legislation would also allow CMS staff to “facilitate medical reviews” of patients “receiving care for more than 180 days.” Hospice centers would have to reach a certain threshold, however, before medical reviews would take place.

“The specific patient load that would trigger this medical review is yet to be set by CMS,” according to NHPCO. “Such a medical review of what are known as ‘long stay’ patients will help ensure that hospices are caring for individuals with life-limiting illnesses that are often harder to prognosticate than in the earlier days of hospice care when most patients had a cancer diagnosis.”

Supporters of the legislation say it is the latest push by policymakers to bring more accountability to healthcare. Last year, hospice providers were required to report certain quality measures to the federal government or lose out on a one percent increase in Medicare reimbursement.

The hospice measures are part of IMPACT legislation designed to require “post-acute providers” including long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies to report standardized patient assessment data and quality and “resource use” measures as the Medicare health insurance program for the elderly moves from fee-for-service medicine to more value-based care.

Congressman Reed referenced the bipartisanship in advocating the hospice aspect of the legislation.

“Strengthening hospice care is something people from across the political aisle can come together to support and improve hospice care delivery in America,” Reed said in a statement. “We depend on hospice providers for more than helping our loved once. We also depend on them to bring peace of mind and comfort to our families.”

Physician Assisted Suicide Conference Draws Supporters And Opponents To Chicago

Posted on Friday, September 19th, 2014 at 8:17 am by lifemediamatters

We think there are a lot of well-intentioned people here. Most of them have the best of intentions, but they refuse to stop and think about the implications of the policies they are pursuing.

Hundreds of patients, ethicists and medical providers attended the World Federation Conference in downtown Chicago to voice support for physician-assisted suicide, also known as “death with dignity.” The conference, made up of 49 right-to-die organizations from around the world, also drew numerous protestors from religious and disability rights groups.

Hosted by the non-profit Final Exit Network, the event aimed to encourage grassroots organization to support “death with dignity” laws and change attitudes.

“We believe that legislation does not go far enough. We believe that it is the right of every competent adult, suffering from severe, intractable illnesses which have deprived them of quality of life, to choose to hasten their death,” said Janis Landis, vice president of Final Exit Network, in a statement to Life Matters Media.

They would dictate to me how much pain and suffering I have to endure at the end of my life. They want to limit my right to choose.

Protestors with Not Dead Yet

Protestors with Not Dead Yet

Proponents of “death with dignity” legislation say such laws increase patient freedom at the end of life, because the seriously ill can avoid suffering and die on their own terms. In Oregon, the first state to legalize physician-assisted suicide, terminally ill adults may self-administer a prescribed lethal dose of barbiturates.

But some disability advocates, medical providers and religious organizations argue physician- assisted suicide is unnecessary and endangers the most vulnerable patients. The American Medical Association, the nation’s largest organization of doctors and medical students, does not support it.

Adam Vallard, a member of Not Dead Yet – a national disability rights group opposing all forms of aid in dying legislation – said he worries doctors could pressure disabled patients to end their lives early.

“There is this movement of right-to-die advocates who are not making distinctions between allowing someone to die with dignity and steering someone to assisted suicide. We see this as a larger trend in our society to devalue lives that are costly,” Vallard said. “We think there are a lot of well-intentioned people here. Most of them have the best of intentions, but they refuse to stop and think about the implications of the policies they are pursuing.”

Other protestors held signs, wore skeleton masks and chanted. Some conference attendees said they were told to avoid them. Many reported being instructed to avoid conversation out of fear of inciting violence.

Ken Leonard, a board member of the Hemlock Society of Illinois, called the protestors “religious extremists” and misinformed.

“Most of them are there because they believe it is God telling them to do so,” Leonard said. “They would dictate to me how much pain and suffering I have to endure at the end of my life. They want to limit my right to choose.”


Kathryn Tucker, executive director of Disability Rights Legal Center

Kathryn Tucker, executive director of the Disability Rights Legal Center and former legal counsel to Compassion & Choices, one of the nation’s leading advocacy groups for the legalization of physician-assisted suicide, said she works to ensure disabled Americans receive the care they want at the end of life.

“Dying these days has become a long, arduous journey,” Tucker said in her presentation. “Choices will expand, aid in dying will become increasingly available, we will see more clinical practice guidelines and more evidence that the process is becoming normalized.”

Physician-assisted suicide is legal in five states: Oregon, Washington, Vermont, Montana and Hawaii.

A Simple Change? The IOM Report On “Dying In America”

Posted on Thursday, September 18th, 2014 at 8:24 am by lifemediamatters

Courtesy Creative Commons via Flickr

Courtesy Creative Commons via Flickr

Say there was a simple change to the health care system that would reduce cost, reduce demand, increase quality of life and satisfaction, address the patient and not just the disease, improve care coordination and increase patient autonomy. This change is possible, but it requires addressing the problem that in America, we do not die in the manner we wish.

The Institute of Medicine released its report this week, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Despite decades of efforts, the report shows that there has not been much change in how we die. We mostly want to die at home, and yet we die in hospitals. We mostly want comfort care, and yet we mostly receive aggressive care. We want our emotional and spiritual needs met, yet physicians are not trained in dealing with them.

The trends in end of life care have changed recently, though not for the better. We tend to move around a lot at the end- between home, long term care facility and hospital. More technical caregiving is done by family members. Although palliative care leads to a higher quality of life, including better understanding and communication, access to home care, emotion and spiritual support and symptom management, physicians rarely refer to such services.

The goal of the report is to create a roadmap examining what steps should be taken in order to make the end of life a better experience. Among its suggestions:

  • The system of care needs adjustment to provide for “higher quality, integrated, patient-centered, family-oriented, and consistently accessible around the clock” care. Palliative care can provide this, so more palliative care professionals are needed, along with more (and earlier) referrals. All medical students should receive training in palliative care.
  • Increased communication between physicians and patients. At the end of life, most need assistance in making care decisions at a time they are likely surrounded by people they do not know. Thus, the report suggests that advance care planning conversations begin in the teenage years and continue throughout life. These chats should address not only desired care and values, but also spiritual and emotional needs. People should receive assistance in completing advance directives. Health care providers should document these conversations not only in the physician’s office but also in medical records easily accessed from most care locations.
  • A change in funding priorities. Whereas most funding to aggressive, last-ditch efforts to keep bodies functioning, health care dollars should fund coordination of care, palliative care-like programs and physician time for conversing on end of life issues. There should be additional fund for POLST programs in all states, creating truly integrated, inter-operational records accessible in all settings.
  • Lastly, the report recommends improved and increased public education and engagement to “raise awareness and elevate expectations about care options, the needs of caregivers and the hallmarks of high-quality care” as well as to complete advance care planning conversations and documents.

Ever since Elisabeth Kübler-Ross inconveniently pointed out that Americans have an “avoidance problem” with death, efforts have been taken to improve care for the dying. As this report shows, those efforts are noble and innovative- but not nearly as endemic as they should be for real change allowing more to experience a good death.

How A Dying Grandmother Shaped Japan’s End-Of-Life Debate

Posted on Wednesday, September 17th, 2014 at 4:16 pm by lifemediamatters

My grandmother, Hisako Miyake, was one of 260,000 bedbound and elderly patients in Japan kept alive, often for years, with a surgically inserted feeding tube (Bloomberg).

Teen On Hospice Care Ties The Knot With Young Groom

Posted on Wednesday, September 17th, 2014 at 4:15 pm by lifemediamatters

It was a dream come true Friday night for an area Hospice patient who became a bride in a rose garden ceremony that delighted not only those who attended her wedding, but also millions of other people around the world (WNYT).