To:          NHPCO Membership
From:    Edo Banach
Date:     July 17, 2019

I have been thinking lately about the nature of the press these days. Too many people dying in pain?… Too many people dying in the hospital?…  Median hospice lengths of stay only a few weeks?… Snoozer to current media.  Yet, a reporter finds an extreme example of a hospice failure and it becomes a headline in The Washington Post, echoed by headlines in other media outlets like CNN, NBC and NPR. Yes, I’m thinking of media attention resulting from the release of recent reports from the Office of the Inspector General.

I must admit, I was troubled by the way these OIG reports were rolled out – with somewhat sensational media coverage published before the reports were made publicly available. But we must not miss the opportunity that we have to learn from the OIG investigations and work to improve care for all people.

Do not misunderstand me. I do not want to diminish the serious nature of the cases brought to light in last week’s OIG reports. They were extremely troubling and call for immediate action on the transparency, education, and quality front. And as the OIG makes clear, the provider community must look to CMS to provide appropriate oversight that is constructive and necessary to ensure positive outcomes. We have work to do.

Let me be perfectly clear about the following points:

      • TRANSPARENCY: NHPCO believes that a patient or family member must be confident that a Medicare-certified hospice will provide high-quality care and they should be able to access reliable data that supports the choices they make.
      • EDUCATION: NHPCO believes professional education and training for staff and volunteers is an ongoing commitment that must be part of an organization’s culture. High-quality care, regulatory compliance, and clinical excellence require ongoing education. We owe this to our teams as well as those that they serve.
      • OVERSIGHT: NHPCO supports increased oversight for the field and we have been a strong advocate for this for many years. We recognize the need for systemic changes that will allow for smart oversight. We are prepared to work with the Administration and Congress to make it happen.

That said, I believe that the extreme cases reported by the OIG and shared by the media this past week do not represent the overall, positive experience that millions of Americans have had with hospice and palliative care. Unfortunately, horrible stories grab headlines. And selling papers and garnering Internet clicks are a reality in today’s 24/7 media. I’m concerned that headlines like these do more to scare the public than to educate them about the many benefits of hospice care. Every person deserves access to high quality care when facing a serious illness and the media should help people make more informed decisions, not discourage them from choosing hospice and palliative care when they need it most. Family caregivers, already overwhelmed with the myriad of emotions that come with caring for a loved one, do not need added anxiety.

I need to stress to the entire field that we rise and fall as one community. While we are keenly aware of the differences among the many varied provider types, most Americans see hospice as one brand. We know this from the many members of the public we speak with here at NHPCO that don’t realize their community hospice is not our organization, and is not the same hospice that may have cared for a loved one in another state – to many people, we are all the same. We have such conversations pretty much every day, and we do our best to help educate the public. To the extent that misdeeds of bad performers are reported publicly, they affect every provider. We rise and fall together.

No one understands better than we do that hospice and palliative care providers have one chance to get it right with patients and families – and most do. Of this we should be proud. In fact, we must shine a greater light on the excellent person- and family-centered care that we make available. However, there is no room in the field for providers who will not or can not reach for the highest levels of quality, compliance, and patient safety.

Situations that challenge us also give us an opportunity to bring our best and collective spirit to the table. The healthcare landscape in this country is changing, and changes to hospice are inevitable. We must ensure that the principles of hospice and palliative care that we love, that we have built upon the past forty years are not lost in the evolving care delivery system. We must be part of the evolution; we must drive the change and design what hospice of the future will look like. Let’s use this moment to rally, improve the things we need to improve upon, learn from past challenges, and work collaboratively to create a version of hospice that will help millions more receive the care they need and deserve.

Please, don’t let gotcha moments like those of the past week keep us from the work that we need to do to provide more interdisciplinary, person-centered care to more people, earlier.  I look forward to working with you to make sure that we rise, united, to demand smarter oversight and better patient care.


Edo Banach, JD
President and CEO