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GAR Update

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NHPCO Geographic Area Representative Update
February 2013

The first NHPCO board meetings of the year for NHPCO and our affiliate organizations took place on January 25-26 following NHPCO’s successful event, Creating the Hospice Palliative Care Continuum: A Futuring Forum, in Hollywood, Florida. As your Geographic Area Representatives, we are sending you this update to cover some of the key issues that were discussed. Our intention is to keep you informed of the work of your organization. We hope you find this update useful – if there’s something else that might be valuable in terms of staying up to date, please let us know (our contact information is at the end of this document).

To begin this GAR Update, Ron Fried, our new board chair, would like to share the following message with you that he shared at the board of directors meeting.

Message from our Board Chair

Thank you for the privilege to serve this year as NHPCO’s board chair. There is much we can do together working as a unified community and I value the contributions of every single NHPCO member and supporter.

As we begin this new year, I want to thank our immediate past chair, Mark Murray, for his leadership, brilliance and unmatched humor. It has been an honor to serve as vice chair during Mark’s term as NHPCO chair.  I also want to recognize Linda Rock, our incoming board vice chair.   I look forward to hearing her bold voice this year, especially on behalf of the many important issues affecting small and rural providers. Additionally, I appreciate the opportunity to work closely with the NHPCO management team.  Each member of that team is uniquely talented and makes an important contribution to the hospice and palliative care community. Under Don Schumacher’s great leadership, they do an outstanding job.

Thank you also for the opportunity to continue working with the other dedicated members of NHPCO’s board and various committees. I learned much  during my past service as vice chair, national director, board treasurer, committee member, and chair of the Hospice Action Network during its beginning years; I know those experiences will serve me well during my term as board chair.

Lastly, please know that I understand and appreciate the great responsibility you are entrusting in me and the rest of the NHPCO Executive Committee. You have my promise that I will work every day during my term to maintain your trust and to work diligently to keep us unified, inclusive, strong and resolute while we do this important work on behalf of patients and families. I am committed to keeping the NHPCO board open and engaged and will work to communicate freely in our shared mission.

We have an exciting year ahead, and you are vital to NHPCO’s success. Let us continue to do good on behalf of so many.

Ron Fried
Board Chair

Board Leadership for 2013
It is always helpful to remind members about our board leadership. The NHPCO board of directors is comprised of many skilled professionals that reflect the wide range of providers that make up our membership. A complete list of NHPCO’s Board of Directors is available on the NHPCO website.

Just as we welcome the 2013 board, we extend our special thanks to the board members who concluded service in 2012: Tara Brodbeck, John Feather, and Shareefah Sabur.

Issues Sessions

Each NHPCO board meeting includes an issues discussion. The goal of these discussions is to identify emerging issues of relevance to our field as well as to discuss factors that may have a bearing on our work as a provider community. At our meeting in Florida, the board discussed two topics. One involves current fiscal issues and the other topic was about a legal case known as Jimmo v. Sebelius that might have future ramifications of significance to our field. In this GAR Update, I offer a brief synopsis that highlights some of the key discussion points.

Fiscal Cliff Continues

  • First, we must share some positive news. In 2012, hospice was one of the very few provider communities that did not face new reimbursement cuts – almost all other provider groups did. At one time, hospice was indeed on the table to be cut but through the work of our combined advocacy efforts as a unified community, we changed that. However, 2013 will not be a year free from cuts.
  • Most Americans are aware that Congress took action in January to avoid the Fiscal Cliff that would impact just about every aspect of federal spending. While most tax increases were avoided, Congress provided only short term relief from dramatic spending cuts.  Indeed, absent a more considered alternative, “across the board” spending cuts will be made effective on March 1, 2013.  These forced spending cuts are a process called Sequestration – and in most cases, legislators want to avoid sequestration because the cuts are done with such a broad brush that they negatively impact just about everyone.
  • Unless Congress acts otherwise, Sequestration cuts will go into effect on March 1, 2013, and that will reduce reimbursement for all Medicare providers by 2%. This cut would remain in place for ten years.
  • But there is other possible turbulence ahead for hospice.  While 2% is the limit that Medicare reimbursements will be cut under Sequestration, this is by no means the only threat to our rates – and we’re already faced with rate cuts established by changes to the BNAF and other administration actions of the past.
  • The issue gets more complicated. The federal budget for 2013 has yet to be passed but must be completed by April 15 and Congress has voted to push its decision on the debt ceiling to May 2013.
  • The question we’re asking is whether the Sequestration cuts that go into effect on March 1 will remain in effect. Congress will make a decision later in the summer of 2013 whether to leave the cuts in place or come up with another plan. If Congress wants to do away with Sequestration, they must come up with $1.2 trillion in other budget cuts. There is no way to forecast where those cuts might come from and whether Medicare providers, including hospice, might face a cut greater than 2%.
  • Some observers of the process have suggested, by leaving the Sequestration cuts in place until the summer, that might indicate that Congress wants to examine funding issues in more detail. They will use these extra months to determine how cuts are affecting a range of programs.
  • Years of deficit spending are catching up in Washington, and this Congress is facing the reality that something must be done and our nation’s fiscal challenges cannot be avoided any longer. There is no simple answer but it’s safe to predict that just about every sector of national spending will be affected. With that in mind, we stress the importance that all providers prepare for the future in a fiscally prudent manner.
  • Let me assure you that NHPCO and our affiliate the Hospice Action Network are strategically planning how to advocate for hospice to minimize the impact of our nation’s financial situation and to protect the high quality care we provide to patients and families.

Responsive Hospice Advocacy Efforts

  • The unified voice of the hospice community will be an essential component of our strategic plans to respond. You can play an integral role in our efforts by making plans to attend the Hospice Action Network’s Hospice Advocacy Intensive that will be held July 29-30, 2013 in Washington, DC.
  • As a reminder, with the introduction of the HAN Advocacy Intensive (last summer), there will be no organized Hill Day as part of the MLC in April as members might remember it. Given the time table of all of the deficit reduction deadlines for the Hill and all that hospice has at stake in the negotiations, we’re moving things around a bit to position our efforts to be strongest around decision time, which is going to be in the late summer.
  • So, for the maximum impact, the hospice community will make its presence felt on Capitol Hill during the Advocacy Intensive, July 29-30.
  • Additionally, HAN will also be doing an active grassroots campaign around in-district activity in the fall, as there are significant end-of-year congressional deadlines.
  • A note for those MLC attendees wanting to visit Capitol Hill while in town in April, HAN will provide limited support to providers who wish to go to make Congressional visits on Wednesday morning. Another way to demonstrate hospice’s presence to policy makers in April is to join our first policy symposium, Conversations Before the Crisis: The Intersection of Family, Faith and Policy in Advance Care Planning, hosted by HAN and NHPCO’s Labyak Institute for Innovation on Tuesday, April 23 at the Ronald Reagan Building and International Trade Center in Washington, DC. This will be a unique opportunity to expand our reach to policy audiences beyond Capitol Hill on an issue that is so important to the community.

Jimmo vs. Sebelius

  • Hospice and palliative care providers may not be fully aware of a class action lawsuit, Jimmo v. Sebelius, which has been reported in the news and deserves our attention for future implications.
  • Glenda Jimmo is a 76-year-old resident of Bristol, Vermont who is confined to a wheelchair due to disabling conditions. She requires regular skilled nursing services. Medicare has not covered those services in the past since she was unable to demonstrate any medical potential to improve (which until this legal case had been an expectation for coverage of skilled nursing and therapy services in institutional or home care settings). Kathleen Sebelius is the Secretary of the Department of Health & Human Services.
  • In January 2011 a case was filed, bearing Ms. Jimmo’s name, that argued that the “improvement standard” that has been a measure used to determine the necessity of home health care services is a practice that was never specifically spelled out in the statute. Legally, the question was made that patients with disabilities and chronic conditions should not be required to demonstrate “improvement” to qualify for ongoing home health services.
  • A settlement was reached in October 2012 and the terms of the settlement were finalized the week of January 21, 2013.
  • CMS is required to revise the guidelines for home health and skilled services in a way that will eliminate the expectation of improvement. CMS would cover skilled services that are needed to maintain or allow for slow deterioration of a patient’s condition. This will not change other eligibility requirements.
  • CMS has one year to revise its guidelines and will be required to establish a national education campaign.
  • Many hospice and palliative care providers are asking how this will change our operations. The answer is that nobody knows for certain.
  • Some of the questions discussed during our meeting included:
    • Will referral patterns and length of service form home health agencies and SNFs be changed in a way that will have a negative impact on hospice providers?
    • Will CMS implement the provisions in the settlement but establish other regulations that might limit application?
    • Might some of the legal factors at play in the Jimmo case have parallels to the hospice community?
  • The value and importance of hospice is widely accepted and one of the challenges facing the hospice community is to ensure that patients and families learn about hospice in a timely manner and through a variety of sources. Furthermore, the need to clearly demonstrate the necessity of our palliative expertise to home health agencies will be important for our field.
  • NHPCO and our legal team will continue to follow the many issues involved in this settlement. For now, it’s helpful that hospice and palliative care providers be aware of this case.

Additional Updates

In addition to the issues sessions, the board conducted the business of the organization representative of the first board meeting of the year. Our meeting included reports from the board chair and CEO, a review of the organization’s financials, approval of the NHPCO, NHF, FHSSA, and HAN budgets, updates on the work of our affiliate organizations, and brief status reports from each of the board committees.

One of the most important points that we want to share with you is that NHPCO is in a solid position and is well prepared for our future work together. The board discussed the important role that stewardship plays in our capacity as organizational representatives and the overall commitment to work on behalf of the entire hospice and palliative care community was emphasized.

What follows are updates on a number of various topics that we would like to share with you.

President/CEO Report

A part of every board meeting is a report from our President & CEO Don Schumacher on some of the specific activities he is focused on in his role.

  • Several days before the board meeting, Don Schumacher and senior leadership met with Marilyn Tavenner, CMS Acting Administrator.
  • Phase One of the Affirming Hospice outreach campaign (this included extensive research and messaging) has been successfully completed. The next steps will focus on implementation of our outreach efforts to the first target audience which will be legislators and policy makers. Future outreach efforts will involve the provider community.
  • The capital campaign for the National Center for Care at the End of Life hit the $4 million mark as 2012 drew to a close.
  • The importance of compliance continues to be a major focus for the hospice community as are the new requirements for quality data collection and reporting.
  • NHPCO is in transition to a new state-of-the-art member database platform; and soon we will unveil our new nhpco.org website (expected to launch 02/05/2013).
  • Staff hosted a group of Duke University graduate students at the National Center for Care at the End of Life for a full day of meetings in mid-December.
  • Our membership statistics for 2012 have been very good (we continue our 99% renewal rate) and we plan to expand our membership engagement efforts to new providers in 2013.

CGS Discontinues One Widespread Hospice Edit

Attention on edits being done by CGS – and some unintended consequences of these edits – has drawn the attention of providers nationwide. CGS has announced that the widespread edit, “5101T,” has been discontinued. NHPCO is pleased that the ongoing conversations with both CGS and CMS have resulted in this discontinuation and are in continuing dialogue with CGS on medical review and claims payment issues shared by providers. At CGS’ request, NHPCO did not issue a provider-wide announcement about the discontinuation, since CGS is notifying providers individually by letter. They will be analyzing claims data from this edit to determine next steps. Any claims that were ADR’ed for the edit will be released and providers should start seeing their claims move through the system and will be paid without review in the coming days. It should be noted that the other CGS edits are still in place.

Medicaid Saved in Louisiana

Late in the afternoon on Wednesday, January 23, hospice supporters were gathering for a candlelight vigil on the state capitol steps in Baton Rouge, protesting the elimination of the Medicaid Hospice Benefit in Louisiana, effective February 1. During the vigil, Louisiana Governor Bobby Jindal’s administration announced that the state had scrapped plans to eliminate the Medicaid Hospice Benefit and that the state will continue to provide end-of-life care to people on their death beds who can't afford private insurance. The NHPCO board extends its appreciation to LMHPCO, the state organization, all the other supporters and providers that worked so hard to protect hospice under Medicaid in Louisiana.

Lighthouse of Hope Fund

A new initiative from National Hospice Foundation was announced to the board: the Lighthouse of Hope Fund. The new program will match funds from member hospices to grant patients special wishes or needs that fall outside of customary programmatic capacity. Look for more information about the NHF Lighthouse of Hope Fund to come out later in 2013.

2012 Accomplishments

NewsLine (January 2013) looks at the range of accomplishments and achievements from last year, so please be sure to check out this issue for some representative highlights of our work together. This issue – as well as past issues – is available online at nhpco.org/newsline.

Strategic Plan

The cover article in January NewsLine looks at the new strategic plan for NHPCO and its affiliate organizations that will guide us over the next three years, 2013-2015. I invite you to take a look in NewsLine or download the PDF of the Strategic Plan.

2013 Conferences and Events

Here are some activities that we encourage you to consider attending.

Thank You

As the year begins, I want to thank you for your continued support of NHPCO. Only through your membership and ongoing involvement are we able to accomplish together all that we have over the past year. I’m pleased to report that we continue to see a 99% retention rate, which has remained consistent over the past couple of years. We don’t take this for granted and let me assure you that the board is committed to ensuring that you continue to get the resources and service you need in the years ahead.

Please remember that as your Geographic Area Representatives on the NHPCO board of directors, we are always willing to hear any comments, feedback or suggestions you might have. Please feel free to email us at the email linked below. Our involvement in NHPCO, our membership organization, is an essential component of our ongoing work together.


Susan Lloyd, Delaware Hospice, Wilmington DE
Northeast Geographic Area

John Thoma, Hospice of Wake County, Raleigh NC
Southeast Geographic Area Representative

SueAnn Reynolds, Family LifeCare, Berne IN
Great Lakes Geographic Area Representative

Linda Todd, Hospice of Siouxland, Sioux City IA
Central Plains Geographic Representative

Sally Adelus, Hospice of the Valley, San Jose CA
West Geographic Area Representative