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Hospice Community Shares Commitment

For Immediate Release: December 8, 2011

Hospice Community Shares Commitment to Quality and Compliance

NHPCO Offers Perspective to Critics

(Alexandria, Va) – Bloomberg Financial reporter Peter Waldman once again turns his investigative lens to the hospice community. In his article of December 6, he looks at several of the nation’s approximately 5,000 hospice programs (which represent 2,800 Medicare Certified providers) and highlights issues of concern. Unfortunately, stories like this one that share examples of what NHPCO considers to be outliers among the field, may mislead and misinform members of the public and may result in patients and families opting not to consider hospice care in the final months of life.  As part of any national dialog regarding hospice care, the National Hospice and Palliative Care Organization – the largest and oldest hospice and palliative care leadership organization in the country – offers some important perspective.

First and foremost, NHPCO emphatically states its belief that hospice care is the highest-quality palliative care available to patients and family caregivers struggling with advanced, life-limiting illness.

It is NHPCO’s long-held position that:

  • All providers should subscribe to quality care delivery.
  • More consistent and timely oversight is appropriate for the growing hospice community.
  • Organizational ethics do not stop at clinical care, but must be integrated in all aspects of practice including marketing and admissions.
  • Research should move the entire industry forward by analyzing which hospice interventions further enhance the quality of care.

NHPCO leads and promotes a shared commitment to the highest quality hospice and palliative care and works to support access to care for all patients and family caregivers coping with serious, advanced, and life-limiting illnesses, in all settings. Along with this commitment to serve comes the need for all providers to adhere to regulatory guidelines when assessing new patients.

All medically eligible individuals should have access to quality hospice care yet it should also be remembered that only a physician may certify a patient as eligible for hospice. Marketing representatives or other staff members do not have the authority to bring a new patient on to service.

In its recently issued position statement, Ethical Marketing Practices, NHPCO states, “The promise of services before an in-person assessment is conducted is a questionable practice that is not appropriate for hospice providers.  Additionally, rewarding admission staff bonuses based on predetermined admission goals is not appropriate and must be discouraged.”

The public should understand that hospice and palliative care professionals have special training and expertise required to properly care for the dying. The availability of hospice care in nursing home settings, for example, is not a duplication of services, but adds the skilled abilities needed at the end of life to the care provided by qualified nursing home staff. One in four Americans will likely die in a nursing facility and they deserve the highest quality end-of-life care available.

Hospice is not “brink of death care” and implications that hospice should only be serving people in the last days of life are inaccurate.  Hospice is ideally suited for the last months of life, not the last days. While there is concern over long lengths of service, mechanisms like the Hospice Cap and the new regulatory Physician Face-to-Face Encounter for recertification do address some of the concerns relating to ongoing patient certification and payments for inappropriate admissions.

Annual Medicare expenditures on hospice care are approaching $12 billion. With an aging population and ongoing efforts to promote appropriate access to hospice care, modest increases in those expenditures are not only right but should be encouraged.  These dollars are well-spent and provide the most comprehensive, patient-centered care for people at the end of life. It’s about the best care at end of life; however, independent research out of Duke University found that hospice saves Medicare $2,300 for every beneficiary that received hospice care.

As expenditures on hospice care rise, more scrutiny from regulatory organizations and the media is to be anticipated. NHPCO appreciates such opportunities to voice its call for reasonable regulatory oversight of the field.

With more than 1.5 million patients served annually, the 94 percent “very good to excellent” rate of satisfaction among family members (as reported in the NHPCO Family Evaluation of Hospice Care survey tool) is an important reflection of quality and should be considered in discussions regarding hospice.

Over the past decade, the increased numbers of for-profit providers parallels increased numbers of Americans served by hospice. It is NHPCO’s belief that any business model – for-profit, non-profit or governmental – that provides greater access to quality hospice care and strives for the highest levels of compliance and practice is good for the nation’s healthcare system and good for patients and families.

NHPCO is committed to reaching out and informing, educating, advocating and building awareness of quality end-of-life care.

With multiple hospices serving some communities, it can seem challenging for families to select one. With this in mind, NHPCO provides some guidance for people looking for a quality hospice program best equipped to meet their family’s specific needs. Caring Connections, a program of NHPCO, has developed a worksheet that provides suggested questions to ask when contacting a hospice. The new worksheet, Choosing a Quality Hospice, asks such questions as:

  • Is the hospice a member of NHPCO and its Quality Partners Initiative?
  • Does the hospice utilize NHPCO’s available outcome measurement tools to assess and improve quality of care?
  • When was the last state or federal survey of the program?
  • What extra services does the hospice provide?
  • What services do volunteers offer?

Download the free Choosing a Quality Hospice worksheet from Caring Connections.

To find out which hospices serve your community, call NHPCO’s InfoLine at 1-800-658-8898 or visit www.caringinfo.org/findahospice


Jon Radulovic
NHPCO Vice President, Communications
Ph: 703-837-3139

NHPCO Hospice Talking Points