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Hospice National News 6/13/2023
June 13, 2023

Several Nonprofit Hospices Reported Ones To Watch

  • An article in Hospice News notes that even though nonprofit hospices represent about 25% of hospice providers, they still serve more than half of the Medicare beneficiaries who elect hospice care. The article names three nonprofit hospice providers “that are not only growing, but experimenting with new reimbursement and care models and diversifying their services to extend their presence more broadly through the health care continuum.”
  • Ohio’s Hospice is examined as the first innovative nonprofit. The organization is a collaborative effort that first formed with three hospice providers. The hope in creating the effort was to “better compete with larger, often for-profit providers.” The organization now includes “11 affiliates, with Hospice of Morrow County as its newest addition in July 21.” Together, the network uses the combined-organization’s size to negotiate with “vendors, payers and referral sources.”
  • The article also shares about Ohio Hospice’s palliative care arm, Pure Healthcare, that has a VBID network contract with the CVS Health Corp. This expands the provider’s ability to offer multiple services for reimbursement. Additionally, the collaborative has partnered with United Church Homes (UCH), a nonprofit living company, to create growth in hospice and palliative care for its residents. They also began, in 2021, a palliative care physician fellowship partnership with Kettering Health. The article includes more of the activities of the hospice, and feedback from CEO Anthony Evans from Pure Healthcare.
  • As for the future, the collaborative hopes to help other nonprofits cross the country in their own efforts to form such a collaborative. They have already done  lot of this work in a variety of states.
  • Chapters Health System, the second provider profiled, offers “hospice care, palliative medicine, as well as durable medical equipment and pharmacy services, impacting approximately 105,000 lives annually in the southeast and mid-Atlantic regions of the United States.” Chapters has doubled its hospice services in the past few years by forging affiliative efforts “with Cornerstone Hospice and Palliative Care, Hope Healthcare and, most recently, Capital Caring Health.”
  • Much of the focus of Chapters, says the article, has been focused of “ensuring a positive work environment for its employees to ensure it can meet swelling demand.” The article, which shares feedback from Chapters CEO Andrew Molosky, describes various affiliates that have joined together for greater strength for all.
  • Finally, Empath Health is profiled. From its inception in 2014, Empath now has “17 affiliates and two philanthropic foundations. . .” Empathy offers hospice, home health, primary care, palliative care, PACE, AIDS and sexual wellness care, and adult day services to a combined total of more than 23,000 individuals.”
  • One of the current organization’s priorities is its “‘One Hospice’” initiative. That initiative, says CEO Jonathan Fleece, includes “‘basically standardizing our models of care, our support services, and our infrastructure (such as EMR systems.) . . .’” In addition to these hospice efforts, “the company is partnering with 10 other post-acute care providers to form the Accountable Care Organization (ACO), Responsive Care Partners, including several hospice and palliative care operators.” More details about each of these organizations is included online at the article below. (Hospice News, 5/30)

HOSPICE NOTES

The Senate Comprehensive Care Caucus (SCCC) introduced the Expanding Access to Palliative Care Act. Senator Jacky Rosen (D-NV), John Barrasso (R-WY), Tammy Baldwin (D-WI), and Deb Fisher (R-NE) form the bipartisan SCCC. The bill “would create a demonstration project within Medicare to allow palliative care to be covered concurrently with curative treatment for patients with serious illness or injury.” In a release on Senator Rosen’s webpage, each of the four senators speaks of the interest that drives their desire to support this bill. NHPCO’s interim CEO, Ben Marcantonio, is also quoted, as is John Broyles, CEO of C-TAC. (Jacky Rosen, 6/8)

“Hospice Is a Profitable Business, but Nonprofits Mostly Do a Better Job,” appears in New York Times in a New Old Age column written by Paula Span. The article shares numerous stories and studies that compare for-profit and nonprofit hospices. Span opens the article by sharing the story of a former nursing home nurse who said she could tell if a for-profit or nonprofit hospice was serving a patient, saying nonprofit hospices responded more quickly and fully. Most of the article recalls stories that note quality issues in for-profit hospices. But it also notes that the critique cannot be uniformly applied to every hospice. The article includes feedback from a family who received excellent care from a for-profit hospice for two different family members. MedPAC recently reported that “in 2020, for-profits received 20.5 percent more from Medicare than they spent providing services. The margin for nonprofits, who’s daily per-patient expenditures are higher, averaged 5.8 percent.” For-profits more often discharge patients, a practice that creates, says physician Joan Teno, “‘burdensome transitions.” These transitions happen to 12 percent of patients in for-profit chains; 18 percent in for-profits not in a chain and only 1.4%of patients in nonprofit hospices. A study by Teno found that “more than a third of non-profits, but only 22 percent of for-profits were ‘high performers.’” Representative Earl Blumenauer, (OR-D), “who has long been involved in end-of-life legislation,” says “‘It’s clear we need to strengthen oversight, but we must also modernize payment programs to meet the needs of patients and make it harder for people to game the system.’” The article is online at the link below. (New York Times, 6/10)

“An Unwanted Spotlight: DOJ Announces Hospice Fraud Is Top Priority” is a podcast offered as a part of the Hospice Insights series by Husch Blackwell. Attorneys of the group share feedback from the recent gathering of the American Bar Association’s Annual National Institute on Health Care Fraud. Hospices will learn more about what to “expect after . . .the remarks of Lisa Miller, the Department of Justices’ (DOY) Deputy Assistant Attorney General who oversees the Criminal Fraud Section.” Data has shown, says Miller, “increase in costs to the Medicare program resulting from claims for hospice care.” A link to the podcase is included below. (Husch Blackwell, 6/7)

NHPCO, on Facebook, shares support of Pride Month and reminds readers of an NHPCO resource published last year that offer “results of a first-of-its-kind study exploring perceptions of hospice care within LGBTQ+ communities, among others.” The NHPCO survey reported that almost “one-third of LGBTQ+ respondents doubt or are unsure that hospice would respect their sexuality.” Respondents were more likely to trust a hospice with an LGBTQ+ member of the staff. A link to the resource is online at the Facebook page at the link below. (NHPCO, 6/9)

As reported earlier, there has been community concern over the possible sale of Tennessee’s Alive Hospice to a for-profit provider. The governing board has now “decided that the 48-year-old Nashville end-of-life care center will remain an independent, non-profit organization. . .” Though the hospice is fiscally healthy now, chairwoman of the board, Vicki Estrin, says there are “‘headwinds’ from rising staff costs, increasing competition and consolidation in the industry and uncertainly about the Medicare/Medicaid system. . .’” When asked if the decision might be revisited later, Estrin replied, “‘”I have to say that we’ve made this decision to be independent and not-for-profit. We’re not going back through this again. The decision stands.” (The Tennessean6/7)

A report in Definitive Healthcare examines the growth of physician claims in the top 20 physician specialty groups from 2018-2022. Of the top twenty specialty groups, hospice and palliative care is reported as number one, with a 786% increase in claims. The trends that impact these changes across the country, says the report, are “consolidation and increased ownership of physician groups by private equity (PE) firms.” A list of the specialty groups, as well as a profile of the data collection group, is online at the link below. (Definitive Healthcare, 6/1)

END-OF-LIFE NOTES

Oregon’s KTVZ channel 21 shares a CNN Editorial Research article titled “Physician-Assisted Suicide Fast Facts.” The article offers an overview of physician-assisted suicide laws in the country. It also provides several key facts, data about the use of the laws, and a timeline of how the laws have developed from 1997 forward. (KTVZ, 5/29, https://ktvz.com/news/2023/05/29/physician-assisted-suicide-fast-facts-3/)

NPR station WBUR shares “How the medical aid in dying movement is gaining momentum in the U.S.” “Three times as many states allow the terminally ill to access life ending drugs as did five years ago,” is the opening statement of the program. Currently about 80% of the states allow no access to this care. One guest speaker is Dr. Diana Barnard who specializes in hospice. She was “one of the plaintiffs in a lawsuit against Vermont arguing that the residency requirement to access the state’s medical aid in dying law was unconstitutional.” Others include a wife of a patient who sought to use the law, an attorney who is suing California, the president and CEO of Compassion and Choices, and a partner of a man who shot himself when he “couldn’t access medical aid in dying because his state didn’t offer it.” (WBUR, 5/31, https://www.wbur.org/onpoint/2023/05/31/how-the-medical-aid-in-dying-movement-is-gaining-momentum-in-the-u-s)

“One Man’s Quest to Control the End of Life,” appearing in Next Avenue, describes the story that led to “an unplanned, unflinching award-winning documentary. . .” that “takes us inside a family’s journey through medical aid in dying.” The movie is a collaborative effort of Compassion and Choices and Interloper Films. The movie, “Last Flight Home,,” says the article is “shortlisted for an Oscar, to encourage states to pass laws that give a terminally ill person the right to end their life, especially if they’re suffering or the quality of their life is so diminished.”  The film walks through the story of a California family, and 92-year-old Eli Timoner, as the journey unfolds for them. Timoner is bedridden and has been paralyzed for more than 40 years. Timoner’s daughter, Ondi, had not planned to make the movie about this private part of his journey, even though she is “an accomplished documentarian” who was working on a film about her “father’s leadership in at Air Florida.” The article explains the family’s decision-making process, and about their thoughts and feelings; as well as the final moments of his life. The link below leads to the article. (Next Avenue, 6/9)

Nevada Governor Joe Lombardo says, “I am not comfortable supporting this bill,” and vetoed SB239 which would have legalized medical-aid-in-dying. Supporters of the bill say Nevada citizens, by a percentage of 82%, support the legislation. Kim Callinan, president and CEO of Compassion and Choices, says, “‘Lombardo refused to meet with bill supporters before becoming the first governor to veto a medical-aid-in-dying bill,’” (8 News Now, 6/5)

GRIEF AND ADVANCE CARE PLANNING NOTES

“How Should We Talk to Kids About Death?” appears in Psychology Today. Two women who are child advocates have written a book to help adults talk to children about death. The book, “Everyone Dies,” is geared toward children up to age 10. The two, Marianne Matzo and Darlene Domanik are now considering another book that is geared for “school-aged kids.” (Psychology Today, 5/29)

OTHER NOTES

Family Medicine offers “Preparing for the End of Life: Medical Students Completing Their Own Advance Directives Increased Empathy for Patients.” Over a period of three years, researchers had  third-year medical students complete an advance directive (AD). Then, students, who used “Five Wishes,” shared personal reflections on their experiences. Researchers imagined that students would learn, and appreciate the value of AD. The surprise was that many students reported improvements in “empathy for patients around complex aspects of planning for death.” (Family Medicine, March 2023)

Home Health Value-Based Purchasing Lowered Medicare Spending” appears in RevCycleIntelligence. “The Home Health Value-Based Purchasing (HHVBP) Model reduced Medicare spending by $1.38 billion and improved care quality during its first six years, according to a report from CMS.” The article offers a report on the CMS study. The first link below leads to the article, and the second link leads to the CMS report. (RevCycleIntelligence, 5/24; CMS, May 2023)

Thanks to Jeannette Koijane for contributions.

NOTE: Some URL links require subscription, membership and/or registration. Hospice Analytics is the national sponsor of Hospice News Network for 2022. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209-1237 or see www.HospiceAnalytics.com

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