In May I wrote a post entitled Are Sales People Killing Hospice? that sparked an interesting discussion among members of the LinkedIn Hospice Group. A tangential discussion thread within the My.NHPCO Clinical and Operations Management Group on the use of admission representatives instead of nurses to make the initial visit prompted this post (if you are not an NHPCO member you probably won't be able to access the discussion). Specifically, NHPCO’s ethics guru (not an official title), Tim Kirk’s use of an ethical lens to think about the issue of informed consent reminded me of a perhaps underutilized NHPCO resource – the Ethical Marketing Statement.
May I be the first to acknowledge that I am certainly not a poet! Let me also be clear that this is written with the utmost of respect for the sacred responsibility that we elect in accepting the privilege of caring for those at the end of their lives. However, in the stressful times in which we are living, with increasing regulatory and public scrutiny, burdensome processes (e.g., The Hospice Item Set, CR 8358, etc.), and unclear guidance (e.g., Medicare Part D), my hope is that a small dose of humor might help in palliating some of the symptoms of confusion, frustration and disempowerment. And so yes, this blog post is ‘related’!
If we don't count today or weekends, there are only 17 full work days left until the July 1, 2014 implementation deadline for the Hospice Item Set (HIS). This is getting really serious.
I have had the opportunity in the past week to take my HIS show on the road to two State hospice organizations (Massachusetts and New Jersey). The most important thing I learned from attendees at both 3 hour workshops is that there has been very little information provided by EMR (electronic medical records) vendors with regard to the HIS support that they will/will not be providing to their customers.
For many hospices and other non-profits, fundraising is a “necessary evil.” It is something to slog through in order to be able to continue to provide wonderful services. Hospices need to raise funds, but relegating fundraising to second-class status makes securing enough funding more difficult than it needs to be.
I love that expression: "in the weeds." It has entered into the realm of jargon but, nevertheless, it so clearly describes how I have been feeling with the HIS implementation guide I have been writing with Melanie Merriman. Thoroughly in the weeds with the HIS -trying not to get choked, trying to sort through the gazillion details, trying to pull out the non-essential and get to the heart of the matter.
I have been giving a lot of thought to hospice quality this week for two reasons: 1) I am still working on the Hospice Item Set: A Step by Step Implementation Guide (shameless plug, but we are nearly done!); and 2) I am still reeling from the horrific comments about negative hospice experiences in the comments section of the most recent Washington Post hospice diatribe. The resulting feeling is one of frustration and worry.
With a heavy heart I read the latest Washington Post article lambasting the hospice industry for not providing the higher levels of care: continuous care and general inpatient (GIP) when patients need it. Citing numerous examples, and naming specific hospices at fault, this latest investigative reporting by the Washington Post continues its general thesis from a previous article last December: the hospice industry, dominated by for profit providers, is doing a lousy job.
I am so proud of our last Weatherbee blog post (here) written by Dr. Suzanne Karefa-Johnson. I love how she so elegantly reframed the physician narrative requirements. It resonated so completely with what I have always believed about about hospice regulations - they are inherently good, they serve a purpose, they are worth the trouble because, ultimately, they protect patients and/or lead to better patient care.
It is because of my belief in the importance of hospice regulations that I am so crazed right now!
Imagine this - CMS, a bearer of gifts! From the publication of the "new" Conditions of Participation in 2008 through the most recent Part D requirements, CMS has mandated that we, as hospice physicians, step up to the plate and describe, in narrative statements, our patients’ stories...
The salami approach is one of the most useful lessons I learned somewhere a long the way in my life. If you try to eat, or even imagine eating, a whole slab of salami all at once, it borders on disgusting. However, if you cut the salami into small slices, all of a sudden it looks good! Edible! So it is with the Hospice Item Set (HIS).