14 09, 2017

Just Culture and Hospices

By | 2017-09-14T15:24:46+00:00 September 14th, 2017|1 Comment

Introduction Here is the conundrum: A hospice clinician makes an error (she did not provide patient education on proper use of oxygen in the home because she thought the DME company provided it). Her error/omission resulted in an adverse patient outcome (patient smoked while using oxygen and set himself and surroundings on fire). Even though [...]

27 04, 2017

It’s Spring Cleaning Time. Is Your Hospice In Order?

By | 2017-05-17T09:21:21+00:00 April 27th, 2017|Comments Off on It’s Spring Cleaning Time. Is Your Hospice In Order?

It’s that time of year again when the blooming landscape and longer days inspire a thoughtful inspection of how well our homes are in order. As we know, it is not uncommon during this process to stumble upon some areas of wear and tear that need fixing (e.g., broken gutters, missing shingles, clogged vents, the [...]

24 08, 2015

Returning Medicare and Medicaid Overpayments – Better Act Fast!

By | 2017-05-17T09:21:39+00:00 August 24th, 2015|Comments Off on Returning Medicare and Medicaid Overpayments – Better Act Fast!

Don’t shoot the messenger but compliance with Medicare and Medicaid rules just got tougher for hospice organizations.  In the first judicial opinion on when a Medicare or Medicaid “Overpayment” is “identified” for purposes of the Affordable Care Act’s (ACA) 60-Day Repayment Law, a New York federal court’s interpretation complicates the already difficult task providers face in having sufficient time to assess and quantify potential overpayments. 

3 04, 2015

Hospice Prognosis vs Diagnosis – Can we slow down for a minute please?

By | 2017-05-17T09:21:51+00:00 April 3rd, 2015|17 Comments

I had not been paying much attention to NHPCO's flurry of activity during March regarding prognosis vs. diagnosis until I received an email from a well-respected hospice CEO that said, in part: 

"Our Medical Director is livid and is adamant that what 'influences' the prognosis is very different from what is "related to" the prognosis.  This seems like a fundamental shift from what we have been doing for thirty years - is it possible that everyone (including NHPCO) has been so wrong about this? We think we have financial challenges now - just wait!"

27 11, 2014

Part 1: Appreciative Inquiry and the Certification Process… Imagine that!

By | 2017-05-17T09:22:07+00:00 November 27th, 2014|3 Comments

Every hospice physician has experienced difficulties in assessing “gray” patients. These are the ones who, at admission, do not have a principal diagnosis or terminal story that leaps out from the record, although for many of these patients, the physician is able to answer “no” to the “would you be surprised if your patient dies within the next six months” question. 

  • Are these patients truly terminally ill?
  • Is a period of seeming stabilization sustainable?
  • Should these patients be evaluated for discharge due to extended prognosis?


3 09, 2014

What’s New with Part D? Tools to Guide Your Relatedness Journey

By | 2017-05-17T09:22:29+00:00 September 3rd, 2014|Comments Off on What’s New with Part D? Tools to Guide Your Relatedness Journey

Since our last Part D blog, CMS issued the Revised Guidance for Part D, on July 18th, 2014, effective as of that date. There are some detailed, comprehensive resources (listed below) that address this complex issue. The purpose of this blog is to synthesize and recap “what’s new” in the Revised Guidance for Part D and highlight tools for navigating these changes.

27 05, 2014

Out of the Weeds with the Hospice Item Set (HIS)

By | 2017-05-17T09:22:36+00:00 May 27th, 2014|Comments Off on Out of the Weeds with the Hospice Item Set (HIS)

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.

5 05, 2014

Damned when you do, damned when you don’t: A response to the Washington Post Article

By | 2017-05-17T09:22:43+00:00 May 5th, 2014|3 Comments

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.

28 02, 2014

A Timely Reminder About Part D

By | 2016-01-13T10:45:42+00:00 February 28th, 2014|2 Comments

As of March 1, 2014, Medicare Part D providers will no longer pay for medications that are (or may be reasonably assumed to be) related to a patient’s primary hospice diagnosis and the comorbid conditions that are contributing to his or her terminal status. Rather, hospice providers will be responsible for covering all of the medications that are needed to manage and/or palliate end-of-life symptoms appropriately and effectively.

18 02, 2014

HIPAA Breach Notification Deadline Approaching

By | 2016-01-13T10:43:36+00:00 February 18th, 2014|Comments Off on HIPAA Breach Notification Deadline Approaching

It is that time of year again...  If you have not already notified the government of breaches of unsecured protected health information that affected less than 500 individuals that were discovered in 2013, you must do so by March 1, 2014.