tag:blogger.com,1999:blog-76553342012-01-24T11:29:34.111-08:00Fighting for quality hospice care for everyone that needs it today or someday in the future.Hospice Guynoreply@blogger.comBlogger2941100tag:blogger.com,1999:blog-7655334.post-58912338368983277802009-08-11T17:19:00.000-07:002009-08-11T18:12:58.480-07:00

I have tried to remain silent on the blog about the health care debate in our country. I have very strong political opinions and do not feel that this blog is the place to have political debate. This is a blog about hospice, and the last thing I want to do is turn people away from hospice because they disagree with me politically. I don't think what I'm about to say is really a political

Hospice Guynoreply@blogger.com6tag:blogger.com,1999:blog-7655334.post-8289994665375482572009-07-21T18:49:00.000-07:002009-07-21T19:17:47.450-07:00

I just wanted to put up a quick post thanking those of you who have emailed checking in on me since I have gone so long without posting anything new on the blog. I didn't plan on taking a break from the blog, it has just happened. My time and energy have been needed in other areas of my life. I do miss writing, and hope to be back in the swing of things soon. Thanks for checking in on me, it

Hospice Guynoreply@blogger.com4tag:blogger.com,1999:blog-7655334.post-77025841074881544552009-03-04T10:57:00.000-08:002009-03-04T10:59:30.960-08:00

Palliative Care Grand Rounds has been posted by Dethmama. Check it out and enjoy all the great reading from a wide range of blogs writing about palliative care.

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-43143095641249682452009-02-24T07:52:00.001-08:002009-02-24T07:52:48.161-08:00

I'm way behind in updating the blog, so I'm going to point you to this article about the hospice provision in the recently passed and signed Obama Stimulus Bill. It probably has more information than I would have given anyway.

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-15959593367579958942009-02-17T09:31:00.001-08:002009-02-17T09:31:11.329-08:00

I received this comment/question to a prior post about Continuous Home Care, and thought I would push it to the top of the blog to see what reactions others may have.OK, here's my question. I was TOLD by a hospice here in Illinois (trying to get my business), that because my father was w/i 2 weeks of dying (we ended dialysis), they would provide two 12 hour shifts of continuous care (one CNA in

Hospice Guynoreply@blogger.com15tag:blogger.com,1999:blog-7655334.post-55614365132202475982009-02-13T10:21:00.001-08:002009-02-13T10:21:59.886-08:00

I am regretfully late in pointing out that a Grand Rounds for Palliative Care blogs has been started. Check out the first round up over at pallimed!(For those who are not familiar with Grand Rounds, it is a roundup of the best of the blog posts on a given topic. Palliative Care Grand Rounds will be published monthly and is hosted by a different blogger each time. The host reviews submissions

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-42151485823411775912009-01-29T08:39:00.001-08:002009-01-29T08:39:14.809-08:00

Found this Associated Press article in the San Jose Mercury News. I'm assuming you could find it in many newspapers across the nation.The story was written before the house passed their version of the "Stimulus Package". Since then the bill has passed, and it is my understanding that the one year delay on the rate cut was a part of the bill they passed. I'll stay away from politics here and

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-60031844617342277552009-01-23T09:40:00.001-08:002009-01-23T09:40:52.921-08:00

There is a very through article at Health Beat Blog discussing the great debate between for profit and non-profit hospices. I disagree with the underlying opinions, but they have done their research and put a lot of information into the article. It is a good read for anyone involved in this debate.You can read the post here.As I said, I don't totally agree with their conclusion that for-profit

Hospice Guynoreply@blogger.com10tag:blogger.com,1999:blog-7655334.post-29032153855570181852008-12-28T11:59:00.000-08:002008-12-28T12:11:25.207-08:00

I've been going over my checklists for compliance for my hospice's implementation of the new Medicare Hospice Conditions of Participation for the thousandth time, and was wondering how many hospices across the nation are not 100% compliant at this point.The new COPs went into effect on December 2nd, and my hospice was not ready. We're nearing a month later, and my hospice is still not 100%

Hospice Guynoreply@blogger.com10tag:blogger.com,1999:blog-7655334.post-75381960933748574432008-12-05T06:35:00.000-08:002008-12-05T06:35:00.644-08:00

Thanks to the brains at Pallimed for pointing out that the Journal of Palliative Medicine is free online through the end of the year. You can check out every edition ever published, so jump in, dig in, and learn all you can over the next few weeks.

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-61767979600824172412008-12-02T06:23:00.000-08:002008-12-02T06:23:00.829-08:00

The lawsuit filed against Medicare by the National Hospice and Palliative Care Organization has been dismissed. As I understand it, the case was dismissed without any comment on the actual claims of the case, because the judge felt like hospice providers should appeal Medicare's decision directly (through an internal Medicare appeals process) before the lawsuit should be considered. You can

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-40809374806162867022008-11-26T01:00:00.000-08:002008-11-26T01:00:00.811-08:00

Here's wishing each of you a wonderful Thanksgiving. Before you head off to dinner with the family, there is a project I would like to draw some attention to. The following is a post that you will find on a handful of blogs this weekend. Please read on and think about what you can do to help your family prepare for their end of life journey. God bless.We make choices throughout our lives -

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-42194651450096587262008-11-11T10:01:00.001-08:002008-11-11T10:01:30.037-08:00

I concluded a post recently by saying that the big corporate hospices had won another battle, and that it was going to be even harder for the small guy to make it. Guess, I may have overestimated the health of the big hospices. Trinity Hospice, which is a subsidiary of Sunrise Senior Living (NYSE: SRZ), is shutting it's doors. Here is the "announcement" within their most recent financial

Hospice Guynoreply@blogger.com8tag:blogger.com,1999:blog-7655334.post-41475949220425540232008-11-05T07:18:00.000-08:002008-11-05T07:18:00.772-08:00

NHPCO has published its latest statistical compilation on hospice care in America. It is the 2007 numbers on hospice care and covers a lot of information. Good stuff to know when looking at the industry as a whole. (I think it's a free link, but if not, it's just another reason you may want to consider membership.)Palmetto GBA, one of the handful of Medicare Intermediaries that work with hospices

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-69530708719188469522008-11-03T06:44:00.001-08:002008-11-03T06:44:37.619-08:00

Medicare has released its next round of billing changes, and this one won't be fun. (The last one wasn't fun either, but that's beside the point.) You can find the information here. (Click on the zip file to read the .pdf explanation of the proposed changes.) Clearly, there will be more on this as comments are made and the final rule is posted, but here is my quick gut take.The biggest change

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-2837115014863268822008-10-27T09:32:00.000-07:002008-10-27T09:32:00.663-07:00

I gave an impromptu lesson in government in my recent update on the Medicare Hospice Rate Cuts post, and figured I should extend that to what is going on with the Medicare Hospice Cap issue.In the prior post, I discussed the fact that congressional fights are much easier won when your side can claim victory through congressional inaction. Doing nothing is a strong suit of our folks in Washington.

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-68647243239764597322008-10-20T06:53:00.000-07:002008-10-20T06:53:00.868-07:00

I guess I may have left some of you hanging on the subject of the Medicare Hospice rate cut. Sorry about that, I haven't updated, because there hasn't been any motion.One of the big lessons I picked up along this adventure is that Congress' strength is inaction. Whoever is on the side of inaction usually wins when it comes to our government. In this instance, the rate cut was sent down from on

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-9121277560539333262008-10-17T06:38:00.000-07:002008-10-17T06:52:52.468-07:00

There is an interesting article on MSNBC.com about long time married couples dying within a few months of each other. It gives research evidence that the phenomena does exits and a mixture of medical and psychological factors that may explain the phenomena. If nothing else, reading it may just tug at your heart.As someone who has seen their share of hospice patients, I sure can't deny that it

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-52730905429804121592008-09-15T08:56:00.001-07:002008-09-16T08:11:51.953-07:00

Bills have been introduced in both the House and Senate to stop the Medicare hospice rate cuts. Follow the link to find out the history of the rate cuts, who sponsored the bills, what the bill actually does, and (most importantly) what you NEED to do to support this legislation. Time is very short to make this happen!

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-88661857554938590212008-09-08T09:58:00.001-07:002008-09-08T09:59:43.893-07:00

The National Hospice and Palliative Care Organization is suing Medicare to stop the rate increase.Guess that will silence all the people who have complained over the years that NHPCO wasn't aggressive enough. Personally, I'm not sure that they haven't been too aggressive in this instance, but I don't really know enough about the inner working of the process or the lawsuit to know for sure. I hope

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-85723960141474395082008-09-04T09:09:00.000-07:002008-09-04T09:09:00.628-07:00

I was recently introduced to a blog written by a full-time hospice on-call nurse, and wanted to point you to one of her stories. I spend most of my time talking about the business of hospice, but we should never forget how hard hospice is. Everyone understands that we work with death and dying everyday, but what many don't remember is the fact that we work with families who are under great stress

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-17024033678852627992008-09-01T07:13:00.000-07:002008-09-02T14:58:32.163-07:00

In my last post I said, "It is not an overstatement to say that we are reaching the goal of changing the way our nation views and faces the end of life." Now, I have proof.The Beloit College Mindset List, which is "a look at the cultural touchstones that shape the lives of students entering college", has provided me with my proof. I found the list very interesting since it is full of pearls of

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-38531484883350353662008-08-27T09:59:00.000-07:002008-08-27T09:59:00.501-07:00

I have been writing lately about the changes our industry is going to have to deal with in the future, and what needs to happen now. In this post, I want to deal with the scary future of hospice if these changes are not made. Currently, hospice as a business is at a crossroads. Where it will end up is anybody's guess. My guess (or prayer) is that we end up being what hospice was created to be. We

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-42045919822981113682008-08-21T09:07:00.000-07:002008-08-21T10:08:35.553-07:00

I have no clue who first said, "The main thing is keeping the main thing the main thing", but I owe them a debt of gratitude. That odd little line has helped keep me focused through the years, and it is very timely advice for the hospice industry. My last couple of posts have dealt with the necessity of hospices moving from the relaxed business practices of the past to the world of having very

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-2801755535698780872008-08-15T13:16:00.000-07:002008-08-15T13:16:00.638-07:00

As I mentioned earlier, I believe there has been a real resistance within the hospice community to accept the fact that hospice is a business and that we need to adopt best business practices. In my mind, Andrew Reed of Multi View Incorporated has been the industry's John the Baptist as he has been carrying this message through the wilderness for years. He has been preaching financial

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-28423984332018002232008-08-11T09:06:00.000-07:002008-08-11T09:06:00.690-07:00

A commenter on the previous post about the Medicare Hospice Benefit rate cut asked if, "the 'average' profit margin for hospice has a lot of built in inefficient and wasteful hospices"? In his mind, if the average profit margin of hospices is being dragged down by a lot of hospices that are not being run well, then those inefficient hospices are the ones who will go away, and that's not such a

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-86745054671250451732008-08-04T08:41:00.001-07:002008-08-04T08:41:43.136-07:00

Medicare has published the wage index and payment rates for FY 2009, and the announcement is the finalization of one part of the feared rate cuts. Of course, that isn't quite how CMS sees what it has done. They actually put out a press release that packages the whole thing as hospices getting a pay raise. Let me explain what's happening and then tell you why this is really bad timing.First, to

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-19840189246604087702008-07-31T06:10:00.001-07:002008-07-31T06:10:06.179-07:00

Dr. Sinclair at Pallimed has written a very informative post to add on to my series on How to Choose a Hospice. This post is titled How to Choose a Hospice: Why Doctors Matter. Dr. Sincleiar is a full-time hospice doctor, so he brings a point of view and set of experiences to his writing that is different from my own. The subject of hospice doctors is one that I have been thinking about quite

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-48652041640707860372008-07-07T07:02:00.000-07:002008-07-07T07:02:01.355-07:00

(This post is part of a series of posts. To read from the begining of the series go here.)This is my final post in the How to choose a hospice series for now. As time goes on, I'll think of other suggestions, but nine is enough for now.In this post I'll tell you a few of the things that don't matter and some that do. Most of this post is in response to other websites that have lists of things

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-20311393515016587202008-06-30T07:02:00.000-07:002008-07-01T20:47:30.375-07:00

(This post is part of a series of posts. To read from the begining of the series go here.)There is little better than the recommendation from someone who has experience with a specific hospice. If you have friends that have used hospice in the past, you should talk to them. Be warned though that hospice is overwhelmingly popular with families who have used it, so one glowing recommendation

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-24142096205560004972008-06-23T07:02:00.000-07:002008-07-01T20:24:08.900-07:00

(This post is part of a series of posts. To read from the begining of the series go here.)In "Why Size Matters", I talked about how many patients each nurse has. This time I want to talk about how much attention you should expect and who you should expect to get it from.First, frequency of visits. Your nurse should visit at least twice a week. Any nurse that thinks they can keep up on a hospice

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-39679260677354276692008-06-16T07:02:00.000-07:002008-06-16T07:02:00.974-07:00

(This post is part of a series of posts. To read from the begining of the series go here.)No matter what they tell you, size does matter. To be honest, I can't decide how much it matters. That means that while this post is good advice, it is not as important as many of the other suggestions you'll receive in this series.You don't want a hospice that is too big. You don't want a hospice that is

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-58732838073951449202008-06-09T07:02:00.000-07:002008-07-01T20:28:18.709-07:00

(This post is part of a series of posts. To read from the begining of the series go here.)My thoughts on this subject have changed quite a bit since I first wrote this series in March of 2005. Then I was not a fan of hospices that use the large "mail order" hospice pharmacies, now I believe that those pharmacies may be the best option for some hospices.Your hospice is in charge of providing all

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-25314581743328281712008-06-04T18:12:00.001-07:002008-06-04T18:12:15.659-07:00

This is not the first time where my membership in NHPCO has made it hard to know what I should or should not say on this blog. In theory, everything that I know to date about the new Medicare Hospice Conditions of Participation is from publically accessible information. In reality, there is no way that I would know everything that I know without the help of the National Hospice and Palliative

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-30282644651521244172008-06-02T07:01:00.000-07:002008-07-01T20:29:00.687-07:00

(This post is part of a series of posts. To read from the begining of the series go here.)For part three of this series I want to deal with the most important question - location, location, location.I want to say from the top that I am not talking about where the office is located. Many hospices operate out of some really dumpy buildings in really bad locations. Hospice is one of the few

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-23240167288186291882008-05-29T13:22:00.001-07:002008-05-29T13:22:55.297-07:00

Clearly I am nowhere near finished digesting the 757 pages of the final Medicare Hospice Conditions of Participation, but, since I have read until my eyes can't take it any longer, I figured I'd give you my first impression. I reserve the right to change my mind, but, at this point, I'm impressed with what Medicare has done.Shockingly, I believe Medicare has done a good job here. Perfect? Of

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-72697857536031686532008-05-28T07:43:00.001-07:002008-05-28T07:43:04.026-07:00

Here is a link to the .pdf of the new Medicare Hospice Conditions of Participation. I've gotten to page three of 757, so no great insight from me. The thing I was scanning for was the implementation information, and I was very happily surprised when I found it. Most were expecting a sixty day implementation period and hoping for ninety. We got 180! That gives us six months to figure out what

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-33628806375187970402008-05-27T13:30:00.000-07:002008-05-27T13:35:55.792-07:00

One of my first posts on this blog was about my dreams and requests for the upcoming changes in the Medicare Hospice Conditions of Participation. Well, a few years have gone by, and I'm finally going to get to see if my dreams have come true. According to NHPCO, the newly revised final COP's have been posted at the Federal Register. They are not available on the internet yet, but should be

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-28980396088874554822008-05-26T07:01:00.000-07:002008-07-01T20:33:38.645-07:00

(This post is part of a series of posts. To read from the begining of the series go here.)Part three is an easy follow up question to the one you asked in part 2. Now that you know who owns the company, you need to know how many offices they have, where the offices are, and which one is the home office. You now need to know if the "big cheese" works out of your local office. (I use "big cheese"

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-32953605604921534942008-05-19T07:01:00.000-07:002008-05-19T07:01:08.669-07:00

(This post is part of a series of posts. To read from the begining of the series go here.)As I said in the previous post, the differences between hospice companies are often small and usually hard to find. This post deals with one thing that I feel is a huge difference; Ownership. Who owns the hospice is a very important question, because it gets to the very core of the reason the company exists.

Hospice Guynoreply@blogger.com6tag:blogger.com,1999:blog-7655334.post-80567422806135172842008-05-16T11:31:00.000-07:002008-05-16T11:31:00.399-07:00

In case you have not found it yet, the Hospice Foundation of America has started a Hospice and Caregiving Blog. There is some great content there for professionals and families; bookmark it.

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-13346944489590185202008-05-12T07:01:00.000-07:002008-07-01T20:35:10.288-07:00

This is the first in a multi part series on how to choose a hospice. The later posts will go into detail about what you need to know and how to find out, but before I get into all of that I wanted to talk about why it matters. If you pump truth serum into most hospice workers they will tell you that there isn't much difference between their company and the others, and in reality there isn't. We

Hospice Guynoreply@blogger.com5tag:blogger.com,1999:blog-7655334.post-86849318545632342312008-05-07T14:40:00.000-07:002008-05-07T14:40:00.745-07:00

Over the next few weeks I will be publishing an updated set of posts on how to choose a hospice. This is a series I posted first in March of 2005. The format will remain the same and much of the content will remain the same. My thoughts on some issues have changed over the past couple of years (I may have even been wrong about a few things.) and the industry has changed quite a bit. I think

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-61452934652856765002008-05-03T09:39:00.000-07:002008-05-03T09:39:01.496-07:00

The price of gas has been making headlines for a while now, and has become a political football. There are all kinds of ideas being put out there by the President and those who want his job. We could have a gas tax holiday, drill for our own oil, punish the oil and gas companies, ride our bikes more… In the end I expect that our "leaders" in Washington will probably point their fingers at the

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-84055462004198001592008-04-30T08:01:00.001-07:002008-05-01T09:19:43.907-07:00

(update: The link to the nhpco press release has been fixed. Sorry.)I have focused quite a bit in the past on the proposed hospice rate cuts, and have probably done a poor job of explaining the different fronts on which this battle is taking place. One of those fronts has heated up quite a bit.The Centers for Medicare and Medicaid Services has now officially proposed a rule change that will

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-32582361292559253022008-04-22T08:09:00.001-07:002008-04-22T08:09:50.452-07:00

I have been accused of many things in the comments section of my prior posts that mention the Medicare Hospice Cap issue. Most seem to be from people who are effected by the cap problem and think that I just can't understand the issue since I am not. Many were nice, many were not. To be honest, I have had trouble from day one knowing exactly what I think and feel about this issue. I'll try to

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-85469022678344929642008-04-17T11:13:00.001-07:002008-04-17T11:13:04.783-07:00

As you know, I have been trying to raise some awareness about the hospice reimbursement cuts in the proposed federal budget. Christian at Pallimed has jumped on the bus with a post that is much more informative than anything I have written. Make sure and read his post to gain a solid understanding of what the issues are and then do something about it by contacting your congressman. Another

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-86727141991981388112008-04-09T08:38:00.000-07:002008-04-11T09:04:28.353-07:00

I've written a bit recently about the Medicare hospice payment changes proposed in the president's budget, and now NHPCO has a tool to help you let our legislators know about your feelings on this issue.If you are like me, the effort you must go through to write your Senators or Representative a letter about any subject isn't worth the minuscule impact that the letter will have. Seriously, do you

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-83597135295736692402008-04-01T21:15:00.001-07:002008-04-01T21:45:45.942-07:00

I can't believe I haven't written anything in a month! To make it even worse, it has probably been the busiest month in the industry since I started writing this a few years ago. While it seemed everything hit hyperdrive within the industry it also hit hyperdrive in my life. Wow.It is almost midnight as I write this, so I'm not even going to attempt to give any type of detail to the things

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-26421381089172485272008-02-27T14:24:00.001-08:002008-02-27T14:29:03.958-08:00

I wrote a quick post earlier this month about the budget proposal that President Bush sent to congress. On first look, it was a little worse for the hospice industry than last year's proposal, but not a big deal. Well, your lowly hospice blogger missed something big in that post. Before telling you what I missed, I'd like to say that this is the precise reason that I encourage you to become a

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-17609026421719310652008-02-08T14:21:00.000-08:002008-02-08T14:39:49.311-08:00

Excuse me if I'm not up in arms about the new budget proposed by President Bush. I thought about cutting and pasting my post from almost exactly 365 days ago here, because the proposal is largely the same.When President Bush sent his proposed budget to congress, it called for a zero percent rate increase for hospice in 2009-2001. In 2012 & 2013 we would get our normal rate increase minus .65%.

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-31918014635729722672008-02-04T07:54:00.001-08:002008-02-04T08:25:32.313-08:00

Briefly, I wanted to mention a section of the gaming portion of the article I've been writing about that I skipped. It is the section on the Medicare Hospice Cap. (My earlier posts on this article are here and here.)Mr. Hoyer does not devote a lot of time to the cap, but what he says is priceless. First, let's review his credintials. He, as a CMS employee, was the person in charge of drafting

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-21359068569193040262008-01-18T13:07:00.001-08:002008-01-18T13:07:23.124-08:00

I wrote a post about an article in Caring Magazine a couple of weeks ago, and want to continue working through the article today. (You should go back to post number one to understand what the article is about and who wrote it.)As promised, today I want to discuss Mr. Hoyer's thoughts on the "gaming" that is currently going on in the Medicare Hospice world. First, none of these things are new to

Hospice Guynoreply@blogger.com5tag:blogger.com,1999:blog-7655334.post-21599889945372492492008-01-04T08:40:00.000-08:002008-01-04T08:47:01.943-08:00

The awesome folks at Pallimed (if you are a hospice clinician and not reading this blog, then you are missing out on some great education and insight) pointed out a recent journal article advocating for the use of the word "die" when doctors talk to their terminally ill patients.Good stuff.

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-53055859103493217182007-12-27T07:54:00.001-08:002007-12-27T07:59:21.931-08:00

The National Association for Home Care and Hospice puts out a very good magazine called Caring. As far as I can tell, it is not available on-line which is too bad, because the November edition had a great article titled "The Future of Hospice". The article was written by Tom Hoyer who worked for Medicare for thirty years and was "assigned to work on implementing the Medicare hospice benefit and

Hospice Guynoreply@blogger.com5tag:blogger.com,1999:blog-7655334.post-62169730966190517502007-12-25T06:40:00.000-08:002007-12-24T14:51:29.019-08:00

Luke 21In those days Caesar Augustus issued a decree that a census should be taken of the entire Roman world. 2(This was the first census that took place while Quirinius was governor of Syria.) 3And everyone went to his own town to register.4So Joseph also went up from the town of Nazareth in Galilee to Judea, to Bethlehem the town of David, because he belonged to the house and line of David. 5He

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-8285627366807965232007-12-20T14:52:00.000-08:002007-12-20T15:14:15.133-08:00

The OIG released the first of two reports today looking at the differences between hospice care provided in nursing homes and hospice care provided somewhere else. (Thanks to NHPCO for pointing this report out to its members.)The basic conclusion reads:In our comparison of Medicare hospice beneficiaries who reside in nursing facilities to hospice beneficiaries who reside in other settings, we

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-72235620516680708452007-12-13T12:06:00.000-08:002007-12-13T13:05:09.393-08:00

I really wanted to get off the subject of the Medicare Hospice Cap today, but I couldn't. There is one cap argument that I hear quite a bit that, while sounding fair and logical, fails to actually work. The argument in question is what I will term the "But the doctor certified them" argument.As I said, this argument seems to make all the sense in the world, but I want to give two reason that it

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-24460531114068708192007-11-28T09:14:00.000-08:002007-11-28T09:36:28.990-08:00

I don't have a lot of time today to comment on this article about the hospice cap issue in the New York Times. It quotes the NAHA group that has been a part of all the other press on this issue, but it also seems to have a bit more reporting to it than other articles on the subject. It does not manipulate patients as I have felt other articles have, so, on that front, it seems that while the

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-33412176699780142992007-11-23T07:16:00.000-08:002008-12-08T14:16:41.008-08:00

Below is a copy of a press release that was sent to me by someone in Oklahoma (whom specifically asked to remain anonymous). It is, if I understand correctly, a press release from the Oklahoma Hospice Association dealing with the news stories about the Medicare Hospice Cap. The person sending it to me included a note that said in part, "felt that you should know that not all hospices in Oklahoma

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-13178676587149672942007-11-12T13:07:00.000-08:002007-11-12T11:21:08.928-08:00

I finally got a chance to check out the web site of the group that is producing all of this press about the Medicare Hospice Cap. They call themselves the National Alliance for Hospice Access, and their web site does a good job of making it seem like fighting against the Hospice Cap is a no brain decision. As usual, I think only half the story is being told, but they do a very good job of telling

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-39338626464316089822007-11-01T14:45:00.000-07:002007-11-02T13:37:14.617-07:00

I posted here about a story on a local news channel about the Medicare Hospice Cap issue. In that post I said that something about having an actual hospice family interviewed made me a bit uneasy, but I "couldn't put my finger" on why. I've put my finger on it now.A comment left on that post said:I think using a real hospice patient makes this important story easier to understand and relate to at

Hospice Guynoreply@blogger.com5tag:blogger.com,1999:blog-7655334.post-6779541111852777232007-10-29T09:29:00.000-07:002007-10-29T09:40:32.776-07:00

Apparently Oklahoma is the home of the Medicare Hospice Cap issue, or at least that is the place where the news media is paying attention. Again, thanks to a reader who sent a link to this local news report on the cap. (I have never linked to video, so I hope this works. Let me know if you have problems.) Personally, I seem to find something distasteful about using an actual hospice patient in

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-63216357341791160462007-10-17T14:31:00.001-07:002007-10-17T15:09:17.596-07:00

A friendly reader pointed out this article in the Daily Oklahoman newspaper about a hospice that is facing a huge cap issue.Since it seems that most of the people interviewed for the article are from the hospice that has this large cap problem, it is a bit slanted to their point of view, but this does show the prominence that the cap issue is taking in the hospice world.Here's a question for the

Hospice Guynoreply@blogger.com4tag:blogger.com,1999:blog-7655334.post-4755839387833982752007-08-22T12:08:00.001-07:002007-08-22T12:08:12.557-07:00

I have had some questions about my assertion in this post that there seems to be more cap issues in states with increased competition. Palmetto GBA, one of the Medicare Regional Home Health and Hospice intermediaries, released their cap overpayment stats by state for 2005. (It is part of a much longer document, you can find it here go to the last page for the table I am referencing.)The facts

Hospice Guynoreply@blogger.com15tag:blogger.com,1999:blog-7655334.post-87059014898646838992007-08-17T09:54:00.001-07:002007-08-17T10:00:30.039-07:00

There were two people who commented on this post about theMedicare Hospice Cap issue yesterday and both were of the opinion that we must do something about this issue right now. I think there are three different groups with much different opinions on this issue within the hospice community. Group one is made up almost totally of hospices who are over the cap and they believe that the cap must be

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-33807139047774465592007-07-24T13:27:00.000-07:002007-07-24T14:20:15.358-07:00

Thanks to a friend who e-mialed me this story on the Hospice Cap. I believe the article very much gives one side to this discussion and paints a picture that is much worse than reality for the average hospice provider. The cap is a growing problem, but I don't think it is quite as dire as this article may indicate.As per my new vow of being less opinionated on this blog, I will leave it up to you

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-71509621257781740992007-06-08T07:39:00.000-07:002007-06-08T07:49:29.274-07:00

Aging With Dignity, the creator of the awesome Five Wishes Advanced Directive, announced yesterday that they have translated the document into twenty different languages and are launching a year long drive to encourage minority populations to execute advanced directives.I have said in the past that I love the Five Wishes form. It covers the basics of Advanced Directives and then goes into all

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-62879292413895287742007-06-04T12:10:00.000-07:002007-06-04T10:12:40.386-07:00

I try to keep myself from making rash decisions and try to live by the "sleep before you make a big decision" rule, but I don't think sleep will change the thoughts racing through my mind right now. I said all of that to give myself wiggle room to change my mind at a later date just in case what I am about to write is crazy.Effective now, I will no longer be posting original thoughts and opinions

Hospice Guynoreply@blogger.com8tag:blogger.com,1999:blog-7655334.post-22341265636873891132007-05-30T09:53:00.000-07:002007-05-30T07:55:10.613-07:00

I have taken on this subject in the past, but, since it was a theme in the article I linked to last Wednesday, I figured I better give my thoughts again.I do not think that the profit status of a hospice is a worthwhile criteria for deciding if they are a good hospice. There are good and bad for profit hospices just like there are good and bad non-profit hospices. That's just the facts. Many

Hospice Guynoreply@blogger.com6tag:blogger.com,1999:blog-7655334.post-11134639487423670122007-05-23T09:30:00.000-07:002007-05-23T07:31:07.437-07:00

Carreen, a reader in Kansas, sent me a link to this article, published by Massachusetts General Hospital, which is probably the best thing I have read recently about the state of the hospice industry.There are some things in the article that I question, but overall, they have the story right. (It is very hard to summarize hospice, and I think they took a few liberties for the sake of brevity.)

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-41938593478112189212007-05-21T08:50:00.000-07:002007-05-21T11:15:03.440-07:00

Here is an article from News-Press.com profiling the day in the life of a Hospice Chaplain. I believe the Chaplain profiled is a good representative of most of the Chaplains that I have met along the way. They are just good, kind, non-judgemental people who understand what a blessing it is to spend sacred time with families.

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-55215775121252145192007-05-18T06:38:00.000-07:002008-12-08T14:16:41.325-08:00

Newsweek Online has a article written by a hospice volunteer about why she volunteers. Every volunteer has a different story, but this one is a good reminder to us all of what is special about what we do.Thanks to NHPCO for pointing this one out.There are varieties of hearing aids available in the market that help people who cannot hear well. The digital hearing aids have exploded in the market

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-76194435408629462402007-05-14T11:50:00.000-07:002007-05-14T09:47:58.402-07:00

I recently received this e-mail from a reader. (I've tried to take out any personal references for the sake of anonymity.) I have not heard or seen what he is talking about, but thought you may have. If you have it, send it to me or post it in the comments. Thanks.Many years ago while I was assisting in a hospice, the then director (whose name I cannot remember)introduced a fund raising talk to a

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-80279000669621452192007-05-09T16:05:00.000-07:002007-05-09T14:04:16.835-07:00

The Kaiser Network took a look at hospice care for minorities recently, and I wanted to pass along the link. They link to quite a few resources and reports on the subject. Spend some time looking through their page and you'll find much more information about what hospices across the nation are doing to combat the utilization issues in different minority communities.Another interesting link on the

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-89808069508090318732007-05-07T10:30:00.000-07:002007-05-07T08:39:27.634-07:00

As I wrote before, there is a bit more focus on the development of leadership skills in the hospice field. On that note, I wanted to pass along the three book recommendations from the recent NHPCO Management and Leadership Conference that I found most interesting.The first is Working With You is Killing Me. A title that most hospice leaders can identify with. This book talks about recognizing the

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-61063572988086677262007-05-01T08:29:00.000-07:002007-05-02T06:30:12.763-07:00

There has been much hand wringing within the hospice industry that there is a coming leadership vacuum. I gave my opinion in a previous post that I don't really see this as much as most, because I think the number of young leaders in hospice is in direct proportion to the number of (or lack of) opportunities for young leaders. As the first generation of hospice leaders prepare for retirement, you

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-10016673464156286332007-04-30T11:57:00.000-07:002007-04-30T09:58:19.261-07:00

Medicare has released the Hospice Wage Index for Fiscal Year 2008, but more noteworthy is everything else they released with it. This link will take you to the seventy-eight page file for your own reading enjoyment. Hopefully, you are smarter than me, because I can never read this stuff and make much sense out of it. They say that baseball is fifteen minutes of action crammed into three hours.

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-19425266650153732602007-04-24T05:49:00.000-07:002008-12-08T14:16:41.503-08:00

I have quite a few things from the Management and Leadership Conference to talk about and have tried to think about how best to present them. I think I am going to try to condense things and make these posts more to-the-point than most. I'm not giving opinion in these posts as much as I'm trying to disseminate information, so, with that said, here are some highlights from the Public Policy

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-63577134771586035332007-04-23T10:54:00.000-07:002008-12-08T14:16:41.522-08:00

I’m writing this from the airport on my way home from NHPCO’s Management and Leadership Conference. I must say, it was a good few days in the nation’s capitol and I have a lot that I want to talk about on the blog, but, since I only have a few minutes before my flight boards, I figured I’d write a quick post giving my overall thoughts. (I refuse to pay to connect to the airport wireless, so I’ll

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-60029089868283923872007-04-16T14:37:00.000-07:002007-04-16T13:14:30.849-07:00

After having some time to digest my own post on hospice chaplains, I have one thing I feel I need to add. There are some incredible people out there doing the job of the hospice chaplain. They work endless hours for less pay than they deserve and usually get little respect from the clinical staff that surrounds and outnumbers them when they gather around the table for team/staff meetings.If you

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-45573259541567086102007-04-12T19:04:00.000-07:002007-04-12T19:41:16.466-07:00

It is a bit funny to me that I have written so little about the role of the hospice chaplain, since that is how I first entered the world of hospice. I guess my lack of writing on the subject is about in line with the lack of attention that many hospices give to this position. Although Medicare does require all hospices to have a chaplain, what, exactly, this person is supposed to do and how

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-71238466962270587752007-04-09T14:32:00.000-07:002007-04-09T12:28:13.087-07:00

Assisted Living Facilities have been showing up on every corner over the past few years. They are a great alternative for people who can't keep up their own house but don't need to be in a nursing home. Most are very nice and allow their residents much more freedom and privacy than nursing homes. Hospice sees patients in both facilities.If you have read this blog much at all, you know that the

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-27880814483856641082007-04-06T10:45:00.000-07:002007-04-06T11:16:51.404-07:00

For those of you who have been looking for this blog, I apologize for the absence. One week ago, I made a change that I knew could, at the most, take the site down for the weekend. Being down for the weekend ended up being down for a week. I am sorry, but we are back now. (Thanks to those of you who e-mailed to make sure everything was okay.)The good news is that you can now find us at http:/

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-28102326872607862062007-03-30T10:04:00.000-07:002007-03-30T08:01:10.584-07:00

I promised last week that I would write something about the different levels of care available through the Medicare Hospice Benefit. Thus, I want to quickly give the basics of hospice respite care. It is, in my mind at least, the most simple or easy to explain level of care.The Respite Level of Care is offered to any Medicare hospice patient for the express purpose of giving the primary caregiver

Hospice Guynoreply@blogger.com4tag:blogger.com,1999:blog-7655334.post-82786084985987197682007-03-26T06:50:00.000-07:002007-03-26T07:00:05.999-07:00

Thanks to a reader who pointed this story out to me over the weekend.Bob Lee, from Illinois, is going to ride 6,500 miles on his bicycle to celebrate his sixty-fifty birthday and raise money for the American Cancer Society, Les Turner ALS Foundation, and the National Hospice Foundation.The ride starts in Florida, takes him to Maine, and, after a quick airplane ride, from Washington State back to

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-65190830262550839952007-03-21T09:39:00.000-07:002007-03-21T09:56:16.062-07:00

The National Hospice and Palliative Care Association had a study published in the March edition of the Journal of Pain and Symptom Management that further documents the fact that hospice patients live longer than those who do not elect hospice. The full article is available for free on the NHPCO website.I wrote this post in 2004 after a similar study came out with similar results, and still agree

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-25156206914569038452007-03-19T07:31:00.000-07:002007-03-19T09:08:00.954-07:00

I have not talked much, if any, about the different levels of hospice care provided for by the Medicare Hospice Benefit. I'll try to rectify that over the next few weeks.First, I want to deal with Continuous Home Care, because it is the most misunderstood, confusing, or abused portion of the Medicare Hospice Benefit. The confusion comes from a bit of a vague description of what qualifies a

Hospice Guynoreply@blogger.com12tag:blogger.com,1999:blog-7655334.post-91500326686607717642007-03-16T08:20:00.000-07:002007-03-16T06:15:28.195-07:00

I spend a lot of time on this blog talking about Medicare or the business aspects of hospice. Every once in a while, I get a chance to tell a feel good story about a patient or something above and beyond that a hospice has done for a patient. I don't spend enough time talking about the thing that makes hospice so special - The Workers.If you have been doing hospice for more than a year, you

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-89604948679955800082007-03-06T10:46:00.000-08:002007-03-06T08:43:30.727-08:00

I was alerted to this journal article by many sources, but I'll give pallimed the credit.The study, published in the Journal of Clinical Oncology finds, unsurprisingly I might add, that cancer patients are not getting the spiritual support they need. I don't think anyone thought the study would show that the medical system was giving them the spiritual support they needed, and we were right. 72%

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-55017478696256491932007-03-02T06:08:00.000-08:002007-03-02T04:06:16.374-08:00

When I wrote the post about the ten Senators who are pushing for "concurrent care", I really didn't think much about it. First, I don't see anything coming from this push and second, I wasn't really sure exactly how much good concurrent care would do. I still don't believe there is much of a chance that President Bush is going to get comprehensive health care reform done in the next two years,

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-58710016057642368632007-02-27T09:05:00.000-08:002007-02-27T07:01:24.168-08:00

I recently wrote again that I believe hospices should be paid a different amount depending on if the patient lives at home or in a nursing home. I know some people disagree, and I understand that. I also understand their argument, so I wanted to take a moment here to explain my stance.It is true that hospices are required to provide the exact same care for nursing home patients as they provide

Hospice Guynoreply@blogger.com7tag:blogger.com,1999:blog-7655334.post-61180376092903634212007-02-20T06:58:00.000-08:002007-02-20T07:28:59.912-08:00

If you need further proof that the team concept used by hospice would work for people who have a chronic/terminal illness but more than six months to live, then you should read the article in the February issue of the American Journal of Managed Care titled "Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life". (The link takes you to the page where you can

Hospice Guynoreply@blogger.com0tag:blogger.com,1999:blog-7655334.post-7256931609383037932007-02-16T08:58:00.000-08:002007-02-22T08:13:58.588-08:00

In a recent letter to the President, a bipartisan group of ten Senators urged him to fix the health care system now. The full text of the letter can be found here.In the letter they set out six points that health care legislation should cover. Point # 5 says:5) Encourage more cost-effective chronic and compassionate end-of-life care. Studies show that an increase in health care spending does not

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-47514130829545789002007-02-15T14:17:00.000-08:002007-02-15T12:13:51.497-08:00

As I have pointed out before, there is a lot of talk in the hospice community about "open access" or the need for hospices to be more open about the types of people and treatments they accept. A paragraph from the New York Times article I linked to earlier sums the problem up well.Only comfort care is covered through the hospice benefit, and patients sometimes have to fight for therapies to

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-4804569389427380382007-02-12T08:16:00.000-08:002007-02-09T14:50:44.827-08:00

(Thanks to Pallimed for pointing these out to me. If you are not reading their site, then you are missing out on some great information!)The New York Times published a couple of articles about hospice this weekend.The first discusses open access which I have talked about some already. It is a good look at the movement although it focuses mainly on insurance companies who are actually paying for

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-30626015233331170562007-02-07T11:38:00.000-08:002007-02-07T12:45:34.325-08:00

Received an alert from NHPCO today indicating that part of President Bush's proposed budget is a 0.65% cut in the Medicare Hospice reimbursement rate starting next year and continuing every year thereafter. Let me be clear on what this means. If this passes, next year when it is time for Medicare to figure out how much of a raise I should get (usually it is around 3%), they will subtract 0.65

Hospice Guynoreply@blogger.com2tag:blogger.com,1999:blog-7655334.post-8457991125478041492007-02-06T10:10:00.000-08:002007-02-06T08:10:42.382-08:00

I have had a few people recently make comments or ask questions about the money I make from this blog, so I figured I would be transparent about the big bucks associated with hospice blog.I make this massive amount of cash in two ways. My first jump into the cash cow that is blogging came when I set up an account with Amazon.com to get a referral fee if anyone ever buys one of the books I talk

Hospice Guynoreply@blogger.com3tag:blogger.com,1999:blog-7655334.post-49180784190779725912007-01-31T09:38:00.000-08:002007-01-31T07:31:46.245-08:00

This one may surprise a few of you. I'm generally a conservative by the books type of guy, but, when it comes to access to hospice care, I'm a liberal.I received an e-mail recently asking my opinion of the move by one of the larger chain hospices to start accepting patients who are on TPN (feeding through an IV, which is seen as more drastic and tube feeding) or other things like that. My answer,

Hospice Guynoreply@blogger.com1tag:blogger.com,1999:blog-7655334.post-84975280334616590472007-01-29T07:10:00.000-08:002007-01-29T07:15:52.856-08:00

The death of Art Buchwald prompted this very good story in the New York Times about hospice. It is a great summary of what hospice is and some of the major hurdles it faces. Thanks to Pallimed for pointing this one out to me.

Hospice Guynoreply@blogger.com0