Face-to-Face Encounter Recap Guidance on Doing It Right

The Monthly Membership Publication of the National Hospice and Palliative Care Organization February 2011

Inside Documenting Hospice Physician Services:

Face-to-Face Encounter Recap Guidance on Doing It
Right
This new Medicare rule went into effect on January find the staff has difficulty answering
1, but on the request of NHPCO, CMS has granted questions about compliance activities
a three-month suspension of its enforcement. concerning physician services. With that
This recap covers the requirements and the steps in mind, this article will review the all-
you should be taking now—along with tools that
can help. important process of documentation—

A Message from Don By Christopher P. Acevedo, CPC, CHC namely, how to substantiate hospice
physician services through proper
NHPCO President/CEO Don Schumacher speaks T he use of physician services in documentation.
to the valuable role we must serve in our hospice and palliative care has
communities in light of the Administration’s recent increased dramatically in the The overwhelming majority of
decision on voluntary advance care planning last decade—by roughly 500 percent! hospice physician services must be
consultations. At the same time, billing Medicare for substantiated by the level of service
physician services has become more provided (or complexity of the patient)
The Voice of NCHPP
challenging, especially as the patients as well as by the amount and type of
In this new monthly feature, NewsLine shines
the light on the work of NCHPP and each of being admitted to hospice have more documentation the physicians generate.
its 15 professional sections. This month the
CEO/Executive Director/President Section is complex medical conditions and It is also important to understand that
spotlighted, with a landmark article by hospice
leader, Mary Labyak. may need more physician most physicians

People and Places involvement. do not receive

News about NHPCO members. Given this, it any formal
comes as no education
Educational Offerings surprise that on how to

NHPCO conferences, Webinars, webcasts and E-OL many organizations are struggling continued on
courses.
to bill—and code—correctly for next page
FHSSA Quarterly Newsletter
these services. As a physician
Plus:
billing consultant, it is always eye-
2011 Hospice Predictions
opening for me to have discussions
What are the pressing issues that
face our field and how best can
hospices prepare for them? Three
members of NHPCO’s leadership
team offer their insights.

with hospice compliance staff only to

continued from previous page

substantiate these services from a Medical necessity of a service in “today’s” note. This may be
billing perspective. is the overarching criterion convenient for the physician,
for payment in addition to helping him/her avoid having to
There are seven components in the individual requirements flip back in the chart, but only the
CMS’s documentation guidelines of a CPT code. It would not new information provided by the
for Evaluation and Management be medically necessary or patient that day can “count” when
(E/M) Services: appropriate to bill a higher selecting the E/M service code.
level of evaluation and
• History management (E/M) service On the other hand, physicians
when a lower level of service should not downcode or “code
• Physical examination is warranted. The volume of middle of the road” (such as
documentation should not always choosing 99232) when
• Medical decision making be the primary influence a higher level of service has
upon which a specific been provided. CMS’s other
• Nature of the presenting level of service is billed. contractors (such as the CERT
problem Documentation should support contractor) consider downcoding
the level of service reported. to be as much of an error as
• Counseling (30.6.1A) upcoding—and the Medicare
carriers are “graded” based on
• Coordination of care Providers are of course entitled the CERT contractor’s findings.
to the appropriate level of Consequently, we are now seeing
• Time reimbursement for medically the Medicare MACs apply this
necessary services that are approach too: placing physicians
Payers utilize either CMS’s 1995 supported by documentation. on prepayment review for
or 1997 documentation guidelines However, information that is not excessive billing of 99231 (level
to determine whether or not pertinent to the patient’s condition one hospital visit) as, on an audit,
documentation supports the “level at the time of the encounter the physicians were found to be
of service” billed—but there cannot be “counted” toward code downcoding.
are some nuances in how the selection. The push behind this
Medicare program looks at E/M “new” perspective is electronic I don’t think any of us ever
services on medical review. medical records—specifically the expects to see the Medicare
software that facilitates carry- program penalize a physician
Medical Necessity overs and “repetitive fill-ins” of for downcoding if inappropriate
stored information. payment of Medicare program
There has been a recent push to dollars has not occurred, but
remind physicians that even when For example, I have seen the the fact that there are now
a “complete” note is generated, entire HPI (history of present physicians on prepayment review
only medically necessary services illness), dating back to when a for this coding “error” indicates
for the condition of the patient patient was first seen, appear otherwise. I have never really
at the time of the encounter can
be considered when selecting an
appropriate level of E/M service.
The Medicare Claims Processing
Manual (Pub 100-4, Chapter 12,
§30.6) addresses this as follows:

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A Message From Don

Some Positive Media Coverage to
Support Our Continued Fight

On January 4th, we received some very disappointing news. I’m speaking, of course,
about the Administration’s reversal of its decision to cover voluntary advance care
planning consultations as part of a Medicare beneficiary’s annual wellness exam.

As we pursue our policy agenda during this new year, we will continue to fight for
the inclusion of this important patient right as a covered Medicare service. However,
I want to take this opportunity to highlight some of the positives that have come
from this upset.

The day after the New York Times story broke, NHPCO issued a press release over the
newswire urging all Americans, despite the reversed decision, to think about their
wishes and engage in advance care planning. This opened up dialog with a number
of major news outlets and has resulted in some excellent articles that will go a long
way in supporting our continued fight here on the Hill. As we go to press with this
issue, let me share what’s been published so far:
1/05: The Many Lives of The ‘Death Panel’ NPR’s All Things Considered
1/13: End-of-life Health-care Issues Debated, Winston-Salem Journal
1/11: Plan Now So Your Later Years Can Be Comfortably Extended, USA Today
1/12: End-of-life Instructions Can Allow Patients to Control Their Fate,” Miami Herald
1/12: Death Panels Out; Talks are Not,” Fort Myers News-Press
1/13: Keep Talking: End-of-life Discussions Must Go On, Even Without Pay,”
Syracuse Post-Standard
01/13: Evidence is Growing for Benefits of End-of-life Talks, Houston Chronicle
01/14: Two Documents Every Baby Boomer Needs to Have for Death Planning,
Fox News
01/18: Don’t Put Off Talking About the Inevitable: Care at Life’s End, National
Public Radio
01/18: Advance Directives Can Ease the Stress of Life-or-death Medical Decisions,
Washington Post
01/18: End-of-life Counseling Means ‘Survival Panels,” The Daily Iowan
01/19: Talk About End-of-Life Preferences Anyway, Santa Barbara Independent

Another important step that should be taken, which is really a valuable opportunity,
is outreach to the physician community.

Given the debate over this regulation, many community physicians may be more
reluctant than ever before to initiate these conversations. If you are not already,
become a valuable resource to them. Share your expertise, as well as appropriate
materials, to help them help their patients. To help you, NHPCO has some excellent
resources, such as our two-page guide for clinicians and a host of materials on our
Caring Connections website.

NewsLine 3

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understood why a physician Reference Sheet code represents (as noted earlier)
would deliberately downcode. for Physician Service and the organizations are being
While many tell me it is to avoid required to repay the difference.
an audit, it is only when your Billing Codes
coding pattern looks different History Elements
from your peers that you are A convenient one-page sheet
likely to be audited. So if your with codes for physician As a reminder, the four elements
peers don’t have as many 99231s of the history component (in
or 99232s as you do, you can services is shown on page 6. CMS’s documentation guidelines
expect an audit either way. (Click “Print this Page” for Evaluation and Management
[E/M] Services) are: chief
Using the CPT Book for a print-friendly version complaint; history of present
for Guidance to print or save!) illness; review of systems; and
past family/social history. Their
In addition to defining the level of complication or a significant definitions have not changed,
documentation required, the CPT new problem. but there are new interpretations
(Current Procedural Terminology) relative to the review of
Book provides guidance on when Medicare’s medical review nurses systems and when a history is
to use the three codes (99231- find that many subsequent unobtainable.
99233) for subsequent hospital hospital visits are being billed
visits: with a code that is higher than Review of Systems
the documentation supports. The A review of systems (ROS) is
• 99231—Focused Interval documentation may meet the an inventory of body systems
Hx or PE, low complexity required two of three components obtained by questions to identify
(15 minutes): Usually used for the level billed, but not the signs or symptoms the patient
when the patient is stable, support the medical necessity for is or has been experiencing.
recovering or improving; the level billed.
Per the guidelines, ROS is defined
• 99232—Expanded Interval Hx For example, a 99233 as billed as follows: “At least 10 organ
or PE, moderate complexity and documented meets two of systems must be reviewed. Those
(25 minutes): Usually used three required components, but systems with positive or pertinent
when the patient is responding does not reflect that the patient negative responses must be
inadequately to therapy is unstable or has developed a individually documented. For the
or has developed a minor significant complication or new remaining systems, a notation
complication; problem, as stated in the 2010 indicating all other systems
CPT Book code descriptor. These are negative is permissible. In
• 99233—Detailed Interval Hx services are being recoded to the absence of such a notation,
or PE, high complexity (35 meet the “type” of patient the at least 10 systems must be
minutes): Usually used when individually documented.”
the patient is unstable or
has developed a significant

4 NewsLine

Recently we have been told A recent interpretation, at least
that the use of “all other by the Florida Medicare MAC,
systems negative” with specific is that this situation does not
documentation of only a couple automatically qualify as a
of systems will lead the nurse comprehensive history. The
reviewer to ask “Which other carrier says that “any information
systems are negative?” And, subsequently obtained from other
similarly, referring to a system as physicians, family, etc. can then be
being “noncontributory” raises counted toward determination of
into question whether the system level of history.” However, it is my
was inquired about or not. More experience that should additional
than likely, reviewers will question history be obtained subsequent to
this if the patient’s presenting the initial encounter, the physician
problem (perhaps just a sty in an would “count” it when coding the
otherwise healthy patient) does current encounter.
not seem to justify a complete
review of systems. Counseling and Coordination
of Care
A complete ROS is required for When an E/M service is dominated
level 4 and 5 new patient home by counseling and/or coordination
visits (commonly coded as 99344 of care (i.e., more than 50 percent),
and 99345), ALF visits (commonly time is the controlling factor in
coded as 99326 and 99327), and selecting the level of service.
initial hospital visits (commonly
coded as 99222, 99223). See page 6 Take, for example, a patient
for these service code descriptors. who has had all treatment and
studies completed, and a medical
When History is Unobtainable decision is made to discontinue
There are times when the chemotherapy and enroll in
physician cannot obtain a history hospice. At a home visit, the
from the patient due to the physician discusses the treatment
patient’s condition, and there options and subsequent lifestyle
may be no one else present with effects the patient may encounter
knowledge of the patient’s history. or is experiencing. The physician
need not complete a history and
The documentation guidelines physical examination in order to
state: “If the physician is unable to select the level of service; the total
obtain a history from the patient time of the visit will determine the
or other source, the record should level of service billed. However,
describe the patient’s condition or the documentation should be
other circumstance that precludes detailed enough to reasonably
obtaining a history.”

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6 NewsLine

justify the amount of time the some examples of “acceptable”
physician spent with the patient. documentation.

It is important to remember that in CMS implemented revised
the outpatient setting, counseling guidelines, effective November
and/or coordination of care must 22,2002, for Evaluation and
be provided in the presence of the Management (E/M) Services
patient. In an inpatient setting, billed by teaching physicians,
however, the counseling and/ residents, and students. The
or coordination of care can be revised guidelines clarify the
provided at the bedside or on the documentation requirements for
patient’s floor or unit. a teaching-physician who bills
for E/M services, and addresses
When time is used to substantiate resident qualification, direct
the level of service, the amount of Graduate Medical Education
time spent in counseling or in the (GME) services, Medicare
coordination of care, along with coverage, and Medicare billing
the total duration of the visit, must requirements for physician
be recorded. services provided in teaching
settings.
The “Teaching
Physician Rules” Medical Students
I really only have one thing to
In my work with hospice and say about medical students. From
palliative care organizations which a reimbursement perspective,
have fellowship programs, an they are not to be treated any
additional area of concern arises. differently than you would treat
Just like many community based an office medical assistant. While
physicians, many of our industry they can do rounds, nothing
physicians are not familiar they document in a patient’s
with Medicare’s documentation chart can be “counted” when
requirements for counseling choosing what hospital visit code
and/or care coordination—often to bill. Only the services the
called the “teaching physician teaching physician provides and
rules.” And, the last thing any personally documents are billable
organization with “teaching services. Period. End of story. No
physicians” needs is the threat of exceptions.
having to repay monies received
(and already spent!). So, let’s take Teaching Physicians
a moment to discuss the teaching You are considered a “teaching
physician rules and review physician” if you involve residents

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in the care of your patients. (National Provider Identifier) other complex and high-risk
Medicare will pay for the of the teaching physician. The procedures to be performed
following physician services when HCPCS GC (Healthcare Common by a resident, the teaching
furnished in a teaching setting: Procedure Coding System General physician must be present
Classification) modifier must also during all critical and key
• Services personally furnished be attached to each CPT code portions of the procedure,
by a physician who is not a billed by a teaching physician as well as be immediately
resident. when some of the services being available to furnish services
billed were provided by a resident. during the entire procedure.
• Services performed by a The GC modifier denotes that the
resident when (1) the teaching service was performed, in part, by Who may document patient
physician is physically a resident under the direction of a medical information?
present during critical or teaching physician. Residents and/or teaching
key portion(s), and (2) the physicians may document
teaching physician participates Here are answers to some physician services within the
in the management of the commonly asked questions patient’s medical record.
patient. concerning these teaching
physician rules: What type of documentation
• Services performed by is acceptable for billing
residents in the absence of Which resident services must Medicare?
a teaching physician where be performed in the presence Notes may be dictated
the GME Program has been of a teaching physician in and transcribed, typed,
granted a primary care order to bill Medicare? handwritten, or computer-
exception, as follows: As noted above, any billable generated. Notes must be
• Office and/or outpatient service performed by a dated, and must include a
visits for new patients student (other than the legible signature or identity of
(CPT codes 99201-99203); review of systems and/or each individual participating
• Office and/or outpatient past, family, or social history in the service. Teaching
visits for established which are taken as part of physicians billing Medicare for
patients (CPT codes 99211- an E/M service) must be E/M services must personally
99213). performed in the physical document the following (at a
presence of a teaching minimum):
Note that level 4 and 5 visits physician or a resident that
are not payable for an E/M meets the requirements for • They performed the
service performed in the teaching physician billing (see service or were physically
absence of the teaching Chapter 12, Section 100 of the present during the key
physician. Medicare Claims Processing or critical portions of the
Manual). In a case requiring service when performed
When submitting a claim for major surgical procedures and by the resident; and
services, the claim should
reflect the name and the NPI

8 NewsLine

• They participated in the and, together, must support
management of the patient. the medical necessity of the
service. Documentation by
When assigning codes to the resident, certifying the
services billed by teaching presence and participation
physicians, Medicare of the teaching physician, is
reviewers will combine the not sufficient to establish the
documentation of both the presence and the participation
resident and the teaching of the teaching physician.
physician. However, there is
one notable exception: If you Documentation must identify, at a
are choosing an E/M code minimum, the service furnished,
based on time, the teaching the participation of the teaching
physician must be present for physician in providing the
the period of time for which service, and whether the teaching
the claim is made. physician was physically present.

For example, a code that Here are three common scenarios
specifically describes a for teaching physicians when
service of 20 to 30 minutes providing E/M services:
in duration may be paid only
if the teaching physician is Scenario 1
physically present for 20 to 30 The teaching physician personally
minutes. On Medical Review performs all the required elements
(MR), the combined entries of an E/M service without a
into the medical record by resident. In this scenario, the
the teaching physician and resident may or may not have
the resident constitute the performed the E/M service
documentation for the service independently. In the absence of

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a note by a resident, the teaching Scenario 2 Scenario 3
physician must document as he/ The resident performs the The resident performs some
she would document an E/M elements required for an E/M or all of the required elements
service in a nonteaching setting. service in the presence of, of the service in the absence
Where a resident has written or jointly with, the teaching of the teaching physician and
notes, the teaching physician’s note physician and the resident documents his/her service. The
may reference the resident’s note. documents the service. In this teaching physician independently
At a minimum, the documentation case, the teaching physician performs the critical or key
might look like this: must document that he/she was portion(s) of the service with or
present during the performance without the resident present and,
Admitting Note: “I performed of the critical or key portion(s) as appropriate, discusses the case
a history and physical of the service and that he/she with the resident. In this instance,
examination of the patient and was directly involved in the the teaching physician must
discussed his management management of the patient. The document that he/she personally
with the resident. I reviewed teaching physician’s note should saw the patient, personally
the resident’s note and agree reference the resident’s note. performed critical or key portions
with the documented findings of the service, and participated in
and plan of care.” For payment, the composite of the the management of the patient.
teaching physician’s entry and The teaching physician’s note
Follow-up Visit: “Hospital the resident’s entry together must should reference the resident’s
Day 3. I saw and evaluated support the medical necessity note. For payment, the composite
the patient. I agree with and the level of the service billed of the teaching physician’s entry
the findings and the plan of by the teaching physician. At a and the resident’s entry together
care as documented in the minimum, the documentation for must support the medical
resident’s note.” these situations might look like necessity of the billed service and
this: the level of the service billed by
Follow-up Visit: “Hospital the teaching physician. And for
Day 5. I saw and examined Initial or Follow-up Visit: “I this last scenario, the minimally
the patient. I agree with was present with the resident allowed documentation might be
the resident’s note except during the history and exam. along the lines of:
the heart murmur is louder, I discussed the case with
so I will obtain an echo to the resident and agree with Initial Visit: “I saw and
evaluate.” the findings and plan as evaluated the patient. I
documented in the resident’s reviewed the resident’s note
Note that, in this scenario, if there note.” and agree, except that picture
are no resident notes, the teaching is more consistent with
physician must document as he/ Follow-up Visit: “I saw the pericarditis than myocardial
she would document an E/M patient with the resident and ischemia. Will begin NSAIDs.”
service in a non-teaching setting. agree with the resident’s
findings and plan.”

10 NewsLine

Initial or Follow-up Visit: “I This type of documentation Of Note
saw and evaluated the patient. is not acceptable because the
Discussed with resident and documentation does not make NHPCO has requested
agree with resident’s findings it possible to determine if the clarification from CMS on
and plan as documented in the teaching physician was present, several aspects of billing
resident’s note.” and if he/she evaluated the patient for physician services
and/or had any involvement with concerning:
Follow-up Visit: “See resident’s the plan of care (the required
note for details. I saw and criteria as noted earlier). • Contracted Medical
evaluated the patient and agree Directors and Associate
with the resident’s finding and The Bottom Line Medical Directors
plans as written.”
Hospice physicians tend to see • Professional
Follow-up Visit: “I saw and more complex patients and, Consultations
evaluated the patient. Agree as always seems to be the
with resident’s note but lower case, everything hinges on • Administrative Services
extremities are weaker, now the documentation. Since E/M
3/5; MRI of L/S Spine today.” services are the main source of • Back-up Contracted
physician services revenue, the Medical Directors for
Examples of unacceptable need to understand and correctly Limited Time Periods
documentation include: apply their documentation and
coding guidelines is crucial to • Contracts with
• “Agree with above” followed your organization’s bottom line. Physician Group
by legible countersignature or Hopefully the guidance presented Practices
identity. here will help arm compliance
staff and physicians with the Feedback will be shared
• “Rounded, reviewed, information needed to document with members in NHPCO
agree” followed by legible the services appropriately. Regulatory Alerts and
countersignature or identity. also posted online (www.
Christopher Acevedo is a partner of nhpco.org/regulatory).
• “Discussed with resident and Acevedo Consulting Incorporated.
agree” followed by legible He can be reached by phone (561-
countersignature or identity. 278-9328) or email (cacevedo@
acevedoconsulting.com).
• “Seen and agree” followed by
legible countersignature or
identity.

• “Patient seen and evaluated”
followed by legible
countersignature or identity.

• No comments at all, followed
by a legible countersignature
or identity.

continued on next page NewsLine 11

Navigating the
Sea of Change

26th MANAGEMENT &LEADERSHIP CONFERENCE

&7th NATIONAL HOSPICE FOUNDATION GALA

Gaylord National
Resort and
Convention Center
National Harbor
Maryland
Preconference &
Capitol Hill Events:
April 5-6, 2011
Main Conference:
April 7-9, 2011

Don’t miss the Capitol Hill Day 2011 Events, April 5–6

For more information on Capitol Hill Day 2011 please visit http://www.hospiceactionnetwork.org/action/hill_day

A Recap of the
Face-to-Face Encounter

A s NHPCO has shared with members through its Regulatory
Alerts and the weekly e-newsletter, NewsBriefs, the Medicare
“face-to-face encounter” rule went into effect on January 1, 2011.

However, on the request of NHPCO, the Centers
for Medicare and Medicaid Services (CMS)
has granted a three-month suspension of its
enforcement. This means that hospices
should be adjusting and finalizing
their internal processes now to
become “survey-ready” by April 1, 2011.
This suspension does not change the date that
the rule took effect, it just gives hospices three
more months to implement their new procedures.

To assist your organization with final preparations, here is a recap of the
rule’s requirements and the steps you should be taking now—along with
tools NHPCO has made available to help.

The Requirements as of January 1, 2011
Hospice physicians and nurse practitioners must conduct face-to-face
encounters with hospice patients covered by Medicare when the patients
enter their third benefit period or later.

Steps to be Taking Before April 1, 2011
You should use the three-month suspension of enforcement to finalize
your internal processes for compliance, as follows:

New Admissions
• Check the Common Working File for each new admission during

the referral process to identify patients who are entering their
third benefit period or later. Note: even if a patient is new to your
hospice, the patient may have had hospice services previously
from another hospice.

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• If the patient is face-to-face encounters can be Answers to
entering his/her third conducted before the certification Your Questions
or subsequent benefit or recertification is completed.
period, schedule a face- To date, NHPCO has responded
to-face encounter with Resources and Tools to Help to more than 500 inquiries from
a hospice physician or A range of materials are available members concerning the face-
nurse practitioner before on the Regulatory & Compliance to-face rule. Here are answers to
admission. section of the NHPCO website, some recent questions.
including:
For Current Patients Does the suspension mean the date
• Use your patient-record • Recertification of Terminal of implementation has changed?
Illness Tip Sheet (PDF) No. By statute, the January 1,
systems to identify 2011 date of implementation
patients who need a face- • Sample Recertification of still applies. Enforcement by
to-face encounter and Terminal Illness Forms and contractors (MACs), however,
schedule those visits no Instructions (Word) will not begin until April 1,
more than 30 days prior to 2011 (and CMS has alerted the
the beginning of the third • Recertification Care Map (PDF) contractors of such).
or later benefit period.
• Recertification of Terminal If Medicare is a patient’s
• Complete the recertification Illness Audit Checklist (PDF) secondary insurance and is being
process as indicated. billed the balance after primary
• PowerPoint Presentation insurance, is the face-to-face
As noted, CMS has directed for Use in Staff In-Service encounter still a requirement?
contractors (i.e., MACs) to delay Education (PPT) By statute, in order for Medicare
any enforcement of the final rule to cover and pay for hospice
for the first three months of 2011. services, the beneficiary must
CMS stated that “although many have a face-to-face encounter
hospices... and physicians are as part of the recertification
aware of and are able to comply process prior to the third benefit
with this policy, CMS is concerned period recertification and each
that some may need additional subsequent recertification. It
time to establish operational doesn’t matter whether Medicare
protocols necessary to comply is primary or secondary; it only
with this new law.” matters that Medicare is a payor.

Providers should use this time Does the face-to-face encounter
to get their processes in place, apply to Medicaid patients?
especially for the referrals and No, the face-to-face encounter
admissions that occur at night is only a requirement under
or on the weekend, so that the Medicare (per the Affordable
Common Working File can be Care Act).
checked and the necessary

14 NewsLine

Does the hospice physician only have If a patient is discharged or If you have additional
to complete an attestation statement revokes hospice, he/she forfeits questions, email
for the face-to-face encounter or does the remaining days in that benefit
CMS expect the physical assessment period. If the patient reelects [email protected].
to be documented too? hospice, he/she is admitted to the
CMS has not specified what clinical next benefit period. Only a patient
documentation should be completed who transfers from one hospice
for the face-to-face encounter, so provider to another remains in the
it would be at your discretion. same benefit period.
However, from a survey standpoint,
a surveyor may look for visit Is there a grace period to complete a
documentation of an assessment/ face-to-face encounter? Will billing be
evaluation. retroactive back to the beginning of
the period?
When a patient transfers to a new There is no grace period and billing
hospice during the third or later cannot be retroactive. Billing for
benefit period, must the new (or days of care will commence once
receiving) hospice recertify the the face-to-face encounter has been
patient at the time of the transfer, completed.
even when there is documentation
that shows the patient has had the I’m having trouble with the
required face-to-face encounter and recertification process for new
been recertified by the previous (or patients with prior hospice services
transferring) hospice? who are being admitted in their third
When a patient transfers to a or later benefit period. Does the face-
new hospice in their third or later to-face encounter have to occur prior
benefit period, the transferring to them being admitted/recertified or,
hospice would provide the new because we have two days to obtain
(or receiving) hospice with the verbal certification, can the face-
documentation of the face-to-face to-face occur on the first or second
encounter at the time of transfer. day of admission/recertification?
When/if the patient’s next benefit The statute language states that
period approaches, the new hospice the face-to-face encounter must be
would be required to complete a completed “prior to” the 180th day
face-to-face encounter at that time. (i.e., third benefit period). There is no
two-day allowance after admission.
If a patient is in his/her third benefit
period and had a face-to-face visit, Can a clinical nurse specialist
but then leaves the service area or is conduct the face-to-face encounter?
discharged, but is later readmitted Unfortunately, a clinical nurse
to the same hospice, does the hospice specialist cannot complete the
have to start over with the new face-to-face encounter; per the
admission and do another face-to- statute, only a physician or nurse
face visit prior to the admission? practitioner can.

NewsLine 15

What Lies

A s the new Ahead? management services.
year unfolds, The data should be
what are some 2011 Predictions for gathered in one place,
of the pressing issues the Hospice Industry whether or not CMS
that face our field and requires it.
how best can hospice

organizations prepare for Providers should also have a

them? NewsLine posed a series system for analyzing the costs

of questions to three members of care; that is, breaking down

of NHPCO’s leadership team to (CMS), the cost of providing the the data in a variety of ways
explore these broad concerns— encounters is not considered to understand costs and make
Jonathan Keyserling, JD, senior “administrative” and cannot be decisions about how to conserve
vice president, Office of Health billed as a physician visit (unless resources without sacrificing
Policy; Judi Lund Person, MPH, other symptom management the quality of care. Analyzing
vice president of compliance issues are also addressed). A such things as the cost of each
and regulatory leadership; and provider who wishes to start a discipline (e.g., by pharmacy,
Carol Spence, PhD, director hospice, or to add hospice as a DME, outpatient therapies,
of research and quality. What new service line, will also find transport) by “day of care” and by
follows is their collective feedback it increasingly difficult to obtain “payor” should be done by each
to help members prioritize their initial certification. provider on a regular basis, not
organizational goals for the new just in figuring the hospice cost
year. What steps will hospices have report.
to take to prepare for hospice
Will the new hospice face-to- payment reform? In NHPCO’s work with providers
face encounter rule mean a to gather more data in preparation
reduction in the number of new for hospice payment reform, the
freestanding, hospices?

The new rule does mean that In preparation for hospice single most significant issue is the
providers will be incurring new payment reform, hospices should lack of comparable data among
expenses for their face-to-face be vigilant about collecting data providers on the set of services
encounters with longer-stay on their services—not just visits, hospices provide. So collecting
patients and, per the Centers for but also phone calls, team time, such data is critically important to
Medicare and Medicaid Services and consultations with other each hospice as well as to the field
community services and care as a whole.

16 NewsLine

Will this increased data so that meaningful comparisons The single most
collection mean hospices will across hospices can be made. significant issue is the
have to invest in new software?
What effects will the changes lack of comparable
In general, we don’t believe that in hospice quality requirements data among providers
hospices will need to buy new (i.e., Affordable Care Act Section on the set of services
software systems, but those who 3004 and the Concurrent Care
don’t have some kind of software demonstration project) have hospices provide.
system will find it increasingly on hospices? In what direction
difficult to meet all the new are these changes taking the
reporting requirements. Those industry?
which have electronic patient
software will need to use the The changes in reporting
software to its full capacity. In performance measures to ascertain
other words, hospices should hospice quality will provide a
consider upgrading to the newest platform for comparing hospices
version when available and on a few identified measures—and
minimizing customization so these measures will most likely
the data can be extracted from focus on patient care. Hospices will
the software. That said, utilizing be able to see how they compare
software that allows hospices to to others and will be able to use
capture and analyze a range of the results in their performance
data—including administrative improvement programs. The work
data, chart abstraction, and that will need to be done in 2011
ongoing data collection at the in preparation for hospice public
bedside (like pain scores)—would reporting will focus on systematic
be especially valuable. data collection—consistency in
tracking patient information will be
Another final issue is that of the key.
consistent data definitions. The
hospice community, like many The Concurrent Care
other parts of healthcare, must demonstration project will give
adopt consistent data definitions the hospice community the
that will conform to industry opportunity to document and
standards and CMS requirements analyze the impact of having
(when there are requirements) both conventional treatments and

continued on next page NewsLine 17

continued from previous page

hospice services at the same time. From left: Carol Spence, Jonathan Keyserling and Judi Lund Person.
Hopefully, this demonstration
project will show increased compliance officers to their staffs regulations required for hospices
utilization of more appropriate to monitor regulatory changes in the last year. Keeping up
services in a timely manner and agency compliance. And we with the changes in regulations
and higher patient and family are also seeing more hospices will require constant attention
satisfaction. than ever before engaging legal throughout the year and beyond.
counsel to help answer regulatory
In addition to increasing data questions and assist with more We also think that there will
collection, in what other ways complex compliance issues. be a continued increase in the
will providers need to prepare number of patients and families
for pending payment changes? What other ways do you see making decisions about the care
the hospice industry changing they want and need, long before
Providers are already preparing in 2011? a crisis, and choosing hospice
for decreased reimbursement and services as their source of end-of-
have been making adjustments in Hospice providers will be life care.
revenue projections and budgets experiencing increased scrutiny
for the coming years. The pending as the types of audits and reviews The very theme of
payment system changes are a bit increase, while new hospices NHPCO’s Management and
farther out, but many hospices are will find it harder and harder to Leadership Conference,
actively looking at their patient get started as initial certification April 7-9 in Washington,
mix to see what the utilization surveys become more difficult to DC, is “Navigating the Sea
intensity looks like. Through schedule or must be conducted of Change.” See the display
the NHPCO Moran Data Project, through an accrediting body. ad on page 12 or visit
we have collected patient-level www.nhpco.org/mlc2011.
information from a large number Providers will also be juggling
of hospice providers and will be the implementation of the new
looking closely at possible payment physician face-to-face encounter
system alternatives as well. on top of the variety of new

What steps should hospices
be taking in light of increased
fraud-prevention efforts?

We are seeing increasing efforts
to evaluate patient eligibility
carefully. More attention is also
being paid to documentation.
Many more hospices are adding

18 NewsLine

Great Gift Ideas From…

MaNHrPCOk’s etplace!

Hospice Social Worker

A. social worker B. F.

G.
A.

E.

D.
C.

March is National Social Worker Month - Be Prepared!

Acknowledge your hard working Social Workers with this wonderfully coordinated collection specifically designed for them!

A. Hospice Social Worker Tote Bag C. Hospice Social Worker Lunch Bag E. Hospice Social Worker Bookmark

The beige with orange trim Hospice Social Enjoy your lunch in style with a Hospice Social Celebrate this special month with a Hospice
Worker tote bag is an eye catching tote that Worker silver lunch bag made of 600 denier Social Worker bookmark. The white 2” x 7”
keeps you organized while on the go. The front poly-canvas. Features include a dual zippered laminated 10 point coated paper bookmarks
features a pen loop (pen not included) for easy insulated main compartment, an additional have a white tassel.
access, a large main compartment with outside pocket, mesh side catch pockets, and Item #: 821474
zippered closure, an interior organizer for pens, an adjustable black comfort shoulder strap.
MP3 player and business cards. It is made of The size is 8” x 7” x 5” and will hold a lot. Member: $1.00
400 denier polyester and is 17.5” x 14” x 3”. Item #: 821472 Non-Member: $1.50
Item #: 821470
Member: $10.95 F. Hospice Social Worker Keylight
Member: $13.00 Non-Member: $13.00
Non-Member: $17.00 Light up National Social Work Month with a
D. Hospice Social Worker Photo Frame silver oval key light with a white LED light.
B. Hospice Social Worker Note Pad The button cell batteries are included.
Brighten up your day with your favorite Item #: 821475
The Hospice Social Worker 4” x 5 ¼” spiral photograph. The Hospice Social Worker white
notebook with an attached folding mini pen photo frame has a digital display desk clock, Member: $5.00
is perfect to keep your notes or to give as a gift. calendar and alarm functions. It also includes Non-Member: $7.00
Item #: 821471 wall pegs or a stand. The AA batteries are
included but not inserted. G. Hospice Social Worker Travel Mug
Member: $5.95 Item #: 821473
Non-Member: $8.95 This 16 ounce silver stainless steel travel
Member: $12.95 tumbler is a great way to display the Hospice
Non-Member: $15.95 Social Worker logo while quenching your
thirst. The tumbler has an insulated steel outer
F or more informationCALL 800/646-6460 GO TO WWW.NHPCO.ORG/MARKETPLACE wall and plastic liner. The lid screws and has a
slide opening. Keep it for yourself or get one
to give to others.
Item #: 821476

Member: $12.95
Non-Member: $15.00

20 NewsLine

NHPCO’s National Council of Hospice and
Palliative Professionals (NCHPP) is comprised of
40,000 staff and volunteers who work for NHPCO
provider-members. Organized into 15 discipline-
specific sections that are led by the NCHPP
chair, vice chair and 15 section leaders, NCHPP
represents the perspectives of the interdisciplinary
team—the very essence of hospice care.

These individuals—together with each Section’s
Steering Committee—volunteer their time and
expertise to a variety of NHPCO projects to
help preserve and develop the “interdisciplinary
model” within the evolving world of hospice and
palliative care.

Beginning this month, NewsLine is introducing
this new monthly feature—The Voice of NCHPP. It
will shine the light on a different NCHPP Section
each month, so all members can benefit from
each discipline’s perspective on important topics.
It will also help members learn more about the
work of NCHPP and how to get more involved—
whether it’s taking better advantage of some of
the Section’s free activities or joining a Section’s
Steering Committee.

This month we spotlight the CEO/Executive
Director/President Section, and a landmark article
by Suncoast Hospice president/CEO, Mary Labyak.

continued on next page

NewsLine 21

continued from previous page

In 2001, Mary Labyak wrote The Experience Model
this landmark article in which
she introduced The Experience By Mary J. Labyak, MSSW, LCSW
Model. This model called
for the provision of hospice N o one would argue that served. When staff and volunteers
and palliative care services each patient, family and at all levels of the organization
that are based on the unique community member who focus on the experiences of
values, end-of-life goals and seeks services from a hospice or patients, families and community
wishes of each patient and palliative care provider deserves members, we foster an
family rather than on the the best we can offer them. organizational culture in which
disease itself. People who need our support our services are based on the
are often in the midst of a heart- unique values, end-of-life goals
Now, a decade later, NHPCO wrenching journey for which and wishes of each person we
members embrace this model. they have received no preparation serve.
Still, today’s challenges or guidance. As end-of-life
and new regulations can providers we usually have only As reflected in The Quest to Die
sometimes distract us from one opportunity to ensure that the with Dignity: An Analysis of
always keeping the patient experiences of these patients and Americans’ Values, Opinions and
and family first. We need families meet their unique needs. Attitudes Concerning End-of-life
only look at last year’s most Care, people tend to see the last
frequently cited deficiencies by Palliative care providers are also phase of life as one of awaiting
CMS surveyors as testament challenged to meet the growing death, with the hope for some
to this: many providers are still expectations of people familiar measure of comfort while not
neglecting to develop (and with our services. Twenty years being a burden to others. These
document) truly individualized ago patients and families were perceptions about the end of life
plans of care. happy simply to have someone can be transformed into a more
to call, and to receive basic pain meaningful journey through
As one of NHPCO’s most and symptom management, and quality palliative care that honors
popular and frequently acknowledgement of their grief. each individual’s values and
requested articles, we Today’s consumers know the goals.
are pleased to reprint The incredible support and services
Experience Model here, as a that palliative care teams provide Hospice and palliative care
valuable reminder to all of us. and frequently express a desire providers create a transformative
for “that medicine my neighbor experience for patients and
had.” families that differs significantly
from the experience of receiving
Successful current and future care through a disease-focused
models of hospice and palliative model. A disease-focused
care will honor what we have approach involves curing the
learned from those we have

22 NewsLine

disease or restoring to a previous D Patientss
health state. In the hospice Staff & Vo Resources
and palliative care model, the Families
experience for the patient becomes The Model works best
that of a journey toward comfort, Communities when the concept
resolution, and life closure (rather
than a forced march toward lunteeirresctWSheorCvirceeatPerSoyvsidteemr s & transcends all areas of
physical wellness). an organization.
Figure 1
In reflecting on what patients
and families have taught us, the How do we help to transform
experiences of advanced illness, experiences for patients, families,
dying and bereavement are much and community members; for the
more than medical experiences. By staff and volunteers who provide
helping to reduce all dimensions of direct service; and for those who
suffering and reframe the end-of- create and maintain systems and
life experience, quality palliative resources that support the other
care facilitates personal growth two groups?
and meaning toward a more
peaceful life closure. Transforming the Experiences of
Patients and Families
A Model for End-of-Life Care As the family member of one
patient shared: “What I appreciate
The Experience Model, which about hospice is that you cared for
transforms end-of-life care, works her as the person she had always
best when the concept transcends been, not the patient she had
all areas of an organization. become.”

Figure 1 depicts the relationships Hospice and palliative care are
of all staff and volunteers to uniquely different from the care
patients, families and community provided by other providers of
members. In the center of the health and human services. In
circle are the patients, families contrast to the more traditional
and community members who disease-focused model that
direct our care and services. The addresses the physical dimensions
next circle represents the direct of illness, the Experience Model
service staff and volunteers who is directed by the patient’s and
provide the care and services. family’s individual goals and
The outer-most circle represents wishes as they adapt to the effects
all other staff and volunteers
who serve and support the direct
service staff and volunteers in
providing optimal care.

continued on next page NewsLine 23

continued from previous page

of advancing illness, dying and for a patient/family Experience begin to tell their life stories.
bereavement. Model. However, it is oftentimes Through ongoing discussions,
a challenge to transform a we discern what is important to
We have learned from patients professional’s approach to care them at this time in their lives,
and families that this experience since the drivers of a traditional based on their unique values and
involves not only a physical disease-focused model differ from life experiences. We take their
dimension but also psychological, the drivers of the Experience lead and our interdisciplinary
social, emotional, and spiritual Model. collaboration and service are
dimensions. As an example, we directed by what the patient and
know pain is not only a physical When we start by understanding family wish this experience to be
problem. The physical dimensions the inter-dimensional experience and on what they define as their
of pain simultaneously affect described above, our relationship end-of-life goals.
other dimensions as well, with the patient and family is
including the ability to care for directed by their defined end-of- Our assessment focuses on
oneself, the quality of interactions life goals and values instead of a what is happening in all of the
with others, the sense of well- more traditional disease-focused dimensions that are helping
being or disease, and the sense model directed by healthcare or hindering the patient and
of spirituality. Like an infant’s goals alone. family from attending to what
mobile, this experience is is important to them at this
dynamic. When one dimension Table 1 illustrates the differences time. Services are chosen by the
is affected, all other dimensions between the Experience Model patient and family and evaluation
are involved. The experience is and disease-focused model. is based on their perception of
not only “multidimensional,” it is how well they have reached their
“inter-dimensional.” In the more traditional disease- end-of-life goals. This process
focused model, the process can happen whether the patient
Therefore, quality hospice and begins with identifying disease has nine hours, nine days or nine
palliative models of care must be and symptoms. Then, based on months to live—always focusing
able to support and address all the discipline’s area of expertise on what is most important to the
four dimensions—the physical, (e.g., nurse, physician, social patient and family at any given
interpersonal, spiritual and worker), goals are developed to moment.
emotional. help reverse or minimize the
disease process. Care is usually Assessment by any discipline goes
Transforming the Experiences directed by what the professionals beyond identifying a problem
of Staff and Volunteers believe is important and needed. in the dimension they are most
Patient-and-family values and Outcomes are based on meeting comfortable assessing, such as
life-closure goals should drive the professional’s goals of care. the physical dimension assessed
care and services. They define by a nurse. All disciplines
what is important at this time in The Experience Model begins approach assessment from the
the patient’s and family’s life and with a dialog with the patient perspective of identifying how
become the focus and foundation and family during which they

24 NewsLine

Table 1

Disease-Focused Model Experience (Palliative) Model

Patient Presents with Symptoms Patient and Family are Affected by a
of Disease. Life-limited Condition that Cannot be
Reversed.

Facilitate a dialog to help the patient
and family define their end-of-life
values, goals, and life-closure
wishes. These become the overriding
goals of the patient and family care
plan to direct our services.

Focus on Curing or Fixing the Determine What is Helping or Like an infant’s mobile,
Problems. Hindering the Patient and Family this experience is
from Reaching their End-of-Life
Goals and Wishes. dynamic. When one
dimension is affected,
Assess from the perspective of how Assess from the perspective of what all other dimensions are
symptoms and disease process is helping the patient and family from
should be different. reaching their goals with regard to involved.
pain, family dynamics, spiritual
issues, and caregiving support.

Plan and define goals of medical care Plan how the interdisciplinary team
for patient based on what care can support the patient and family in
providers feel is best. reaching their goals and, in so doing,
reduce suffering and maximize
potential toward a self-determined
life closure.

Provide interventions as outlined on Help patient and family to minimize
the plan of care to restore or reverse or eliminate those things that are
medical condition. hindering them from reaching their
goals. Create opportunity for
transformational experiences of
growth.

Evaluate the effectiveness of Evaluate effectiveness based on the
disciplines’ care plan based on patient and family’s experience of
medical goals. what is important to them at this
time. To what degree have we helped
them reach their goals?

continued on next page NewsLine 25

continued from previous page

any issue or problem is affecting He is anxious at night, has grandchildren before he dies.
all dimensions. For instance, trouble walking from his He is also concerned about how
all disciplines approach patient bed to his living room and his wife will be cared for after
and family-identified problems is demanding. The doctor he is gone. Mrs. Jones is hoping
of pain with a broader vision of changed his inhaler this that she has enough strength
how it is simultaneously affecting week because he was not and endurance to stay by his
the patient’s and family’s other compliant with taking his other side and care for him until the
dimensions, including their medications since he didn’t like end. They define themselves as
functional abilities, interpersonal the aftertaste. The HHA visits practicing Catholics and state
relationships, sense of well- four times a week to assist with that their faith has given them
being and sense of spirituality. his personal care. They are not strength. Their usual activities,
In palliative care, the disciplines asking for any other help at before Mr. Jones could no
don’t own problems or care this time. longer participate, included
plans—they are not ours to golf and travel. They now
own. It is not our experience, The discussion becomes problem- enjoy reading, movies, writing
it is the patient’s and family’s focused, often identifying the letters, and listening to old-
experience. All disciplines must patient as a disease first, then time music.
be competent at some level to perhaps mentioning how this is
respond to all of these dimensions affecting the rest of the patient’s Once the interdisciplinary team
and adept at collaboration with life (although this part is often has been introduced to patients
an interdisciplinary team to not a focus). In contrast, team and families through the story of
optimally transform this end-of- dialog in the Experience Model their lives and what is important
life experience. focuses on the patient and to them, the team can consider
family’s values, goals and wishes the following question: What is
Comparing how a patient and as the starting point: happening with this patient and
family are discussed in an family that is helping or hindering
interdisciplinary care plan meeting Mr. and Mrs. Jones have shared the patient and family from
will illustrate these differences. 58 years together since they getting to what is important to
In a disease-focused model, met and married in college. them at this time?
the following might be used to They have stated that what is
introduce a patient and family, most important to them at this Each team member approaches
usually “reported” by the nurse: time is for Mr. Jones’ symptoms his or her assessment from
to be controlled enough to this perspective by supporting
Mr. Jones is a 78-year old allow him to spend quality those aspects that are helping
patient with COPD. He was time with his children and the patient and family reach
on O2 prn. With his increased grandchildren who live close their goals, reframe their hope
dyspnea at rest and bilateral by. Mr. Jones wants to be able and experiences, or by helping
congestion, he is using his to communicate his thoughts them meet the challenges of
oxygen on a continual basis. and wishes to each of his those aspects that are hindering

26 NewsLine

them from reaching their goals. The Benefits to Those The disciplines don’t
Symptoms that take away the Who Serve own problems or care
patient’s ability to focus on what
is important are minimized or Organizational culture plays plans—they are not
controlled so his energies can be a large role in affecting the ours to own.
used to reach his goal of spending delivery of the Experience
quality time with his family. Model. Systems and resources
Additional activities that help the that allow for individualized
patient create and communicate care while maintaining high-
his legacy, such as life review with quality standards encourage and
his children, are critical aspects motivate everyone toward service
of service. The team can provide excellence. It is this culture of
additional caregiving support to service excellence that transforms
his wife so she can endure the 24- all interactions and experiences.
hour care required and still have
energy to do the activities they Transformative end-of-life
enjoy together. Each member of experiences for patients and
the interdisciplinary team brings families happen when staff
expertise on one or more of the and volunteers understand the
dimensions of the patient and value of their roles in creating
family experience, which makes these experiences, even when
all of their input and suggestions they do not provide direct
equally valuable in the Experience care. For instance, the finance
Model. The care plan problems are department understands the value
not ‘nursing problems’ or ‘social in processing medical bills so
work problems,’ but the patient’s patients and families don’t have
and family’s experience—and the burden of that additional
their care plan is directed by their task and can spend more time
values and end-of-life goals. doing what is important to them.
Education staff understands that

continued on next page NewsLine 27

continued from previous page

many of the resource materials Define Issues Ext IernntaelrRneasleaRrechs Iesasruceh Issue Are all disciplines encouraged
they develop will help caregivers BPBaoruatsnriendresPs,sVoeAlinscdsyoorcsi,ates to participate in team care
feel confident about the care StewOtRahreedlrasDhtieioppna/srPtmuebnlitcs CuRletudreefi,nMeViIasslssuuieoesn, Vision, discussions?
they are providing and perhaps Legal Patient/ Marketplace Issues
bring meaning to the caregiving Family History of Issue Is every member of the IDT
experience. And administrative ConQsuuamlietyr IFnefeodrmbaactikon/ competent in recognizing all
teams create systems that allow Regulatory SEPtthorialcitscegy,icPPralacntice dimensions of patient and
for decision making and flexibility Financial family experiences?
at the bedside, without lengthy
bureaucratic approvals. Leaders Dissemination Education Is staff empowered to take
motivate staff and volunteers risks that support patient and
by helping them to see the Policy family goals?
connections between their job
functions and transforming the Figure 2 Are community members
patient’s and family’s experiences. asked on a regular basis what
When we share stories about how What are your organization’s end-of-life services they want
their efforts transform end-of-life systemic barriers to and need?
experiences, we create a passion transforming patient and
for their roles and enhance family experiences? Are programs and services
their desire to provide service provided, based on current
excellence in everything they do. Are care delivery models reimbursement mechanisms
flexible enough to meet the or the needs of all members of
Policies and procedures, systems, unique needs of each patient our communities?
and the organizational culture and family?
must reinforce the concept that What drives organizational
all hospice staff work to enhance How does the voice of the decisions—the needs and
the end-of-life experiences for patient and family drive experiences of patients and
those they serve. Figure 2 depicts interdisciplinary discussions? families, or regulations,
a framework for mission-based reimbursement, and liability
policy decisions that take into Do IDT collaborative issues?
account the patient and family’s discussions begin with the
values, goals and wishes. story of the patient and The future of end-of-life service
family, including what is most delivery is being written every
The following questions will help important to them at this day by hospice and palliative care
hospice staff members assess their time? providers. All end-of-life care
organization’s ability to transform models must honor the patient’s
the end-of-life care experiences of Is the care planning process and family’s unique experiences
their patients and families: truly directed by the goals, and be ready to simultaneously
values, and wishes of patients address all dimensions. We
and families? must respond by developing

28 NewsLine

new, evolving models that not NCHPP CEO/Executive Director/President
only address the disease but also 2011 Steering Committee
address all dimensions to truly
create transforming experiences. Section Leader:
Cindy (Yocum) Scott
We only have one chance to Silverado Hospice, South Houston
support patients through a Houston, TX
transforming experience at the Leona Bucci, RN, MS, CNA, BC
end-of-life. The price of failure is Gaston Hospice
not acceptable. Gastonia, NC
Sue Anne Reynolds, MA
Mary Labyak has served as the Family Hospice & Palliative Care
president/CEO of Suncoast Hospice Berne, IN
(formerly The Hospice of the Florida Teresa Sanderson, RN, ADN
Suncoast) since 1983. Under her Abundant Life Hospice Inc
leadership, the organization has Horton, KS
evolved from a small volunteer- Marty Johnson-Swagerty, RN, PRN
based program to the largest Hospice Care of America
nonprofit community based Rockford, IL
hospice in the nation. A nationally
recognized expert in hospice and Section Activities:
palliative care, she has been the CEO Executive Mentoring Project
recipient of numerous accolades,
including the National Hospice The CEO/Executive Director/President Section sponsors
Foundation’s prestigious Heart of this Mentoring Project to help educate and support new
Hospice Award. She has also been hospice leaders. It matches experienced hospice CEOs with
an active member and supporter those who have been in their positions for less than a year,
of NHPCO, serving as chair of the with the goal of guiding the newer CEOs to be effective
NHPCO board (1994), and as a hospice and community leaders.
member of the National Hospice The project runs for a minimum of six months, and offers
Foundation’s board of trustees, the mentee the option to continue for up to a year. During
where she currently serves as chair. this time, the mentee must be available for at least one
monthly phone call with the mentor and must also be willing
continued on next page to communicate via email on a regular basis. In addition, the
mentee is required to establish at least three goals that he/
she would like to achieve as a result of having a mentor, and
respond to a three-month and six-month evaluation survey.
To learn more about participating, visit the NHPCO website.
Also, see the NewsLine article that spotlights this program
and includes feedback from a mentor and mentee.

NewsLine 29

continued from previous page

Get Involved

One of the easiest ways to get involved in the NCHPP
CEO/Executive Director/President Section (or any
NCHPP Section) is to utilize NHPCO’s professional
networking site, My.NHPCO.
Each NCHPP Section has an eGroup (much like NHPCO’s
old listserves, but better). Just visit the My.NHPCO
website to watch the introductory tutorial, then go to
the tab, “Getting Started,” for details:

Information about NCHPP is also available on the
NHPCO website: www.nhpco.org/nchpphome.

30 NewsLine

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NewsLine 31

Now Online–the Winter Edition of NHPCO’s Insights

In the midst of Winter 2010 A Publication of NHPCO’s National Council of Hospice and Palliative Professionals
many changes and
challenges, it is easy The IDT:
to focus only on your Staying the
work, your worries,
your goals. But where Course,
does that leave your Staying True
team? And why does it
matter?

In the Winter edition
of NHPCO’s Insights,
your colleagues explore
these questions and
provide guidance to
help all of us manage
the changes in our work
life while upholding the
interdisciplinary team
model.

Here’s a glimpse of what’s inside…

All past issues of Insights are available on the NHPCO website.
Visit www.nhpco.org/insights.

32 NewsLine

A Philosophical Complementary Take a Look at
Look at the IDT Therapy Innovators the Entire
Barbara Bouton, NCHPP Allied
NHPCO’s director Therapy Section Table of Contents
of professional Leader Valerie
development, discusses the critical Hartman shares how three hospices
importance of upholding the IDT have expanded their CT services,
model and why some teams succeed and offers guidance to those
in doing so while others do not. interested in doing the same.

Resistance to Connecting with
Change: Perception Your Team
or Reality? NCHPP Chair Gregory
Hospice of Northwest Wood shares some
Ohio successfully simple yet profound
managed sudden change that techniques that can help managers
called for the opening of a new and leaders create an environment
office in another state in just six for growth and success among their
weeks. Executive Director Judy teams.
Seilbenick discusses the factors
that contributed to the successful Keeping the IDT
transition. Spirit Alive
Shareefah Sabur,
The Hospice NCHPP’s immediate-
Physician: More past chair, takes
Involved—and More a closer look at team dynamics,
Engaged team-facilitation roles and the
While some may responsibilities of each team
view the new regulations that call member in bringing meaning
for greater physician involvement as and value to the interdisciplinary
more of a hassle and expense than process.
a benefit, NCHPP Physician Section
Leader Dan Maison reminds us of Spending a Day
the positives. in Their Team
Member’s Shoes
The Role of NCHPP members
Volunteers in share their
Management observations from shadowing
Director of Volunteer colleagues on the interdisciplinary
Services Rose van team, an exercise that helped them
der Berg talks about Hospice of the get past the broad brushstrokes
Comforter’s successful IPU volunteer of a job description and into their
services program. colleague’s day-to-day practice.

NewsLine 33

People and Places

Member News and Notes

Hospice of Lancaster County Donates Special Gift to National Center

Hospice of Lancaster County (Lancaster, PA) called upon the talents of
a local Amish quilter to create a fabric replica of NHPCO’s 2010 Hospice
Quilt (now designed electronically). The organization had it framed
and delivered to NHPCO, where it is now prominently displayed in the
entrance of the National Center for Care at the End of Life, home to
NHPCO and its three affiliate organizations.

From left: Leadership from Hospice of Lancaster with their thoughtful gift:
Steven M. Knaub, CPA; Joan K. Harrold, MD, MPH, FACP, FAAHPM; Krista Kae
Hazen, CPA; Bonnie Jess Lopane, CFRE; Susan Young, BSN, RN; and Cathy A.
Stauffer, MPH, MBA.

Robert Wood Johnson Foundation Names 12 New Nurse Faculty Scholars

The Robert Wood Johnson Foundation announced the selection of 12 nursing faculty from across the country
to participate in its prestigious Nurse Faculty Scholars program. The program is providing $28 million over five
years to outstanding junior nursing faculty to promote their academic careers and reduce the national nurse
and nurse faculty shortages.
Each scholar receives a three-year $350,000 grant to pursue research, as well as mentoring
from senior faculty at his or her institution. The scholars chosen this year are investigating a
range of health issues, including a legacy-making intervention
to reduce suffering of children with cancer. To learn more,
visit www.rwjfnursefacultyscholars.org.

HPC Healthcare Appoints Andrew Lutton
as Chief Operating Officer

Andrew E. Lutton has been named the COO of HPC Healthcare (Tampa, FL), the
non-profit parent company of LifePath Hospice in Hillsborough County and Good
Shepherd Hospice in Polk, Highlands and Hardee Counties.
In his new role, Lutton oversees hospice operations, strategic planning, new program
development and corporate communications. He will also take an active leadership
role in launching PACE and Nursing Home Diversion programs and establishing an
HPC Enrollment Center.

34 NewsLine

FHPC Receives Association of the Year Award

Florida Hospices and Palliative Care
(FHPC) was the recipient of the
2010 Association of the Year Award,
sponsored by the Tallahassee Society of
Association Executives (TSAE).

The award recognizes an association

that has demonstrated outstanding

efforts, excellence and innovation related

to its ongoing or special programs and

services. Among the accomplishments

Paul Ledford, executive director noted by the TSAE was FHPC’s PIC-TFK
of FHPC (left), receives the 2010 (Partners in Care: Together for Kids)
Association of the Year Award from program; its efforts to work with the
TSAE president, Shawn Stewart. Agency for Health Care Administration

on the “Hospice Report Card”; and its Statewide Hospice Consumer Help &

Referral Hotline for those looking for end-of-life and palliative care services.

IDT Members Honor
Veterans in Their Care

IDT members from Hospice of the
Valley (San Jose, CA) ‘mobilized’ on
this past Veteran’s Day to honor 20
Santa Clara County veterans who are
currently in their care.

Each veteran was presented with an

attractive American flag lapel pin that

was graciously donated by Tiffany & Korean War Veteran PFC Hank with Case

Co. and received a specially designed Manager Nurse Joanne Getas (left) and
patriotic card that read: “Thank you Social Worker Trish O’Connor.

honored Veteran. We pay special tribute to you for your military service

to America by advancing the universal hope of freedom and liberty for

all.” (Visit NHPCO’s new website, We Honor Veterans, for tips and tools to

recognize Veterans in your program or community.)

continued on next page

NewsLine 35

continued from previous page Advertisement

Participants during training in San Diego.

International Palliative Care
Physicians Receive Leadership
Training in San Diego

Last fall, 22 doctors from around the world
convened at San Diego Hospice to attend leadership
training that will equip them to advance palliative
care in their countries.

The training is part of the groundbreaking program,
the International Palliative Care Leadership
Development Initiative (LDI), being conducted
by The Institute for Palliative Medicine. Over the
course of two years, the physicians participate in
classroom studies, ongoing mentorships, one-on-one
skill building sessions, personal development plans,
and peer-to-peer networking that help prepare them
to manage the organizational and societal changes
necessary to implement new medical programs or
healthcare solutions. To learn more, visit www.
palliativemed.org/International-Program.

Two Members Win Kindles™ in
NHPCO Drawing

Sarah Van Winkle of Sholom Care and Johnson
Hospice (St Louis Park, MN) and Shelly Steiner of
Hospice of Washington County, Inc (Hagerstown,
MD) were the lucky winners of a drawing to win
a free Kindle™ electronic reader. Their names
were selected from among the 2,500 professionals
who completed NHPCO’s 2010 Education Needs
Assessment Survey, conducted between September
and October 2010. Results from the survey—
and how they will be used to inform NHPCO’s
educational activities—will be featured in next
month’s Newsline.

36 NewsLine

NHPCO’s Upcoming

Educational Offerings

Conferences Webinars E-OL Webcasts

T he best way to keep informed of the changes
occurring in the hospice and palliative care field
is to take advantage of NHPCO’s diverse range of
educational offerings.

Our goal is to ensure that you and your colleagues are well-
informed and better able to deliver quality end-of-life care to
all members of your community.

To learn more about our upcoming national conference, our
series of timely Webinars, and our E-OL distance-learning
courses, just click on the tabs above.

For full details, please visit the NHPCO website:
www.nhpco.org/education.

If you are reading a PDF of this issue, please read
the digital edition to access the information
on the featured tabs. The digital edition is
available on www.nhpco.org/newsline.

NewsLine 37

Preview the New NHDD Website….

Since National
Healthcare
Decisions Day
was established
in 2008, it has
helped raise public
awareness about
the importance
of advance care
planning. Now, a
newly redesigned website will leverage the strengths of the social web to
raise its national profile and improve upon its good work. Visit the new site
now to learn more. And look for details about 2011 NHDD—coming up on
April 16—in next month’s NewsLine.

NewsLine is a publication of the National 1731 King Street, Suite 100
Hospice and Palliative Care Organization Alexandria, VA 22314
703 / 8 37-150 0
ISSN 1081-5678 • Vol. 22, No. 2 www.nhpco.org • www.caringinfo.org
Affiliates:
Vice President, Communications: Jon Radulovic
Editor: Sue Canuteson w w w.nationalhospic efoundation.org
Advertising Inquiries: David Cherry, 703/647-8509
Membership Inquiries: 800/646-6460 w w w.hospic eac tionne t work .org

Copyright © 2011, NHPCO and its licensors. w w w.f hs s a.org
All rights reserved. NHPCO does not endorse
the products and services advertised in this
publication.

The PDF and digital editions of NewsLine are
posted on the NHPCO website: www.nhpco.org/
newsline.

FOCUS Quarter 1 – 2011

ON COMPASSION

a quarterly newsletter

tOorgFHanSiSzAataionndstDheonAafrtiecaMnoPraellTiahtaivne$C2a2r0e,0A0s0sociation

The funds will be used to improve pain management
in the Gambia, Kenya, and Malawi

For many who are sick in Africa,
freedom from pain is elusive.
With generous funding
totaling more than $220,000
FHSSA and the African Palliative
Care Association are partnering to
improve pain management among
palliative care patients receiving
care in hospitals in the Gambia,
Kenya, and Malawi.

These counties were selected to lack of skills in pain assessment Funders of the Pain
because they each have well- and management, coupled with Management Initiative
established national palliative fears around the use of these
care organizations, strong clinical powerful medications. We thank the following for their
leadership, historical success financial support:
with related projects, and sound Another significant challenge is that • Astellas Pharma US, Inc.
professional relationships with there is a general lack of support
APCA and FHSSA staff/leadership for palliative care among hospital • AstraZeneca Pharmaceuticals LP
administrators and managers. This
Challenges to Pain may lead to hospital bureaucracies • Daiichi Sankyo, Inc.
Management delaying the implementation of
FHSSA and APCA have palliative care, including access to • Endo Pharmaceuticals Inc.
identified a set of challenges pain management medications.
for the management of pain. • Lundbeck Inc
Hospital-based health care The Project’s Framework
workers sometimes have a limited The project framework is based • OSI Pharmaceuticals Inc.
understanding of the palliative care on the success of a pilot project in
concept and the need for palliative Uganda that was endorsed by the • Pharmaceutical Research and
care services. Often, physicians World Health Organization and the Manufacturers of America (PhRMA)
are not comfortable in effectively Ugandan Ministry of Health.
prescribing opioids. This can be due • The Brin Wojcicki Foundation
continued on next page...

1

FHSSA | FOCUS ON COMPASSION

FHSSA Welcomes New Board Chair, Shareefah Sabur

Sabur has served on the FHSSA board since 2002

Shareefah Sabur, MA, MNO, DCP, has begun her two-year term as chair
of the FHSSA board. Among her duties as FHSSA board chair, her
responsibilities include representing FHSSA as a member of the executive
committee of the NHPCO board of directors.
FHSSA’s Importance to Her
Shareefah Subur is the new FHSSA board “FHSSA is important to me because it was formed with the intention of
chair. Here she is on the grounds of the building a foundation dedicated to supporting the provision of compassionate,
Apartheid Museum during a trip to South dignified end-of-life care during the peak of the AIDS pandemic in Sub-Saharan
Africa in 2005. Africa. A need was evident and FHSSA took on the challenge. Now, 11 years
later, it is evident that FHSSA has made a difference. Although FHSSA is not a
direct care provider, it supports and leverages the work of those organizations
that do provide care. FHSSA, through its partnership program, has provided
hospices in the United States an avenue to help also. Partnership is a fundamental
building block in FHSSA and as it continues to forge new and different
partnerships, the positive impact will increase exponentially,” says Sabur.

“My Feet on African Soil”
Sabur is the chief strategy officer at Hospice of the Western Reserve in Ohio,
where she has been for 18 years. Her interest in FHSSA was cemented in May
2001 when she participated in a sub-Saharan hospice seminar tour. That was a
very powerful experience.

Continued on page 3...

$220,000 for Pain Management, continued from page 1... Do You Have Corporate
Connections?
The project has the following Through the project, hospital
specific objectives: physician and other senior health We could use your help in
workers (e.g. nurses and pharmacists) identifying companies
1. To create awareness of, support will be trained in pain assessment interested in supporting FHSSA
for and prioritization of palliative and management, and the safe and
care delivery among hospital effective use of opioids. They will Corporate support can make help
management/administrators. receive follow-up and on-going FHSSA make a big difference in
support supervision and mentorship the provision of palliative care in
2. To train hospital physicians in from APCA, FHSSA, and their Africa. If you work for a company
pain assessment and management, respective national organizations that has interests in Africa, we
with a central focus on opioid use. following the training. Project invite you to help us identify
activities will be implemented in partnership opportunities with us.
3. To sensitize other health care hospitals in selected regions of For more information,
workers in the hospitals and each target country based on a please contact Sarah Meltzer at
community to support palliative needs analysis. smeltzer@f hssa.org
care service delivery.

2

Shareefah Sabur, Continued from page 2 ... New Board
Members for 2011
She explains, “Once I had my feet on African soil I felt an immediate
connection. I believe we are a global society and that I am my brother’s keeper. 4 new members joined the
I was in awe as I watched hospice staff do so much with so little. My heart FHSSA board in January
ached for children who had become heads of their household all too soon. I
became increasingly aware of what opportunity there was to offer support and I FHSSA welcomes the following
knew that other staff at Hospice of the Western Reserve would welcome the new members to the board.
opportunity as well.”
• Elizabeth Clark, executive
Community Involvement director, National Association
In addition to her work with FHSSA, Sabur has been active in a wide range of Social Workers
of NHPCO’s committees and councils. She has just concluded three years
of service as chair of NHPCO’s National Council of Hospice and Palliative • Terry Duncombe, president
Professionals (NCHPP) and was an NCHPP section leader prior to that. and chief executive officer,
“I’ve enjoyed working with my colleagues on many NHPCO projects, Community Health
particularly the Inclusion and Access Toolbox. I’ve always been very aware Accreditation Program
of the many disenfranchised groups in our society and see myself as an
advocate for all of them,” said Sabur. This passion to care for all in need • Robin Fiorelli, senior director
fuels her dedication to FHSSA. of bereavement and volunteers,
VITAS Innovative Hospice Care
In addition to her service to FHSSA and NHPCO, Sabur has an extensive
resume of other volunteer work. She has served on the board of the Ohio and • Mark Murray, President/CEO,
Palliative Care Organization and has volunteered with a variety of organizations Center for Hospice Care (ex
serving women, children, and the elderly. officio in his role as NHPCO chair)

“We are fortunate that Shareefah is devoting her considerable energy, passion, In addition, Linda Todd is the
and expertise into leading FHSSA,” says John Mastrojohn III, FHSSA’s execu- new treasurer and David Lee is
tive director. “We’re excited to be working with Shareefah in this new capacity.” the new secretary.
Becky McDonald serves for
A native of Cleveland, Ohio, Sabur attended Miami University and Cleveland a year as immediate past chair.
State University, earning an undergraduate degree and master’s in psychology.
She also holds a master’s degree in nonprofit management from Case Western We thank each of these
Reserve University. individuals, plus all returning
board members, for their
dedication and commitment.

We heard you!
Starting in March, Partners Can Donate Online to African Hospices
W A setchuereFHonSSliAnewfoerbmsitweiflol sropoanrtbneerasvtaoilaubsele on
e’ve heard many requests over the years Starting in March, you will be able to donate online,
from U.S. partners to make it possible for using a credit card, on our secure website, and designate
them to donate to their African partner the funds for your partner hospice. We will be able to

online, rather than collect and send large numbers of easily track donations and provide you with reports as

checks to FHSSA. We heard you! needed. We will circulate more information once the

form is live.

3

Quarter 1 – 2011

What an impact you have helped make!

Through FHSSA’s Partnership Program, More than $2 Million
Has Been Sent to Africa Since 2004

SBy the end of 2010, FHSSA has 92 partnerships in 15 African countries
ince 2004, through our partnership program, a very long way in Africa, and so the impact of these
FHSSA and our partners have sent more than $2 donations is tremendous.
million directly to African hospice and palliative
care organizations to use in providing care to people in Significant Grant Funding As Well
villages, towns, and cities. In addition to these donations from partners, FHSSA
has received significant grant funding from the U.S.
These dollars represent donations—some large and
government and other organizations, to conduct capacity-
some very small—from tens of thousands of people building work with African partners in Tanzania and
who want to make a difference in the lives of African Zimbabwe. Since 2006, more than $5 million in grant
people facing serious illness, death, and grief.
funding has supported those efforts.

Rooted in HIV/AIDS— Have you ever wondered?
But Meeting Today’s Needs
The impetus for the founding of FHSSA in 1999 was How African Partners Use the Funds
the overwhelming number of death from HIV/AIDS
in Africa. Now, more than 10 years later, even though Top uses are patient care supplies, food and
life-enhancing anti-retroviral drugs (ARVs) are reaching nutrition, and general operating expenses
some people who need them, the need for palliative care
services remains vast. Surveys returned by African partners in 2008 and
2009 reveal these are the most common ways funds
While individuals with HIV are experiencing some are spent, in descending order:
signs of renewed health due to ARVs, they often
experience other opportunistic infections due to 1. General operating expenses
decreased immune system function, social stigma, and
financial hardship. In addition, over half the people who 2. Patient care supplies, including medications
need ARVs still do not have access to treatment. Also,
cancer rates in Africa are on the rise and other diseases 3. Food/nutrition
have an impact as well.
4. Programs and services for orphans and
other vulnerable children

FHSSA’s 5. Transportation
partnership 6. Home-based care visits
program provides 7. Staff salaries
a pipeline to send 8. Support services
donations directly 9. Training and
to African hospice
and palliative care related resources
programs in 15 10. Day care services
different countries.
A dollar can go

4

FHSSA Global Partner Award 2011

nNeowmianwatairodnhs oanreorbienigngU.aSc.c/Aepfrtiecdanfopratrhtinserships
The deadline is February 15, 2011
the award will also be announced during the conference’s
We have established the FHSSA Global Partner Opening Plenary. A prize of $500 will be awarded to
Award to recognize the exemplary work the recipient African partner. Additionally, the winning
of one U.S./African partnership. We are partnership will be depicted on a sign at the FHSSA
looking for a FHSSA Partnership that has demonstrated booth during MLC. Each year the recipient partnership’s
leadership, innovation, and has significantly contributed organization names will be added to a public wall display
to the sustainable development of hospice and palliative at the National Center for Care at the End of Life.
care in 2010.

Eligibility The application can be downloaded from
Each U.S. FHSSA partner program is invited to www.fhssa.org/GlobalPartnershipAward2011
nominate themselves and their African partner for the
work that they accomplished in 2010. All applications FHSSA’s “Breakfast of Champions”:
received by the FHSSA office by February 15, 2011 will April 7, 2011
be considered for this award. All applications must be
approved and signed by your program’s Director/CEO. FHSSA Global Partner Award
to be Presented at this Event
Selection Criteria
The following criteria will be used to determine the If you are attending NHPCO’s 26th Management
award recipient: and Leadership Conference in April, please mark
your calendars to attend the FHSSA “Breakfast of
• Successful completion of the basic partnership goals Champions” at 7:00 am on Thursday, April 7. Absolutely
everyone is welcome to attend and there is no charge.
• Creativity in fundraising There is also no need to register; just come! Details will
be available in the conference brochure.
• Staff engagement in your partnership
At the breakfast, you will have the opportunity to:
• Collaboration with your African partner
• Meet FHSSA staff, board leadership, existing
• Local (U.S.) community engagement partners, and special guests

Review Process • Learn more about staff exchanges, visits, and
Each application will be reviewed by a committee other projects
consisting of FHSSA staff, members of the FHSSA
Board of Directors, and representation from the • Discover how to “champion” existing opportunities
leadership of the African Palliative Care Association. in Africa without committing to a partnership

Recognition • Hear lessons learned from existing partners
Both the winning US and African partner organizations regarding successful partnerships
will receive the FHSSA Global Partnership Award at the
2011 NHPCO Management and Leadership Conference • Learn how you can engage your community in
during a special presentation at the FHSSA “Breakfast of developing other champions
Champions” on April 7, 2011. The partnership receiving
• Find out who won the FHSSA Global Partner Award

5