Hospice is for the Patient AND the Family

By Barbara Karnes

Dear Barbara, My husband was diagnosed with dementia. He has been under hospice care for over 2 years in a residential care home and has now entered EOL stage. Our hospice “service” in AZ focus solely on providing for the needs of my husband so I’m looking for resources to support me and our son.

I responded to this woman but feel led to address “our hospice service in AZ focus solely on providing to the needs of my husband” with anyone who will listen.

My hope is this woman fell through the cracks or misunderstood “hospice service focuses solely” on the needs of the patient. For the record, Hospice service very much focuses on the family and primary caregiver. When in a nursing facility, then their service also includes the staff of the nursing facility.

As I type this, the thought occurs to me that the hospice is considering the staff the primary caregiver and not including the family as part of care. Surely not!! Tell me that isn’t true!!!!

From the very beginning of hospice care in this country, before there was reimbursement and regulations, the plan of care ALWAYS included the family and primary care person. When the Medicare regulations were written family was specifically included. Why would we have bereavement follow-up and support written into the regulations and plan of care if it were not addressing the needs of the family?

90% of end of life care is about education. Education of the signs of approaching death and what to do as it approaches for THE FAMILY AND CAREGIVER. 

Dying is not a medical event. It is a social, communal event. Dying is not a time for procedures or medications. It is time for support, guidance and reassurance FOR THE FAMILY. 

These phrases I’ve said, (actually shouted from the rooftops) for years, 43 years to be exact. These sentences are the essence of end of life care, the essence of hospice care FOR THE FAMILY AND CAREGIVER. Hospice is very much about the patient and family. The patient we keep comfortable and the family we support, guide, and reassure.

Is CMS’ Proposed Home Health Rate Cut Legal? Other Court Decisions Suggest No

Home Health Care News / By Andrew Donlan
 
The entire home health industry is anxiously awaiting the release of the final payment rule for 2023, which should be released by the Centers for Medicare & Medicaid Services (CMS) at some point over the next two weeks.
 
The anxiousness is due to the home health proposed payment rule, which included a 4.2% aggregate decrease in payments – or $810 million – and an avenue for future CMS clawbacks of perceived overpayments to providers.
 
Industry leaders and stakeholders have advocated against those cuts relentlessly over the past few months. They’ve also tried to gain traction on legislation, namely through the Preserving Access to Home Health Act, which was introduced in both the Senate and House in the summer. The final route to avoid payment cuts would be through legal action, though multiple sources have told Home Health Care News in the past that they’d like to avoid that at all costs.
 
However, if they did decide to go that route, there is recent and mounting legal precedent to suggest that the courts would side with the home health industry and against CMS and its ability to make as drastic cuts as the ones put forth in this year’s proposed rule.
 
Multiple sources have also told HHCN that the following could be the under-the-radar tool that could save the home health industry from cuts, either now or later.
 
Prior to 2020, CMS proposed a series of policy changes for hospitals, one of which would have reduced payment for hospitals, specifically through the 340B drug pricing program. Broadly, 340B hospitals are generally those that serve lower-income or rural populations.
 
Those cuts represented an about $1.6 billion impact on those 340B hospitals annually.
 
That impact won’t be felt moving forward, though, because the U.S. Supreme Court ruled unanimously against CMS and the U.S. Department of Health and Human Services – and thus, against the rate cuts – in American Hospital Association (AHA) v. Becerra on June 15. 
 
In the hospitals’ case, they were going to see a significant and disruptive cut to reimbursement that they believed would hurt patient care. The same goes for home health providers and their looming potential cuts. Both believe CMS is not statutorily able to cut payments in the ways in which they did, or could be. In AHA’s case, they were ruled correct by the court.

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RSV, Other Viruses Making it Hard to Find a Bed in Children’s Hospitals 

Washington Post /By Fenit Nirappil and Ariana Eunjung Cha

Children’s hospitals are under strain in the United States as they care for unusually high numbers of kids infected with RSV and other respiratory viruses.

It’s the latest example of how the pandemic has upended the usual seasonal patterns of respiratory illnesses, denying a respite for health-care professionals ahead of a potential hectic winter as the coronavirus, influenza and other viruses collide.

Respiratory syncytial virus, a common cause of cold-like illness in young children known as RSV, started surging in late summer, months before its typical season from November to early spring. This month, the United States has been recording about 5,000 cases per week, according to federal data, which is on par with last year but far higher than October 2020, when more coronavirus restrictions were in effect and very few people were getting RSV.

“It’s very hard to find a bed in a children’s hospital — specifically an intensive care unit bed for a kid with bad pneumonia or bad RSV because they are so full,” said Jesse Hackell, a doctor who chairs the committee on practice and ambulatory medicine for the American Academy of Pediatrics.

Nearly three-quarters of pediatric hospital beds are occupied, according to federal health data. Rhode Island, the District of Columbia and Delaware report more than 94 percent of pediatric beds occupied. Maine, Arizona, Texas, Kentucky, Oklahoma and Missouri reported between 85 and 90 percent of beds occupied. The data is limited to facilities that report the information.

Several children’s hospitals in the D.C. area have been at capacity for weeks; 18 children were waiting for a room in the ICU on Tuesday at Children’s National in the District.

D.C. Realtor Kate Foster-Bankey was more attuned to RSV after she started hearing from clients whose children were afflicted with the virus in recent weeks, including one whose child was admitted to Children’s National.

Then her 3-year-old daughter Isabelle fell ill, becoming lethargic, complaining of a fast heartbeat and not eating. They waited two hours in the packed waiting room of a pediatric urgent-care center where Foster-Bankey, a mother of four, was used to seeing only a handful of patients.

During a follow-up visit Tuesday, Isabelle was transported by ambulance to the emergency room of a children’s hospital, where she tested positive for RSV and had to wait until the following morning for a bed.

“It sounds like in covid, we gutted our pediatric care,” said Foster-Bankey, 41. “Kids shouldn’t have to wait in a waiting room with a bunch of other sick kids for hours.”

At Connecticut Children’s Hospital, the emergency room is so full that patients are being triaged in hallways. Teens with bone fractures and appendicitis are being diverted or transferred to adult-care centers to create additional space for respiratory patients. Hospital officials are considering the possibility of enlisting the National Guard to set up tents and care for the influx of patients.

Over the past nine days, 110 children with RSV have come in to the emergency room, and at times as many as 25 children with RSV were waiting for an inpatient bed, said Juan Salazar, physician in chief at Connecticut Children’s. He said that for the first time in his career he has had to mandate doctors in other specialties such as endocrinology and rheumatology work with RSV patients — a situation reminiscent of the “all hands on deck” approach many adult hospitals took in March 2020, when the coronavirus began to sweep through the United States.

“During my tenure here I haven’t seen anything like this,” said Salazar, who has worked in infectious diseases for 30 years.

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Reminder: Medicare Credit Balance Reports Due

As a reminder, the Medicare Credit Balance Report for the quarter ending September 30th is due by October 30, 2022. If we do not receive a completed CMS-838 form and/or certification page for an individual provider transaction access number (PTAN) timely, we will suspend all claim payments at 100%.

Use the myCGS Portal to:

• Ensure your report is legible and received timely. Don't worry about delivery delays or technical issues with fax transmissions. myCGS allows you to complete and submit the required information electronically and instantly.

• Receive confirmation. myCGS will send a message to your inbox to confirm receipt of the form.

• Check status. Once accepted, myCGS will also send a message with a submission ID you can use to check the status.

Avoid suspension of your Medicare payments! Reference the myCGS User Manual (Financial) for step-by-step instructions and submit your Medicare Credit Balance Report in  myCGS today!

For general questions about the Medicare Credit Balance Report, please reference our website or call the Provider Contact Center:

Home Health and Hospice – 1.877.299.4500 (Option 4)